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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only, as there is no specific antiviral therapy approved for this self-limited viral illness. 1

Symptomatic Pain and Fever Management

• Use oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 1
• These analgesics address both constitutional symptoms and discomfort from oral and skin lesions. 1

Oral Lesion Management

Basic Oral Care

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking. 1
• Use mild toothpaste and gentle oral hygiene practices to avoid irritating existing lesions. 1
• Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort. 1

Escalating Oral Interventions

• 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 severe oral involvement (>grade 2 ulcers), consider betamethasone sodium phosphate mouthwash four times daily and delay normal activities until symptoms resolve. 1

Hand and Foot Lesion Management

Skin Care Protocol

• Apply intensive moisturizing creams to hands and feet, particularly urea-containing products, to maintain skin integrity. 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 Itchiness

• Zinc oxide 20% can be applied as a protective barrier to soothe inflamed areas and reduce itchiness. 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. 1
• 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, to prevent secondary complications. 1
• Wear appropriate cushioned footwear and avoid walking barefoot to protect open lesions. 1
• Do not soak feet in footbaths, as this induces skin maceration and worsens open sores. 1
• Do not use topical antiseptic or antimicrobial dressings routinely, as these are not recommended for wound healing in HFMD. 1

Monitoring for Complications

• 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
• Be vigilant for neurological complications (encephalitis/meningitis, acute flaccid paralysis) particularly with enterovirus 71, which causes more severe disease. 1, 2
• Immunocompromised patients may experience more severe disease and require closer monitoring. 1

Follow-Up Timing

• 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

Prevention and Isolation

• 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 unnecessary, as by the time HFMD is diagnosed, the child has likely had the infection for weeks. 1
• Hand hygiene with thorough handwashing using 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

Critical Differential Diagnoses

• 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
• Differentiate from Kawasaki disease (HFMD has vesicular lesions vs. diffuse erythema). 1

Important Caveats

The disease is typically self-limited, resolving in 7-10 days without sequelae. 2, 3 While intravenous immunoglobulin has been recommended by some guideline committees for severe/complicated HFMD, and experimental antivirals like ribavirin have been used in severe cases, these are not part of routine management. 2, 3 Most cases require only the supportive measures outlined above.