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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only, focusing on pain relief with acetaminophen or NSAIDs and maintaining hydration, as no antiviral treatment is available for this self-limited viral illness. 1, 2

Symptomatic Management

Pain and Fever Control

• Use oral analgesics such as acetaminophen or ibuprofen for pain relief and fever reduction 1, 2
• Administer for a limited duration as needed for symptom control 1
• Oral lidocaine is not recommended for pain management 2

Oral Lesion Management

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
• Use warm saline mouthwashes or oral sponges for gentle daily mouth cleaning 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
• Maintain mild toothpaste and gentle oral hygiene practices 1

Skin Manifestations (Hand and Foot Lesions)

• Apply intensive moisturizing care with urea-containing creams to hands and feet 1
• Avoid friction and heat exposure to affected areas 1
• For itchiness, zinc oxide can be applied as a protective barrier after gentle cleansing, repeated as needed 1
• Apply zinc oxide in a thin layer; for nighttime relief, consider loose cotton gloves over application 1
• Do not apply zinc oxide to open or weeping lesions 1

Management of Open Sores on Feet

• Wash feet daily with careful drying, particularly between toes 1
• Avoid walking barefoot and wear appropriate cushioned footwear to protect 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

Hydration Support

• Maintain adequate hydration, particularly important given painful oral ulcerations that may limit oral intake 2, 3

Expected Clinical Course

• Lesions typically resolve in 7-10 days without sequelae 2, 3
• The disease is usually benign and self-limited 3
• Oral vesicular and ulcerative lesions are usually the first clinical signs 4

Prevention and Infection Control

Hand Hygiene

• Handwashing with soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers 1

Environmental Measures

• Disinfect toys and objects that may be placed in children's mouths 1, 2
• Avoid sharing utensils, cups, or food 1
• Clean potentially contaminated surfaces and fomites 2

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
• Children should avoid close contact with others until fever resolves and mouth sores heal 1
• Standard precautions and good hand hygiene practices should be followed in healthcare settings 1

Monitoring and Follow-Up

• Reassess after 2 weeks if lesions are not improving with standard care 1
• Re-evaluate after 4 weeks if evidence of infection has not resolved and consider alternative diagnoses 1
• Monitor immunocompromised patients closely as they may experience more severe disease 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 erythema multiforme, measles, varicella, syphilis, meningococcemia, and Rocky Mountain spotted fever in atypical presentations 1, 2

Severe Disease Considerations

• Neurological complications such as encephalitis/meningitis can occur in severe cases, particularly with Enterovirus 71 1
• Rare complications include acute flaccid myelitis and acute flaccid paralysis 1
• Intravenous immunoglobulin should be considered for severe/complicated cases 3
• Enterovirus 71 is associated with more severe outbreaks, especially in Asia 1

Common Pitfalls to Avoid

• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions 1
• Do not use chemical agents or plasters to remove corns or calluses 1
• Do not prescribe antiviral medications, as none are approved or available for HFMD 2, 3