What is a good topical treatment for itch relief in adults with hand, foot, and mouth disease (HFMD)?

Topical Itch Relief for Hand, Foot, and Mouth Disease in Adults

For itch relief in adults with hand, foot, and mouth disease, apply a topical cooling agent containing menthol or use a bland emollient frequently, as HFMD is a self-limited viral illness requiring only symptomatic management.

Understanding HFMD in Adults

Hand, foot, and mouth disease is typically a benign, self-limiting viral illness that resolves within 2-3 weeks 1, 2. While predominantly affecting children, recent outbreaks have shown adults can be affected with more severe symptoms, particularly with coxsackievirus A6 strains 3. The disease presents with vesicular eruptions on palms, soles, and oral cavity, often accompanied by pruritus 1.

First-Line Topical Approach

Cooling Agents and Emollients

• Apply topical coolants containing menthol as first-line therapy for itch relief, as these are established treatments for pruritus from various causes 4
• Use emollients liberally and frequently to provide symptomatic relief and maintain skin barrier function 4
• Apply mild, low-pH cleansers to avoid further irritation 4

Topical Corticosteroids (If Needed)

• Consider low-to-medium potency topical corticosteroids (such as hydrocortisone 1-2.5%) for areas with significant inflammation and itch 5
• Limit use on sensitive areas like the face to prevent skin atrophy 5
• These can reduce inflammation and associated pruritus, though HFMD lesions typically resolve without intervention 2

Alternative Options

Topical Calcineurin Inhibitors

• Tacrolimus 0.1% ointment may be considered as a steroid-sparing alternative for persistent pruritus, particularly on hands and feet 6
• A pilot study demonstrated tacrolimus ointment applied three times daily significantly improved pruritus in hand/foot eczema within 8 weeks 6
• This option is particularly useful if you want to avoid corticosteroid side effects with prolonged use 6

What to Avoid

Do NOT use topical antihistamines - these paradoxically increase the risk of contact dermatitis through sensitization and have insufficient evidence for efficacy in pruritic conditions 7, 5

Avoid topical antibiotics unless there is clear evidence of secondary bacterial infection, as they increase resistance and sensitization risk 7, 5

Important Clinical Caveats

• Treatment is fundamentally palliative to reduce pain and irritation since HFMD is self-limited 2
• Complications are rare in typical HFMD cases 2
• Nail dystrophies (Beau's lines or nail shedding) may occur weeks after initial symptoms, particularly with coxsackievirus A6 3
• If symptoms are severe or progressive (fever, neurological symptoms, respiratory distress), this represents atypical HFMD requiring urgent medical evaluation 1

Practical Application Strategy

1. Start with menthol-containing cooling agents applied to affected areas as needed for immediate itch relief 4
2. Layer with frequent emollient application to maintain skin hydration and barrier function 4
3. Add low-potency topical corticosteroid (hydrocortisone 1%) twice daily if cooling agents and emollients are insufficient 5
4. Consider tacrolimus 0.1% ointment if corticosteroid use is contraindicated or if symptoms persist beyond typical disease course 6