Prednisone Should NOT Be Used for Hand, Foot, and Mouth Disease
Prednisone and other corticosteroids are contraindicated in hand, foot, and mouth disease (HFMD) and may increase the risk of severe complications and death. 1, 2
Evidence Against Corticosteroid Use
The available evidence specifically addressing corticosteroids in HFMD demonstrates harm rather than benefit:
A case-control study found that glucocorticoid treatment was associated with a greater incidence of severe HFMD when used within 48 hours of onset or before diagnosis of critical disease. 2 This is the most direct evidence addressing your question and clearly demonstrates that corticosteroids worsen outcomes.
In a retrospective analysis of 637 severe HFMD cases, methylprednisolone administered at any stage made no significant difference on mortality (P > 0.05). 3 This study specifically evaluated corticosteroids in severe HFMD and found no benefit even in critically ill patients.
A cytokine profile study of HFMD patients treated with intravenous methylprednisolone showed no difference in expression levels of HFMD-associated biomarkers compared to untreated patients. 4 The steroid treatment failed to suppress the inflammatory response characteristic of HFMD, questioning any theoretical benefit.
Why Corticosteroids Are Harmful in HFMD
The mechanism of harm likely relates to:
HFMD is a viral illness caused by enteroviruses (particularly Enterovirus 71 and Coxsackievirus A16) that requires intact immune function for viral clearance. 1, 5 Corticosteroids suppress this necessary immune response.
Severe HFMD complications include neurological involvement (encephalitis, meningitis, acute flaccid paralysis) and cardiopulmonary complications. 1, 5 Immunosuppression during active viral replication may facilitate viral spread to the central nervous system.
Recommended Management Instead
The appropriate treatment for HFMD is supportive care only:
Oral analgesics (acetaminophen or NSAIDs) for pain and fever relief for a limited duration. 1
For oral lesions: Benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain. 1
For skin lesions: Intensive moisturizing care with urea-containing creams, avoiding friction and heat exposure to affected areas. 1
Zinc oxide can be applied as a protective barrier for itchy skin lesions. 1
Critical Pitfall to Avoid
Do not prescribe corticosteroids for HFMD based on the presence of inflammation or fever. While the provided evidence includes guidelines discussing prednisone for various dermatologic conditions (hand and foot dermatoses like eczema and psoriasis 6), bullous pemphigoid 6, and other inflammatory conditions 6, these are entirely different disease entities from HFMD. The viral etiology and pathophysiology of HFMD make it fundamentally different from these inflammatory/autoimmune conditions where corticosteroids may be beneficial.
When to Escalate Care
For severe HFMD (CNS involvement, stage IV disease), the evidence-based interventions are:
Intravenous immunoglobulin (IVIG) applied in early stage IV significantly improved progression with an odds ratio of 0.24 (95% CI: 0.10-0.57). 3
Mechanical ventilation applied in early stage IV had an odds ratio of 0.01 (95% CI: 0.00-0.10) for mortality reduction. 3
Risk factors requiring close monitoring include: age <3 years, Enterovirus 71 infection, autonomic nervous system dysregulation, pulmonary edema/hemorrhage, CRP >40 mg/L, and cardiac troponin I >0.04 ng/ml. 3