What is the recommended treatment for a patient with hand, foot, and mouth disease?

Treatment for Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only, focusing on pain relief with oral acetaminophen or NSAIDs and maintaining hydration, as there are no approved antiviral treatments available. 1, 2

Primary Treatment Approach

Pain and Fever Management

• Oral analgesics (acetaminophen or ibuprofen) should be used for pain relief and fever reduction 1, 2
• Avoid oral lidocaine, as it is not recommended for HFMD 2
• Pain control is particularly important given the painful oral ulcerations that can interfere with eating and drinking 2, 3

Oral Lesion Management

The following stepwise approach should be implemented for oral symptoms:

• Apply white soft paraffin ointment to lips every 2 hours to prevent drying and cracking 1
• Clean the mouth daily with warm saline mouthwashes 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

Skin Manifestation Management

For 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
• Do not use chemical agents or plasters to remove corns or calluses 1

For itchy lesions:

• Zinc oxide can be applied as a protective barrier after gentle cleansing of affected areas 1
• Apply in a thin layer and repeat as needed when itchiness returns 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 1
• Avoid applying to open or weeping lesions 1

For open sores on feet:

• Wash feet daily with careful drying, particularly between the toes 1
• Avoid walking barefoot and wear appropriate cushioned footwear 1
• Do not soak feet in footbaths, as this induces skin maceration 1
• Monitor for signs of secondary bacterial infection (increased redness, warmth, purulent drainage, worsening pain) and treat if present 1

Hydration Support

• Maintain adequate hydration, as painful oral lesions may reduce oral intake 2, 3
• This is particularly critical in young children who are at higher risk for dehydration 3

When to Consider Advanced Treatment

Intravenous immunoglobulin should be considered for severe or complicated HFMD, particularly cases with neurological or cardiopulmonary involvement 3. This has been recommended by several national and international guideline committees 3.

Important Clinical Pitfalls

• Do not prescribe antiviral medications—none are approved for HFMD 2, 3
• Distinguish HFMD from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not 1
• Rule out drug hypersensitivity reactions, Kawasaki disease, syphilis, meningococcemia, and Rocky Mountain spotted fever in atypical presentations 1
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions 1

Monitoring and Follow-Up

• Most cases resolve in 7-10 days without sequelae 2, 3
• 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
• Monitor for late manifestations including Beau's lines (nail grooves appearing 1-2 months after fever onset) and periungual desquamation (beginning 2-3 weeks after fever onset) 1
• Watch for rare but serious complications including neurological sequelae (encephalitis, meningitis, acute flaccid paralysis) and cardiopulmonary complications, particularly with Enterovirus 71 1, 3, 4

Prevention Measures

• Handwashing with soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers 1
• Clean toys and objects that may be placed in children's mouths 1
• Avoid sharing utensils, cups, or food 1
• Children can return to daycare once fever resolves and mouth sores heal, even if skin rash is still present 1