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

Treatment of Hand, Foot, and Mouth Disease

HFMD treatment is primarily supportive care with oral analgesics for pain and fever control, as there are no approved antiviral therapies for this self-limiting viral illness. 1

Symptomatic Management

Pain and Fever Control

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 1
• These oral analgesics address the constitutional symptoms and 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 Lesion Management

For hand and foot lesions:

• Apply intensive moisturizing creams containing urea to hands and feet. 1
• Avoid friction and heat exposure to affected areas. 1
• Do not use chemical agents or plasters to remove associated corns or calluses. 1

For itchy lesions:

• Zinc oxide can be applied as a protective barrier to soothe inflamed areas and reduce itchiness. 1
• Apply zinc oxide in a thin layer after gentle cleansing of affected areas. 1
• Avoid applying to open or weeping lesions. 1
• For nighttime relief, apply 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, 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 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

Severe Disease Considerations

For severe or complicated HFMD (particularly EV-A71 associated cases with neurological complications):

• Intravenous immunoglobulin should be considered and has been recommended by several national and international guideline committees. 2
• This is particularly relevant for cases with encephalitis/meningitis, acute flaccid paralysis, or cardiopulmonary complications. 1, 2

Important Clinical Pitfalls

Differential Diagnosis

• Distinguish HFMD from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not. 1
• Rule out drug hypersensitivity reactions, which can present with similar palmar-plantar rash. 1
• Differentiate from Kawasaki disease (HFMD has vesicular lesions vs. diffuse erythema). 1

What NOT to Do

• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions, as these are not recommended for wound healing. 1
• Currently, there are no specific antiviral agents approved for treatment of HFMD. 2

Infection Control and Return to Activities

Prevention Measures

• Hand hygiene with thorough handwashing using soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers. 1
• Clean toys and objects that may be placed in children's mouths. 1
• Avoid sharing utensils, cups, or food. 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. 1
• By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others. 1

Follow-Up and Monitoring

• 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
• Monitor immunocompromised patients closely, as they may experience more severe disease. 1
• Be aware that nail changes (onychomadesis) may occur up to 2 months after initial symptoms. 3, 4

Expected Clinical Course

The disease is usually benign and self-limiting, resolving in 7-10 days without sequelae. 2 Most cases follow this benign course, making the supportive care approach appropriate for the vast majority of patients. 2, 3