Is dexamethasone (corticosteroid) helpful in treating hand, foot, and mouth disease (HFMD)?

Dexamethasone is Not Recommended for Hand, Foot, and Mouth Disease

Dexamethasone and corticosteroids have no established role in the treatment of hand, foot, and mouth disease (HFMD) and should not be used. The mainstay of treatment for HFMD remains supportive care with oral analgesics, hydration, and symptom management 1, 2.

Evidence Against Corticosteroid Use in HFMD

The provided evidence base contains no guidelines or research supporting corticosteroid use specifically for HFMD. In fact:

• Animal studies show potential harm: Research in cattle with foot-and-mouth disease virus (a different pathogen, but relevant mechanistically) demonstrated that dexamethasone actually reduced virus shedding during treatment but suppressed the secretory IgA immune response, with virus recovery returning to baseline after cessation 3. This suggests corticosteroids may interfere with the natural immune clearance of enteroviral infections.

• No mention in HFMD treatment guidelines: Comprehensive guidance on HFMD management from the American Academy of Pediatrics, CDC, and other authoritative sources makes no reference to corticosteroid therapy 1.

Appropriate Management of HFMD

Supportive Care (First-Line Treatment)

• Pain and fever control: Use acetaminophen or NSAIDs for limited duration to relieve pain and reduce fever 1.

• Oral lesion management:

  • Apply white soft paraffin ointment to lips every 2 hours 1
  • Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 1
  • Employ gentle oral hygiene with warm saline mouthwashes 1
  • Consider chlorhexidine oral rinse twice daily as antiseptic 1

• Skin care for hand and foot lesions:

  • Apply intensive moisturizing with urea-containing creams 1
  • Avoid friction and heat exposure to affected areas 1
  • Use zinc oxide as a protective barrier for itchy lesions 1

Severe HFMD Requiring Hospitalization

Even in severe cases with CNS involvement, cardiovascular symptoms, or respiratory compromise, the treatment approach focuses on:

• Mechanical ventilation when indicated (average 61 hours in one case series) 4
• Supportive pharmacotherapy including gamma globulin and ribavirin 4
• Cardiovascular support with inotropes as needed 4

Notably, while dexamethasone was mentioned as part of the treatment regimen in one observational study of severe HFMD 4, this was not based on controlled evidence and was given alongside multiple other interventions, making it impossible to attribute benefit specifically to corticosteroids.

Critical Pitfalls to Avoid

• Do not confuse HFMD with conditions where steroids ARE indicated: The evidence provided includes guidelines for COVID-19, pemphigus vulgaris, and chemotherapy-induced hand-foot syndrome—all unrelated to HFMD 5.

• Distinguish from herpes simplex virus: HSV has antiviral treatment options, whereas HFMD does not, making accurate diagnosis essential 1.

• Avoid immunosuppression in a viral illness: HFMD is caused by enteroviruses (primarily Coxsackievirus A16 and Enterovirus 71) that require intact immune function for clearance 2, 6.

When to Escalate Care

Monitor for signs requiring hospitalization 1, 4:

• Neurological complications (encephalitis, meningitis, acute flaccid paralysis)
• Respiratory distress or tachypnea
• Cardiovascular instability
• Inability to maintain hydration due to severe oral lesions