What are the treatment and management options for Hand, Foot, and Mouth Disease (HFMD)?

Hand, Foot, and Mouth Disease: Treatment and Management

HFMD is a self-limited viral illness requiring supportive care only—there are no antiviral medications or corticosteroids indicated, and treatment focuses on pain control, hydration, and preventing transmission through rigorous hand hygiene. 1, 2, 3

Supportive Care (Mainstay of Treatment)

Pain and Fever Management

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1, 2
• Oral lidocaine is not recommended for pain control 3
• Symptoms typically resolve within 7-10 days without intervention 4, 3

Oral Lesion Management

• Apply white soft paraffin ointment to lips every 2 hours to prevent drying and cracking 1, 2
• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1, 2
• Clean the mouth daily with warm saline mouthwashes 1, 2
• Apply chlorhexidine oral rinse twice daily as an antiseptic measure 1, 2
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 1

Skin Care for Hand and Foot Lesions

• Apply intensive moisturizing with urea-containing creams to hands and feet 1, 2
• Avoid friction and heat exposure to affected areas 1, 2
• Use zinc oxide as a protective barrier for itchy lesions—apply in thin layers after gentle cleansing, can be repeated as needed 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to enhance effectiveness 1
• Do not use chemical agents or plasters to remove corns or calluses 1

Management of Open Sores on Feet

• Wash feet daily with careful drying, particularly between toes 1
• Avoid walking barefoot and wear appropriate cushioned footwear 1
• Do not soak feet in footbaths, as this induces skin maceration and worsens open sores 1
• Monitor for signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain 1
• Do not use topical antiseptic or antimicrobial dressings routinely, as these are not recommended for HFMD wound healing 1

Prevention and Infection Control

Hand Hygiene (Most Important Preventive Measure)

• Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers 1
• Intensive education on hand hygiene effectively reduces HFMD incidence (2.1% vs 4.2% in control groups) 5

Environmental Measures

• Clean and disinfect toys and objects that may be placed in children's mouths 1, 3
• Avoid sharing utensils, cups, or food 1
• Disinfect potentially contaminated surfaces and fomites 3

Isolation and Return to Activities

• Children should avoid close contact with others until fever resolves and mouth sores heal 1
• Children can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present—exclusion based solely on healing skin lesions is unnecessary 1
• By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others 1

Diagnostic Considerations

Preferred Testing Method

• Reverse transcriptase PCR (RT-PCR) targeting the 5′ non-coding region is the preferred diagnostic method 1
• Vesicle fluid samples have the highest viral loads and are ideal for testing 1
• Respiratory samples and/or stool specimens can also be used 1

Critical Differential Diagnoses

• Distinguish from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not 1, 2
• Rule out drug hypersensitivity reactions, which can present with palmar-plantar rash 1
• Differentiate from Kawasaki disease (HFMD has vesicular lesions vs. diffuse erythema) 1
• Consider syphilis, meningococcemia, and Rocky Mountain spotted fever in atypical presentations with palmar-plantar involvement 1
• Distinguish from chemotherapy-induced hand-foot syndrome, which requires different treatments 6

Monitoring for Complications

Signs Requiring Hospitalization

• Neurological complications: encephalitis/meningitis, acute flaccid myelitis, acute flaccid paralysis (particularly with EV-71) 1, 7, 8
• Respiratory distress 2
• Cardiovascular instability 2, 7
• Inability to maintain hydration due to severe oral lesions 2

Special Populations

• Immunocompromised patients may experience more severe disease and require close monitoring 1
• Increased mortality associated with brain stem encephalitis in children under 3 years of age and teenagers 8

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

Common Pitfalls to Avoid

• Do not prescribe corticosteroids (including dexamethasone) for HFMD treatment 2
• No antiviral medications are available or indicated for HFMD 2, 7, 3
• Do not apply zinc oxide to open or weeping lesions 1
• Avoid excessive buildup of topical products on skin 1