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 treatments available. 1, 2
Primary Treatment Approach
Pain and Fever Management
- Use acetaminophen or NSAIDs (such as ibuprofen) for a limited duration to relieve pain and reduce fever. 1
- Oral lidocaine is specifically not recommended for symptom management. 2
- The disease is self-limiting and typically resolves in 7-10 days without intervention. 2, 3
Oral Lesion Care
- Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking. 1
- Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain. 1
- Clean the mouth daily with warm saline mouthwashes for comfort. 1
- Apply 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 gentle oral hygiene practices. 1
Skin Manifestation Management
- Apply intensive skin care to hands and feet with moisturizing creams, particularly urea-containing products. 1
- Avoid friction and heat exposure to affected areas. 1
- Zinc oxide 20% can be applied as a protective barrier to soothe inflamed areas and reduce itchiness, reapplying as needed. 1
- For nighttime relief, apply zinc oxide in a thin layer followed by loose cotton gloves to enhance effectiveness. 1
- Avoid applying zinc oxide to open or weeping lesions. 1
Foot Lesion Care (When Open Sores Present)
- 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 including increased redness, warmth, purulent drainage, or worsening pain. 1
- Treat any secondary bacterial infections that develop. 1
Prevention and Contagion Control
Hand Hygiene (Most Important Measure)
- Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers for preventing HFMD spread. 1
- This is the single most important preventive measure according to the American Academy of Pediatrics. 1
Environmental Measures
- Clean and disinfect toys and objects that may be placed in children's mouths. 1, 2
- Avoid sharing utensils, cups, or food. 1
- Disinfect potentially contaminated surfaces and fomites. 2
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. 1
- By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others. 1
- Children should avoid close contact with others until fever resolves and mouth sores heal. 1
Important Clinical Caveats
When to Escalate Care
- Monitor immunocompromised patients closely, as they may experience more severe disease. 1
- Watch for neurological complications such as encephalitis, meningitis, acute flaccid paralysis, or acute flaccid myelitis, particularly with Enterovirus 71 infections. 1
- Reassess after 2 weeks if lesions are not improving with standard care. 1
Differential Diagnosis Considerations
- Distinguish HFMD from herpes simplex virus, as HSV has available antiviral treatment options whereas HFMD does not. 1
- The differential also includes erythema multiforme, measles, varicella, herpangina, and recurrent aphthae. 2, 4
Common Pitfalls to Avoid
- Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions, as these are not recommended for wound healing. 1
- Do not use chemical agents or plasters to remove associated corns or calluses. 1
- Do not prescribe antiviral medications, as none are currently approved for HFMD treatment. 2, 5