What is the treatment for hand, foot, and mouth disease (HFMD) caused by Coxsackievirus?

Treatment of Hand, Foot, and Mouth Disease (Coxsackievirus)

Hand, foot, and mouth disease requires supportive care only, as no antiviral treatment is available for coxsackievirus infections. 1, 2

Pain and Fever Management

Use oral acetaminophen or NSAIDs (such as ibuprofen) for a limited duration to relieve pain and reduce fever. 1 These are the primary pharmacologic interventions for symptom control. 2

• Oral lidocaine is not recommended for pain management in HFMD. 2
• Fever typically subsides within 3-4 days without specific intervention. 3

Oral Lesion Management

The oral ulcers are often the most painful aspect of HFMD and require targeted supportive care:

• 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

Common pitfall: Oral lesions may persist for 7-10 days and can cause significant discomfort leading to decreased oral intake and dehydration risk, particularly in young children. 3 Monitor hydration status closely.

Skin Lesion Management

For Hand and Foot Lesions

• Apply intensive skin care with moisturizing creams, particularly urea-containing products (urea cream/ointment). 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 Itchy Lesions

• Zinc oxide 20% 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, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier. 1

For Open Sores on Feet

• Wash feet daily with careful drying, particularly between the toes, to prevent secondary complications. 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
• 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
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions. 1

Prevention of Transmission

• Handwashing with soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers. 1, 2
• Environmental cleaning, particularly of toys and objects that may be placed in children's mouths, is crucial. 1, 2
• Avoid sharing utensils, cups, or food. 1
• Children should avoid close contact with others until fever resolves and mouth sores heal. 1

Return to Daycare/School

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 and poses limited additional risk. 1

Warning Signs Requiring Urgent Evaluation

Immediately evaluate for complications if the patient develops: 3

• Persistent high fever
• Lethargy or unusual irritability
• Severe headache or stiff neck
• Respiratory distress
• Neurological symptoms (altered mental status, weakness, paralysis)

These may indicate serious complications such as meningitis, encephalitis, acute flaccid paralysis, or neurogenic pulmonary edema, particularly with Enterovirus 71 infections. 1, 3

Special Populations

• Immunocompromised patients may experience more severe disease and should be monitored closely. 1
• Adults can develop HFMD, particularly with coxsackievirus A6 strains, and may present with more severe manifestations including higher fever, longer disease duration, and wider distribution of lesions. 4, 5

Follow-Up

• 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

Critical distinction: It is crucial to distinguish HFMD from herpes simplex virus, as the latter has available antiviral treatment options while HFMD does not. 1 HFMD lesions are typically concentrated on hands, feet, and mouth rather than being widely distributed like chickenpox. 3