What is the treatment for hand foot and mouth disease (HFMD)?

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires only supportive care with oral analgesics for pain and fever control, as there are no approved antiviral therapies for this self-limiting viral illness. 1

Symptomatic Pain and Fever Management

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 1
• These oral analgesics address the constitutional symptoms and discomfort from oral and skin lesions. 1

Oral Lesion Management

The mouth sores are often the most painful aspect of HFMD and require targeted interventions:

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking. 1
• Clean the mouth daily with warm saline mouthwashes or use an oral sponge for 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 more severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily. 1
• Use mild toothpaste and gentle oral hygiene practices. 1

Skin Lesion Management (Hands and Feet)

• Apply intensive skin care with moisturizing creams, particularly urea-containing products, to hands and feet. 1
• Avoid friction and heat exposure to affected areas. 1
• For itchiness, zinc oxide can be applied as a protective barrier after gentle cleansing of affected areas. 1
• Apply zinc oxide in a thin layer and repeat as needed when itchiness returns. 1
• Avoid applying zinc oxide to open or weeping lesions. 1
• Do not use chemical agents or plasters to remove any associated corns or calluses. 1

Management of Open Sores on Feet

When vesicles have ruptured and open sores are present:

• Wash feet daily with careful drying, particularly between the toes, to prevent secondary complications. 1
• Avoid walking barefoot and wear appropriate cushioned footwear to protect open lesions. 1
• Do not soak feet in footbaths, as this can induce skin maceration and worsen open sores. 1
• Monitor for signs of secondary bacterial infection, including increased redness, warmth, purulent drainage, or worsening pain. 1
• Treat any secondary bacterial infections that develop. 1
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions. 1
• Reassess after 2 weeks if lesions are not improving with standard care. 1

Prevention and Infection Control

• Hand hygiene with thorough handwashing using soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers. 1
• Clean toys and objects that may be placed in children's mouths. 1
• Avoid sharing utensils, cups, or food. 1
• Children should avoid close contact with others until fever resolves and mouth sores heal, even if skin rash is still present. 1
• Exclusion based solely on healing skin lesions is not necessary, as by the time HFMD is diagnosed, the child has likely had the infection for weeks. 1

Special Populations and Severe Disease

• Immunocompromised patients may experience more severe disease and should be monitored closely. 1
• Severe cases with neurological complications (encephalitis/meningitis, acute flaccid paralysis) or cardiopulmonary complications require hospitalization and intensive supportive care. 1, 2
• While ribavirin has been used in severe cases, there are no generally recommended antiviral therapies for HFMD. 2, 3
• Intravenous immunoglobulin should be considered for severe/complicated HFMD. 3

Critical Diagnostic Consideration

It is crucial to distinguish HFMD from herpes simplex virus, as HSV has available antiviral treatment options whereas HFMD does not. 1 This distinction changes management entirely, as HSV requires acyclovir or valacyclovir therapy.

Common Pitfalls to Avoid

• Do not prescribe antibiotics unless there is clear evidence of secondary bacterial infection. 1
• Do not keep children out of daycare based solely on the presence of healing skin lesions after fever and mouth sores have resolved. 1
• Do not use aspirin in children due to the risk of Reye syndrome (general medical knowledge).
• Recognize that most cases are self-limiting and resolve in 7-10 days without sequelae. 3