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

Treatment for Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires only supportive care focused on pain relief and hydration, as there are no approved antiviral treatments available. 1, 2

Symptom Management

Pain and Fever Control

• Use oral acetaminophen or NSAIDs (such as ibuprofen) for a limited duration to relieve pain and reduce fever. 1, 2
• Avoid oral lidocaine, as it is not recommended for HFMD management. 2

Oral Lesion Care

• 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 or use an oral sponge for comfort. 1
• 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, consider betamethasone sodium phosphate mouthwash four times daily. 1
• Use mild toothpaste and gentle oral hygiene practices. 1

Skin Manifestations (Hand and Foot Lesions)

• Apply intensive skin care with moisturizing creams, particularly urea-containing products, to hands and feet. 1
• Avoid friction and heat exposure to affected areas. 1
• Zinc oxide can be applied as a protective barrier to soothe inflamed areas and reduce itchiness in a thin layer after gentle cleansing; avoid applying to open or weeping lesions. 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier. 1

Management of 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

Hydration

• Ensure adequate fluid intake, as painful oral ulcerations may reduce oral intake. 2, 3

Expected Course

• Lesions typically resolve in 7 to 10 days without sequelae. 2, 3
• Nail shedding may occur after a latency period following HFMD. 4

When to Escalate Care

Severe/Complicated Disease

• Intravenous immunoglobulin should be considered for severe or complicated HFMD (particularly with neurological or cardiopulmonary complications), as recommended by several national and international guideline committees. 3
• Monitor immunocompromised patients closely, as they may experience more severe disease. 1

Warning Signs Requiring Immediate Evaluation

• Neurological complications such as encephalitis, meningitis, acute flaccid myelitis, or acute flaccid paralysis (particularly with Enterovirus 71). 1, 5
• Cardiopulmonary complications including circulatory failure secondary to myocardial impairment or neurogenic pulmonary edema. 3, 5

Follow-Up and Re-Evaluation

• 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 Measures

• Handwashing with soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers. 1
• Disinfect toys and objects that may be placed in children's mouths. 1
• Avoid sharing utensils, cups, or food. 1
• Children can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present. 1

Critical 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
• 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