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

Treatment of Hand, Foot, and Mouth Disease

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

Primary Treatment Approach

Pain and Fever Management

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 1 This addresses the constitutional symptoms and discomfort that typically last less than 1 week. 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 for comfort. 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 (>grade 2 ulcers), consider betamethasone sodium phosphate mouthwash four times daily. 1
• Use mild toothpaste and gentle oral hygiene practices. 1

Skin and Foot Care

• Apply intensive moisturizing creams to hands and feet, particularly urea-containing products. 1
• Avoid friction and heat exposure to affected areas. 1
• For itchy lesions, zinc oxide can be applied as a protective barrier after gentle cleansing, repeated as needed. 1
• Do not use chemical agents or plasters to remove corns or calluses. 1

Management of Open Foot Sores

• 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 closely 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 with thorough handwashing using soap and water is the most important preventive measure and is more effective than alcohol-based sanitizers. 1
• Clean 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 Exclusion based solely on healing skin lesions is unnecessary, as by the time HFMD is diagnosed, the child has likely been infectious for weeks. 1

Important Clinical Considerations

When to Escalate Care

• Immunocompromised patients may experience more severe disease and require close monitoring. 1
• Watch for neurological complications (encephalitis/meningitis, acute flaccid paralysis) particularly with Enterovirus 71, which is associated with more severe outbreaks. 1
• Severe cases may require mechanical ventilation and consideration of antiviral agents such as ribavirin, though no antiviral therapy is generally recommended for routine cases. 3

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

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

Common Pitfalls to Avoid

• Do not routinely use topical antiseptic or antimicrobial dressings for HFMD foot lesions, as these are not recommended for wound healing. 1
• Do not apply zinc oxide to open or weeping lesions. 1
• Do not exclude children from daycare based solely on persistent skin rash after fever and oral lesions have resolved. 1