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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only—do NOT use corticosteroids, as they suppress the immune response necessary for viral clearance and may increase risk of severe complications and death. 1

Core Treatment Approach

The management of HFMD is entirely symptomatic, as this is a self-limited viral illness that typically resolves in 7-10 days without sequelae. 2

Pain and Fever Management

• Use oral analgesics such as acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 3
• These medications address the constitutional symptoms and discomfort from oral and skin lesions 3

Oral Lesion Management

For mouth sores causing pain and difficulty eating:

• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 3, 1
• Use white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 3
• Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort 3
• Apply chlorhexidine oral rinse twice daily as an antiseptic measure 3
• For more severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 3
• Use mild toothpaste and gentle oral hygiene practices 3

Skin Lesion Management

For hand and foot manifestations:

• Apply intensive moisturizing care with urea-containing creams to hands and feet 3, 1
• Avoid friction and heat exposure to affected areas 3, 1
• Apply zinc oxide as a protective barrier for itchy skin lesions—this works by soothing inflamed areas and has immune-modulating properties 3, 1
• Apply zinc oxide in a thin layer after gentle cleansing; can be repeated as needed when itchiness returns 3
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 3

Critical caveat: Avoid applying zinc oxide to open or weeping lesions 3

Management of Open Sores on Feet

• Wash feet daily with careful drying, particularly between the toes 3
• Avoid walking barefoot and wear appropriate cushioned footwear to protect open lesions 3
• Do NOT soak feet in footbaths, as this induces skin maceration and worsens open sores 3
• Do NOT use chemical agents or plasters to remove corns or calluses 3
• Do NOT use topical antiseptic or antimicrobial dressings routinely, as these are not recommended for wound healing 3

Monitoring for Complications

• Monitor for signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain 3
• Treat any secondary bacterial infections that develop 3
• Reassess after 2 weeks if lesions are not improving with standard care 3
• If infection has not resolved after 4 weeks, re-evaluate and consider alternative diagnoses 3

Special Considerations for Severe Disease

For severe or complicated HFMD (particularly with Enterovirus 71):

• Intravenous immunoglobulin should be considered and has been recommended by several national and international guideline committees 2
• Be aware that circulatory failure from myocardial impairment and neurogenic pulmonary edema from brainstem damage are the main causes of death 2
• Immunocompromised patients may experience more severe disease and should be monitored closely 3

Prevention and Infection Control

• Hand hygiene with thorough handwashing using soap and water is the most important preventive measure—more effective than alcohol-based hand sanitizers 3
• Clean toys and objects that may be placed in children's mouths 3
• Avoid sharing utensils, cups, or food 3
• 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 3

Critical Diagnostic Pitfall

Distinguish HFMD from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not 3, 1. Also rule out drug hypersensitivity reactions, Kawasaki disease (which has diffuse erythema vs. vesicular lesions), syphilis, meningococcemia, and Rocky Mountain spotted fever in atypical presentations 3.

What NOT to Do

• Never prescribe corticosteroids for HFMD based on the presence of inflammation or fever—they suppress the immune response necessary for viral clearance and may increase risk of severe complications and death 1
• There are currently no specific antiviral agents approved for treatment 2