Treatment of Itchy Lesions in Hand, Foot, and Mouth Disease
For itchy lesions in HFMD, apply zinc oxide 20% cream as a protective barrier to soothe inflamed areas, combined with intensive moisturizing using urea-containing creams, and consider oral antihistamines for moderate to severe pruritus. 1
Primary Topical Management
Zinc Oxide Application
- Zinc oxide 20% works as a protective barrier on the skin, soothing inflamed areas and reducing itchiness in HFMD skin lesions through its immune-modulating properties that affect leukocytes and natural killer cells 1
- Apply in a thin layer after gentle cleansing of affected areas, repeating as needed when itchiness returns 1
- For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier that enhances effectiveness 1
- Avoid applying to open or weeping lesions 1
Intensive Moisturization
- Use urea-containing creams or ointments for intensive skin care of hands and feet, as this is specifically recommended for HFMD skin manifestations 1
- Apply moisturizing creams regularly to affected areas, avoiding friction and heat exposure 1
Systemic Treatment for Pruritus
Oral Antihistamines
- For moderate to severe itching (grade 2/3), use oral H1-antihistamines such as cetirizine, loratadine, fexofenadine, or clemastine 2
- These provide systemic relief when topical measures are insufficient 2
Polidocanol-Containing Lotions
- Topical polidocanol cream can be applied to soothe pruritus as an alternative or adjunct to zinc oxide 2
Additional Supportive Measures
Skin Protection
- Avoid chemical agents or plasters to remove corns or calluses, as these can worsen skin irritation 1
- Minimize trauma and pressure to affected areas 2
- Wear appropriate cushioned footwear and avoid walking barefoot to protect lesions 1
Hygiene Practices
- Wash affected areas daily with mild, soap-free cleansing bases and lukewarm water 2
- Pat skin dry gently rather than rubbing 2
- Use fine cotton clothing instead of synthetic materials that may increase irritation 2
Important Caveats
Do not use topical steroids routinely for HFMD lesions, as the evidence provided focuses on their use for other dermatological conditions (EGFR-inhibitor reactions, contact dermatitis) rather than viral exanthems 2. Topical steroids may cause perioral dermatitis and skin atrophy if used inadequately 2.
Monitor for secondary bacterial infection, particularly if lesions show increased redness, warmth, purulent drainage, or worsening pain, as this would require antibiotic therapy 1.
The combination of zinc oxide as a barrier protectant with intensive moisturization addresses both the protective and hydration needs of HFMD skin lesions, while oral antihistamines provide systemic relief for significant pruritus 1, 2.