What is the treatment for hand foot mouth disease?

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires only supportive care with oral analgesics for pain and fever control, as there are no approved antiviral treatments available. 1, 2

Primary Treatment Approach

Pain and Fever Management

• Use acetaminophen or NSAIDs (such as ibuprofen) for a limited duration to relieve pain and reduce fever. 1
• These oral analgesics address both the constitutional symptoms and discomfort from oral and skin lesions. 2
• Oral lidocaine is specifically not recommended for symptom management. 2

Oral Lesion Care

For managing painful mouth sores that interfere with eating and drinking:

• 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 more severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily. 1
• Use mild toothpaste and gentle oral hygiene practices. 1

A critical pitfall is failing to maintain adequate hydration in children with painful oral lesions who refuse to drink. 2

Hand and Foot Lesion Management

For skin manifestations on hands and feet:

• Apply intensive moisturizing creams, particularly urea-containing products, to affected areas. 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, repeated as needed. 1
• Apply zinc oxide in a thin layer to avoid excessive buildup. 1
• Do not apply zinc oxide to open or weeping lesions. 1
• For nighttime relief, consider applying zinc oxide followed by loose cotton gloves to create an occlusive barrier. 1

Management of Open Sores on Feet

When vesicles have ruptured:

• 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 induces skin maceration and worsens open sores. 1
• 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
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions. 1

Expected Clinical Course

• Lesions typically resolve in 7 to 10 days without sequelae. 2, 3
• Fever and sore throat appear first after a 3-10 day incubation period, followed by the characteristic rash a few days later. 4
• If lesions are not improving with standard care after 2 weeks, reassess the patient. 1
• If evidence of infection has not resolved after 4 weeks, re-evaluate and consider alternative diagnoses. 1

Prevention of Transmission

Hand Hygiene

• Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers and is the most important preventive measure. 1
• Environmental cleaning, particularly of toys and objects that may be placed in children's mouths, is crucial. 1

Isolation Guidelines

• 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 not necessary. 1
• By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others. 1
• Avoid sharing utensils, cups, or food. 1
• Children should avoid close contact with others until fever resolves and mouth sores heal. 1

Special Populations

Immunocompromised Patients

• May experience more severe disease and should be monitored closely. 1

Adults

• Can develop HFMD through intra-familial transmission from children. 5
• Treatment approach remains the same as for children. 1

Critical Differential Diagnoses

It is crucial to distinguish HFMD from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not. 1

Other important differentials to consider:

• Drug hypersensitivity reactions (can also present with palmar-plantar rash). 1
• Kawasaki disease (has diffuse erythema vs. vesicular lesions in HFMD). 1
• Erythema multiforme, measles, and varicella. 2
• In atypical presentations with palmar-plantar involvement: syphilis, meningococcemia, and Rocky Mountain spotted fever. 1

Red Flags Requiring Urgent Evaluation

While most cases are benign, watch for severe complications:

• Neurological complications such as encephalitis/meningitis, acute flaccid myelitis, or acute flaccid paralysis (particularly with Enterovirus 71). 1
• Sudden onset of severe respiratory symptoms such as pulmonary edema. 4
• Cardiac complications. 4
• Circulatory failure secondary to myocardial impairment. 3

Enterovirus 71 is associated with more severe outbreaks and higher complication rates than other causative viruses like Coxsackievirus A16. 1, 3

What NOT to Do

• Do not use oral lidocaine for symptom management. 2
• Do not use chemical agents or plasters to remove corns or calluses. 1
• No antiviral treatment is currently approved or available for HFMD. 2, 3
• Do not routinely use topical antibiotics for uncomplicated lesions. 1