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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only, focusing on pain relief with acetaminophen or NSAIDs and maintaining hydration, as no specific antiviral therapy is available or indicated. 1, 2

Immediate Symptom Management

Pain and Fever Control

• Use oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
• Avoid oral lidocaine, which is not recommended for HFMD 2
• Symptoms typically resolve in 7-10 days without intervention 2, 3

Oral Lesion Management

The oral ulcerations are usually the first and most painful manifestations 4:

• Apply white soft paraffin ointment to 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 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 Manifestations (Hand and Foot Lesions)

For intact vesicular lesions:

• Apply intensive moisturizing creams, particularly urea-containing products, to hands and feet 1
• Use zinc oxide as a protective barrier to soothe inflamed areas and reduce itchiness 1
• Apply zinc oxide in a thin layer after gentle cleansing; reapply as needed 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to enhance effectiveness 1
• Avoid friction and heat exposure to affected areas 1

For open sores on feet:

• Wash feet daily with careful drying, particularly between the toes 1
• Avoid walking barefoot and wear appropriate cushioned footwear 1
• Do NOT soak feet in footbaths, as this induces skin maceration and worsens open sores 1
• Do NOT use topical antiseptic or antimicrobial dressings routinely, as these are not recommended for HFMD wound healing 1
• Monitor for signs of secondary bacterial infection (increased redness, warmth, purulent drainage, worsening pain) and treat if present 1

Prevention and Infection Control

Hand Hygiene (Most Critical Measure)

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

Environmental Measures

• Clean toys and objects that may be placed in children's mouths 1
• Avoid sharing utensils, cups, or food 1
• Disinfect potentially contaminated surfaces and fomites 2

Isolation Guidelines

• Children should avoid close contact with others until fever resolves AND mouth sores heal 1
• Skin rash alone is NOT a reason for continued exclusion from daycare 1
• By the time HFMD is diagnosed, the child has likely been shedding virus for weeks, posing limited additional risk 1

Monitoring for Complications

Critical warning signs requiring immediate evaluation:

• Neurological symptoms (severe headache, altered mental status, weakness, seizures) suggesting encephalitis, meningitis, or acute flaccid paralysis 1
• Cardiopulmonary symptoms (respiratory distress, tachycardia, poor perfusion) as circulatory failure and neurogenic pulmonary edema are the main causes of death 3
• Enterovirus 71 (EV-A71) is associated with more severe outbreaks and higher complication rates, particularly in Asia 1

Special Populations

• Immunocompromised patients may experience more severe disease and require close monitoring 1
• Reassess after 2 weeks if lesions are not improving with standard care 1

Important Diagnostic Distinction

Always distinguish HFMD from herpes simplex virus, as herpes has available antiviral treatment options while HFMD does not 1. The differential diagnosis also includes erythema multiforme, measles, varicella, herpangina, and recurrent aphthae 2, 4.

What NOT to Do

• Do NOT use oral lidocaine 2
• Do NOT use chemical agents or plasters to remove corns or calluses 1
• Do NOT apply zinc oxide to open or weeping lesions 1
• Do NOT exclude children from daycare based solely on healing skin lesions 1
• Do NOT expect antiviral therapy to be effective, as none is currently approved 3