Is topical lidocaine (local anesthetic) beneficial for hand, foot, and mouth disease?

Topical Lidocaine for Hand, Foot, and Mouth Disease

Topical lidocaine should NOT be used for hand, foot, and mouth disease in children due to significant safety concerns and lack of proven efficacy for this specific condition.

Critical Safety Concerns

The available evidence strongly argues against using viscous lidocaine preparations in pediatric patients with painful mouth conditions:

• Lidocaine should not be used to treat painful mouth lesions in children until further safety data are available due to altered pharmacokinetics in pediatric patients, including increased absorption, decreased clearance, and prolonged half-life 1
• Doses that are safe for adults may present significant toxic hazards in children, with documented cases of lidocaine overdose from oral use 1
• The risk of systemic toxicity is particularly concerning given that hand, foot, and mouth disease affects young children who are at highest risk for adverse effects 1

Evidence Regarding Efficacy

The limited research on topical lidocaine for painful infectious mouth conditions in children shows:

• A randomized controlled trial specifically examining 2% viscous lidocaine in children aged 6 months to 8 years with painful infectious mouth conditions (including hand, foot, and mouth disease) was designed to establish effectiveness, but the study registration suggests uncertainty about its benefit 2
• While a 2% lidocaine gel showed pain reduction in children with painful oral cavity sites, this was a general study not specific to hand, foot, and mouth disease 3

Guideline-Based Contraindications

Topical lidocaine has specific contraindications that apply to hand, foot, and mouth disease:

• Non-intact skin is an absolute contraindication for topical lidocaine application 4
• Hand, foot, and mouth disease characteristically presents with vesicles and ulcerations, which represent non-intact skin and mucous membranes
• Care must be taken to avoid mucous membrane contact or ingestion, which is nearly impossible to prevent in young children with oral lesions 4

Safer Alternative Approach

Benzocaine may be considered as a safer alternative to lidocaine for oral pain in children due to its low incidence of side effects 1

Critical Prescribing Error to Avoid

• Lidocaine preparations should never be prescribed on a "PRN" basis for children 1
• If absolutely necessary to use (which is not recommended for hand, foot, and mouth disease), very specific instructions must be given regarding amount, frequency, maximum daily dose, and mode of administration 1