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

Treatment for Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only—no antiviral therapy exists for routine cases, and corticosteroids must be avoided as they suppress the immune response needed for viral clearance and may increase risk of severe complications and death. 1, 2

Primary Treatment Approach

Pain and Fever Management

• Use oral acetaminophen or NSAIDs for a limited duration to control pain and reduce fever. 1
• These are the cornerstone of symptomatic relief and should be offered to all patients with HFMD 1

Oral Lesion Management

The mouth sores are often the most distressing symptom and require targeted intervention:

• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1, 2
• Use white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
• Clean the mouth daily with warm saline mouthwashes 1
• Consider chlorhexidine oral rinse twice daily as an antiseptic measure 1
• For severe oral involvement, betamethasone sodium phosphate mouthwash four times daily may be used 1
• Maintain mild oral hygiene practices and use gentle toothpaste 1

Skin Lesion Management

For the characteristic hand and foot rashes:

• Apply intensive moisturizing care with urea-containing creams to hands and feet 1, 2
• Avoid friction and heat exposure to affected areas 1, 2
• Apply zinc oxide as a protective barrier for itchy skin lesions—this can be repeated as needed when itchiness returns 1, 2
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 1
• Apply zinc oxide in a thin layer after gentle cleansing of affected areas 1

Critical caveat: Avoid applying zinc oxide to open or weeping lesions 1

Management of Open Sores on Feet

When vesicles have ruptured:

• Wash feet daily with careful drying, particularly between the toes 1
• Avoid walking barefoot and wear appropriate cushioned footwear to protect open lesions 1
• Do not soak feet in footbaths, as this induces skin maceration and worsens open sores 1
• Do not use chemical agents or plasters to remove corns or calluses 1
• Do not use topical antiseptic or antimicrobial dressings routinely 1

Monitoring and Follow-Up

Signs Requiring Closer Attention

• Monitor for signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain 1
• Reassess after 2 weeks if lesions are not improving with standard care 1
• Immunocompromised patients may experience more severe disease and should be monitored closely 1

Severe Disease Considerations

While most cases are self-limited, be aware that:

• Enterovirus 71 is associated with more severe outbreaks and neurological complications including encephalitis/meningitis, acute flaccid myelitis, and acute flaccid paralysis 1
• Intravenous immunoglobulin should be considered for severe/complicated HFMD 3
• No specific antiviral agents are currently approved for treatment 3

Prevention and Infection Control

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 Measures

• Clean toys and objects that may be placed in children's mouths 1
• Avoid sharing utensils, cups, or food 1

Return to Daycare/School

• Children can return to daycare 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 had the infection for weeks, posing limited additional risk to others 1

Critical Pitfall to Avoid

Do not prescribe corticosteroids for HFMD based on the presence of inflammation or fever. Corticosteroids suppress the immune response necessary for viral clearance and may increase the risk of severe complications and death. 2 HFMD requires intact immune function for viral clearance, and corticosteroids directly counteract this necessary immune response. 2

Diagnostic Consideration

It is crucial to distinguish HFMD from herpes simplex virus, as HSV has available antiviral treatment options whereas HFMD does not 1. Vesicle fluid samples have high viral loads and RT-PCR targeting the 5′ non-coding region is the preferred diagnostic method if confirmation is needed 1.