What is the recommended treatment for hand, foot, and mouth disease (HFMD) caused by Coxsackievirus?

Treatment of Hand, Foot, and Mouth Disease (HFMD)

Treatment for hand, foot, and mouth disease is entirely supportive, focusing on pain relief with acetaminophen or NSAIDs and maintaining adequate hydration—no antiviral therapy exists for this self-limited viral illness. 1, 2

Supportive Care Measures

Pain and Fever Management

• Use oral acetaminophen or NSAIDs (ibuprofen) for a limited duration to relieve pain and reduce fever 1
• Avoid oral lidocaine as it is not recommended for HFMD 2
• Fever typically subsides within 3-4 days without intervention 3

Oral Lesion Management

• 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 severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 1
• Use mild toothpaste and gentle oral hygiene practices 1
• Oral ulcers may persist for 7-10 days and can cause significant discomfort leading to decreased oral intake 3, 2

Skin Manifestations (Hand and Foot Lesions)

• Apply intensive skin care with moisturizing creams, particularly urea-containing products 1
• Apply zinc oxide in a thin layer to soothe inflamed areas and reduce itchiness 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 1
• Avoid applying zinc oxide to open or weeping lesions 1
• Avoid friction and heat exposure to affected areas 1
• Do not use chemical agents or plasters to remove any associated corns or calluses 1

Management of Open Sores on Feet

• 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 can induce skin maceration and worsen 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
• Reassess after 2 weeks if lesions are not improving with standard care 1

Prevention and Infection Control

Hand Hygiene

• Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers for preventing HFMD spread 1
• This is the single most important preventive measure 1
• Wash hands with soap and lukewarm water for at least 20 seconds 4

Environmental Measures

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

Return to Daycare/School

• 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

Warning Signs Requiring Urgent Evaluation

Monitor closely for these complications, particularly with Enterovirus 71 infections:

• Persistent high fever, lethargy, or unusual irritability 3
• Severe headache or stiff neck suggesting meningitis or encephalitis 3
• Respiratory distress indicating potential neurogenic pulmonary edema 3
• Neurological complications including acute flaccid paralysis or acute flaccid myelitis 1, 3

Special Populations

Immunocompromised Patients

• May experience more severe disease and should be monitored closely 1
• Some patients may require hospitalization for supportive care, particularly with coxsackievirus A6 infections 5

Adults

• Coxsackievirus A6 has been increasingly associated with adult HFMD with more severe manifestations 5, 6
• Adults may present with widespread painful eruptions, fevers, joint pains, and neurologic symptoms requiring hospitalization 5

Important Clinical Distinctions

No Antiviral Treatment Available

• Unlike herpes simplex virus infections, HFMD has no available antiviral treatment options 1
• This is a critical distinction when considering the differential diagnosis 1

Disease Course

• Lesions usually resolve in 7-10 days 2
• Nail dystrophies (Beau's lines or nail shedding/onychomadesis) may occur weeks after initial symptom onset, particularly with CVA6 infections 7, 8
• If evidence of infection has not resolved after 4 weeks, re-evaluate and consider alternative diagnoses 1