What is the treatment for hand, foot, and mouth disease?

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only, as there is no specific antiviral treatment available for this enteroviral infection. 1, 2

Symptomatic Management

Pain and Fever Control

• Use oral acetaminophen or NSAIDs (such as ibuprofen) for pain relief and fever reduction. 1, 2
• Administer these medications for a limited duration as needed for symptom control. 1
• Oral lidocaine is not recommended for pain management. 2

Oral Lesion Management

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking. 1
• Use warm saline mouthwashes or an oral sponge for gentle oral hygiene and comfort. 1
• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain. 1
• Use chlorhexidine oral rinse twice daily as an antiseptic measure. 1
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily. 1
• Use mild toothpaste and maintain gentle oral hygiene practices. 1

Skin Lesion Management

For Hand and Foot Lesions:

• Apply intensive moisturizing care with urea-containing creams/ointments to hands and feet. 1
• Avoid friction and heat exposure to affected areas. 1
• Do not use chemical agents or plasters to remove corns or calluses. 1

For Itchy Lesions:

• Apply zinc oxide 20% as a protective barrier after gentle cleansing of affected areas. 1
• Reapply as needed when itchiness returns. 1
• Apply in a thin layer; for nighttime relief, consider using loose cotton gloves over the zinc oxide to enhance effectiveness. 1
• Avoid applying zinc oxide to open or weeping lesions. 1

For Open Sores on Feet:

• Wash feet daily with careful drying, particularly between toes. 1
• Avoid walking barefoot and wear appropriate cushioned footwear to protect lesions. 1
• Do not soak feet in footbaths, as this induces skin maceration and worsens open sores. 1
• Do not use topical antiseptic or antimicrobial dressings routinely, as these are not recommended for wound healing in HFMD. 1

Hydration

• Ensure adequate fluid intake, as painful oral lesions may reduce oral intake. 2
• Direct treatment toward maintaining hydration. 2

Monitoring for Complications

Watch for warning signs of severe disease, particularly in children <3 years with EV-A71 infection and disease duration <3 days: 3

• Persistent hyperthermia 3
• Neurological involvement (encephalitis, meningitis, acute flaccid paralysis) 1, 3
• Worsening respiratory rate and rhythm 3
• Circulatory dysfunction 3
• Elevated peripheral WBC count 3
• Elevated blood glucose 3
• Elevated blood lactic acid 3

Monitor for signs of secondary bacterial infection: 1

• Increased redness, warmth, purulent drainage, or worsening pain 1
• Treat any secondary bacterial infections that develop 1
• Reassess after 2 weeks if lesions are not improving with standard care 1

Isolation and Return to Activities

Isolation Period:

• Isolate patients to avoid cross-infection during the acute phase. 3
• Children should avoid close contact with others until fever resolves and mouth sores heal. 1

Return to Daycare/School:

• Children can return once fever has resolved and mouth sores have healed, even if skin rash is still present. 1
• Exclusion based solely on healing skin lesions is not necessary. 1
• By the time HFMD is diagnosed, the child has likely been shedding virus for weeks, posing limited additional risk. 1

Prevention Measures

Hand Hygiene:

• Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers and is the most important preventive measure. 1

Environmental Cleaning:

• Clean toys and objects that may be placed in children's mouths. 1
• Disinfect potentially contaminated surfaces and fomites. 2

Avoid Sharing:

• Do not share utensils, cups, or food. 1

Special Populations

Immunocompromised Patients:

• May experience more severe disease and require close monitoring. 1

Adults:

• Follow the same supportive care principles as outlined above. 1, 4
• Intra-familial transmission from children to adults can occur. 4

Important Caveats

• Most cases are mild and self-limiting, resolving in 7-10 days. 2
• There is no specific antiviral treatment available for HFMD, unlike herpes simplex virus infections. 1
• The disease is highly contagious via fecal-oral, oral-oral, and respiratory droplet routes. 2
• Nail dystrophies (Beau's lines or nail shedding) may occur weeks after initial symptom onset. 5