Treatment for Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease is a self-limited viral illness requiring only supportive care with oral analgesics (acetaminophen or NSAIDs) for pain and fever relief, along with symptomatic management of oral and skin lesions. 1
Supportive Care (Primary Treatment)
Pain and Fever Management:
- Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
- These are the mainstay of treatment given the self-limited nature of the disease, which typically resolves in 7-10 days without sequelae 2
Management of Oral Lesions
For mild to moderate oral involvement:
- 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 1
- Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
- Apply chlorhexidine oral rinse twice daily as an antiseptic measure 1
For severe oral involvement:
- Consider betamethasone sodium phosphate mouthwash four times daily 1
- Use mild toothpaste and gentle oral hygiene practices 1
Management of Skin Lesions (Hands and Feet)
Skin care measures:
- Apply intensive moisturizing creams to hands and feet, particularly urea-containing products 1
- Avoid friction and heat exposure to affected areas 1
- For itchiness, zinc oxide can be applied as a protective barrier after gentle cleansing of affected areas 1
- Apply zinc oxide in a thin layer; for nighttime relief, consider application followed by loose cotton gloves 1
Important caveat: Avoid applying zinc oxide to open or weeping lesions 1
For open sores on feet:
- Wash feet daily with careful drying, particularly between the toes 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 (increased redness, warmth, purulent drainage, or worsening pain) and treat if present 1
Prevention and Infection Control
Hand hygiene is the most important preventive measure:
- Thorough handwashing with soap and water 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 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 1
Severe Disease and Complications
For severe/complicated HFMD (particularly with neurological involvement):
- Intravenous immunoglobulin should be considered and has been recommended by several national and international guideline committees 2
- Glucocorticoid therapy may be used in severe cases with neurological complications 3
- Mechanical ventilation may be necessary for severe respiratory complications 4
Critical warning: Enterovirus 71 (EV-A71) is associated with more severe outbreaks with potential neurological complications including meningoencephalitis, brainstem encephalitis, acute flaccid paralysis, and cardiopulmonary complications 1, 4, 2
Monitoring and Follow-Up
- Immunocompromised patients may experience more severe disease and should be monitored closely 1
- 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
Important Differential Diagnoses to Exclude
- Distinguish from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not 1
- Rule out drug hypersensitivity reactions, which can also present with palmar-plantar rash 1
- Consider Kawasaki disease (HFMD has vesicular lesions vs. diffuse erythema), syphilis, meningococcemia, and Rocky Mountain spotted fever in atypical presentations 1