What is the treatment for hand foot mouth disease?

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 not recommended for pain management. 2
• These analgesics address both systemic symptoms (fever) and localized discomfort from oral and skin lesions. 1

Oral Lesion Management

The mouth sores are often the most painful aspect of HFMD and require specific attention:

• 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 Manifestation Management

For hand and foot lesions:

• Apply intensive skin care with moisturizing creams, particularly urea-containing products. 1
• Avoid friction and heat exposure to affected areas. 1
• Do not use chemical agents or plasters to remove any associated corns or calluses. 1

For itchiness:

• Zinc oxide can be applied as a protective barrier on the skin, soothing inflamed areas and potentially reducing itchiness. 1
• Apply zinc oxide in a thin layer after gentle cleansing of affected areas. 1
• Avoid applying zinc oxide to open or weeping lesions. 1
• For nighttime relief, consider applying zinc oxide followed by loose cotton gloves to create an occlusive barrier. 1

Management of Open Sores on Feet

• 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 can induce skin maceration and worsen open sores. 1
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions. 1

Hydration Support

Maintaining adequate hydration is critical, especially when oral lesions make eating and drinking painful. 2

Monitoring for Complications

Secondary Bacterial Infections

• Monitor for signs of secondary infection, including 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

Severe Disease Complications

While rare, be aware that certain strains (particularly Enterovirus 71) can cause severe complications:

• Neurological complications such as encephalitis/meningitis, acute flaccid myelitis, or acute flaccid paralysis. 1
• Cardiopulmonary complications. 2
• Immunocompromised patients may experience more severe disease and should be monitored closely. 1

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
• Disinfect potentially contaminated surfaces and fomites. 2
• 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. 1
• Children should avoid close contact with others until fever resolves and mouth sores heal. 1
• By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others. 1

Important Clinical Pitfalls

Diagnostic Considerations

• Distinguish HFMD from herpes simplex virus, as the latter has available antiviral treatment options whereas HFMD does not. 1
• The differential diagnosis includes erythema multiforme, herpes, measles, and varicella. 2
• Atypical manifestations in children with atopic dermatitis may mimic herpetic superinfection ("eczema coxsackium"). 3
• Nail changes (onychomadesis) may occur up to two months after initial symptoms. 4, 3

Treatment Limitations

• No antiviral treatment is currently approved or available for HFMD. 2
• The disease is typically self-limited, with lesions resolving in 7 to 10 days. 2, 5
• Treatment remains symptomatic and supportive in all cases. 3, 5