What is the treatment for hand foot mouth disease?

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only, with treatment focused on pain relief using acetaminophen or NSAIDs and maintaining adequate hydration—no antiviral therapy is available or indicated. 1, 2

Symptomatic Management

Pain and Fever Control

• Use oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
• Avoid oral lidocaine, as it is not recommended for HFMD 2

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 more severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 1
• Use mild toothpaste and practice gentle oral hygiene 1

Skin Manifestations (Hand and Foot Lesions)

• Apply intensive skin care with moisturizing creams, particularly urea-containing products 1
• Avoid friction and heat exposure to affected areas 1
• For itchiness, zinc oxide can be applied as a protective barrier in a thin layer after gentle cleansing of affected areas 1
• Zinc oxide can be reapplied as needed when itchiness returns, but avoid applying to open or weeping lesions 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
• Do not use topical antiseptic or antimicrobial dressings routinely, as these are not recommended for wound healing in HFMD 1

Hydration Support

• Ensure adequate fluid intake, as oral ulcerations can make eating and drinking painful 2, 3
• Monitor for signs of dehydration, particularly in young children 3

Monitoring and Follow-Up

Watch for Complications

• Monitor for signs of secondary bacterial infection, including increased redness, warmth, purulent drainage, or worsening pain 1
• Be vigilant for neurological complications such as encephalitis/meningitis, particularly with Enterovirus 71 (EV-A71) infections 1, 4
• Watch for severe respiratory symptoms such as pulmonary edema, which can occur in severe cases 4
• Acute flaccid myelitis (AFM) and acute flaccid paralysis (AFP) are rare but potential neurological complications 1

Reassessment Timeline

• 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
• Lesions usually resolve in 7 to 10 days without complications 2, 3

Treatment of Secondary Infections

• Treat any secondary bacterial infections that may develop 1
• Immunocompromised patients may experience more severe disease and should be monitored closely 1

Prevention and Infection Control

Hand Hygiene

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

Environmental Cleaning

• Clean toys and objects that may be placed in children's mouths 1
• Disinfect potentially contaminated surfaces and fomites 2

Isolation Precautions

• Children should avoid close contact with others until fever resolves and mouth sores heal 1
• Avoid sharing utensils, cups, or food 1
• Follow standard precautions and good hand hygiene practices in healthcare settings 1

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—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

Important Diagnostic Considerations

Differential Diagnosis

• 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
• Other differential diagnoses include erythema multiforme, measles, and varicella 2

Diagnostic Testing (When Needed)

• Vesicle fluid samples have high viral loads and are ideal for testing, with reverse transcriptase PCR (RT-PCR) targeting the 5′ non-coding region being the preferred diagnostic method 1
• Respiratory samples and/or stool specimens can also be used for diagnosis with RT-PCR 1

Common Pitfalls to Avoid

• Do not use chemical agents or plasters to remove any associated corns or calluses 1
• Do not prescribe antiviral therapy, as none is available or indicated for HFMD 2, 3
• Do not use oral lidocaine for pain management 2
• Do not exclude children from daycare based solely on the presence of healing skin lesions 1