What is the treatment for Hand, Foot, and Mouth Disease (HFMD)?

Treatment of Hand, Foot, and Mouth Disease

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

Core Treatment Approach

Pain and Fever Management

• Administer oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
• These analgesics address the constitutional symptoms that typically resolve within 7-10 days 3, 4, 5

Oral Lesion Management

The oral ulcers are often the most painful manifestation and require targeted intervention:

• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
• 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 or use an oral sponge for comfort 1
• Apply chlorhexidine oral rinse twice daily as an antiseptic measure 1
• For severe oral involvement (>grade 2), consider betamethasone sodium phosphate mouthwash four times daily and delay normal activities until symptoms resolve 1

Hand and Foot Lesion Management

The characteristic skin manifestations require protective care:

• Apply intensive moisturizing care with urea-containing creams to hands and feet 1, 2
• Avoid friction and heat exposure to affected areas 1
• Apply zinc oxide as a protective barrier for itchy skin lesions—this works by soothing inflamed areas and has immune-modulating properties 1
• For optimal zinc oxide use: apply in thin layers after gentle cleansing, repeat as needed when itchiness returns, and consider nighttime application with loose cotton gloves for enhanced effectiveness 1
• Do not use chemical agents or plasters to remove associated corns or calluses 1

Special Management for Open Sores on Feet

When vesicles progress to open lesions:

• 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
• Monitor for signs of secondary bacterial infection: 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

Prevention and Hygiene Measures

Hand Hygiene (Most Important)

• Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers 1
• This is the single most important preventive measure according to the American Academy of Pediatrics 1

Environmental Control

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

Isolation Guidelines

• 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, as by the time HFMD is diagnosed, the child has likely had the infection for weeks 1
• Avoid close contact with others until fever resolves and mouth sores heal 1

Critical Pitfalls to Avoid

Do NOT Use Corticosteroids

This is the most important pitfall: Do not prescribe corticosteroids for HFMD based on the presence of inflammation or fever, as they 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 2.

Do NOT Use Topical Antiseptics Routinely

Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions, as these are not recommended for wound healing 1

Avoid Zinc Oxide on Open Lesions

Do not apply zinc oxide to open or weeping lesions 1

Special Populations

Immunocompromised Patients

• Monitor closely for more severe disease 1
• These patients may experience prolonged symptoms and increased risk of complications 1

Severe Cases with Neurological Complications

While most cases are benign, be aware that:

• Enterovirus 71 (EV-A71) is associated with more severe outbreaks, especially in Asia 1
• Neurological complications such as encephalitis/meningitis, acute flaccid myelitis, and acute flaccid paralysis can occur, particularly with EV-A71 1
• Intravenous immunoglobulin should be considered for severe/complicated HFMD 5
• Circulatory failure and neurogenic pulmonary edema are the main causes of death in severe cases 5

Diagnostic Confirmation (When Needed)

• Vesicle fluid samples have high viral loads and are ideal for testing 1
• Reverse transcriptase PCR (RT-PCR) targeting the 5′ non-coding region is the preferred diagnostic method due to its sensitivity and specificity 1
• Respiratory samples and/or stool specimens can also be used 1
• Distinguish HFMD from herpes simplex virus, as the latter has available antiviral treatment options 1, 2