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

Treatment of Hand, Foot, and Mouth Disease in Adults

Hand, foot, and mouth disease in adults is a self-limited viral infection requiring only supportive care with oral analgesics for pain relief, intensive skin moisturization, and meticulous oral hygiene—no antiviral therapy exists for this condition. 1, 2

Symptomatic Pain Management

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 1 These are the first-line analgesics for symptom control.
• Oral analgesics should be taken as needed, particularly before meals when oral lesions make eating painful. 1

Oral Lesion Management

The mouth sores are often the most debilitating symptom in adults and require aggressive local care:

• 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 to prevent secondary bacterial infection. 1
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily. 1
• Use mild toothpaste and practice gentle oral hygiene to avoid further irritation. 1

Hand and Foot Lesion Care

Skin manifestations require protective measures to prevent secondary complications:

• Apply intensive moisturizing creams to hands and feet, particularly urea-containing products. 1
• Avoid friction and heat exposure to affected areas. 1
• For open sores on feet, wash daily with careful drying between the toes. 1
• Wear appropriate cushioned footwear and avoid walking barefoot to protect open lesions. 1
• Do not soak feet in footbaths, as this induces skin maceration and worsens open sores. 1
• For itchy lesions, apply zinc oxide in a thin layer after gentle cleansing—this creates a protective barrier and has immune-modulating properties. 1

Monitoring for Complications

While HFMD is typically self-limited in adults, severe complications can occur:

• Monitor for signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain. 1
• Watch for neurological symptoms including impaired consciousness, ptosis, limb weakness, or severe headache—these indicate potential encephalomyelitis, particularly with enterovirus 71. 3
• Immunocompromised patients may experience more severe disease and require closer monitoring. 1
• If symptoms have not resolved after 4 weeks, re-evaluate and consider alternative diagnoses. 1

Critical Differential Diagnoses

Do not miss these important mimics:

• Distinguish from herpes simplex virus infection—HSV has available antiviral treatment whereas HFMD does not. 1
• Rule out drug hypersensitivity reactions, which can present with similar palmar-plantar rash. 1
• Consider Kawasaki disease (diffuse erythema vs. vesicular lesions), syphilis, meningococcemia, and Rocky Mountain spotted fever in atypical presentations. 1

Infection Control and Return to Work

• Adults can return to work once fever resolves and mouth sores heal, even if skin rash persists. 1
• Practice meticulous hand hygiene with soap and water (more effective than alcohol-based sanitizers). 1, 4
• Avoid sharing utensils, cups, or food. 1, 4
• Avoid close conversation within a few feet of others during the acute phase, as respiratory droplets transmit the virus. 4
• Direct contact with vesicle fluid poses the highest transmission risk due to extremely high viral loads. 4

Common Pitfalls to Avoid

• Do not prescribe antiviral medications—no effective antiviral therapy exists for HFMD, unlike herpes simplex virus. 1
• Do not use topical antiseptic or antimicrobial dressings routinely for foot lesions, as these are not recommended for wound healing. 1
• Do not use chemical agents or plasters to remove corns or calluses on affected areas. 1
• Do not exclude patients from work based solely on healing skin lesions when fever has resolved and oral lesions have healed. 1

Special Consideration: Severe Cases

In rare cases of HFMD with confirmed encephalomyelitis (via CSF analysis and MRI showing CNS involvement), a single dose of IVIG therapy may be considered and can help reduce fever, skin lesions, and recovery time. 3 However, this applies only to severe neurological complications, not routine HFMD management.

The disease typically resolves within 7 days with supportive care alone. 2, 5, 6