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

Hand, Foot, and Mouth Disease in Adults: Treatment Approach

Treatment for Hand, Foot, and Mouth Disease (HFMD) in adults is entirely supportive care—there is no antiviral therapy available, and the disease is self-limiting. 1, 2

Core Management Principles

The foundation of HFMD management in adults consists of symptomatic relief while the viral illness runs its natural course of 7-10 days 2, 3:

Pain and Fever Control

• Use oral acetaminophen or NSAIDs for pain relief and fever reduction 1
• Limit duration of analgesic use to the symptomatic period 1
• These medications address both systemic symptoms and localized discomfort 2

Oral Lesion Management

For painful mouth ulcers, which can significantly impact eating and drinking 1:

• 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
• Use chlorhexidine oral rinse twice daily as an antiseptic measure 1
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 1
• Maintain gentle oral hygiene with mild toothpaste 1

Skin Lesion Care

For the characteristic hand and foot vesicles 1:

• Apply intensive moisturizing care with urea-containing creams to hands and feet 1
• Use zinc oxide as a protective barrier for itchy skin lesions—apply in thin layers after gentle cleansing, repeating as needed 1
• Avoid friction and heat exposure to affected areas 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to enhance effectiveness 1

Foot-Specific Management (When Open Sores Present)

• Wash feet daily with careful drying, particularly between 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—these are not recommended for HFMD wound healing 1

Critical Pitfall to Avoid

Never prescribe corticosteroids for HFMD, regardless of the degree of inflammation or fever present. 4 HFMD requires intact immune function for viral clearance, and corticosteroids suppress this necessary immune response, potentially increasing the risk of severe complications and death 4.

Monitoring for Complications

While most adult cases follow a benign course 5, 3, be vigilant for:

• Signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain 1
• Neurological symptoms: severe headache, altered mental status, or weakness (rare but serious complications include encephalitis/meningitis and acute flaccid paralysis) 1, 6
• Cardiopulmonary symptoms: chest pain, shortness of breath, or signs of myocarditis 6, 7

Monitor for signs of secondary infection and reassess after 2 weeks if lesions are not improving with standard care 1. If evidence of infection has not resolved after 4 weeks, re-evaluate and consider alternative diagnoses 1.

Special Considerations for Adults

Adults with HFMD, particularly those infected with Coxsackievirus A6, may experience more severe symptoms than the "classical" childhood presentation 6, 5:

• Widespread exanthema beyond hands, feet, and mouth (including trunk, extremities, and perioral zone) 5
• More severe pain requiring hospitalization for supportive care in some cases 7
• Joint pains and arthritis 7
• Potential for onychomadesis (nail loss) occurring up to 2 months after initial symptoms 6

Immunocompromised adults may experience more severe disease and require closer monitoring 1.

Infection Control and Return to Work

• Hand hygiene with soap and water is the most important preventive measure (more effective than alcohol-based sanitizers) 1
• Avoid sharing utensils, cups, or food 1
• Adults can return to normal activities once fever resolves and mouth sores heal, even if skin rash persists 1
• By the time HFMD is diagnosed, the patient has likely been infectious for weeks, so common sense should guide decisions about contagiousness 1

Diagnostic Confirmation (When Needed)

If diagnostic confirmation is required, reverse transcriptase PCR (RT-PCR) of vesicle fluid is the preferred method due to high viral loads and test sensitivity 1. Respiratory samples or stool specimens can also be used 1.