Treatment of Oral Lesions in Hand, Foot, and Mouth Disease
For oral lesions in hand, foot, and mouth disease, supportive care with oral analgesics (acetaminophen or NSAIDs) combined with gentle oral hygiene and topical barrier preparations provides effective symptom relief, as there is no specific antiviral treatment for this self-limited viral illness. 1
Primary Management Approach
Pain Control and Fever Management
- Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
- These oral analgesics form the cornerstone of symptomatic treatment for oral discomfort 1
Oral Hygiene and Barrier Protection
- Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
- Use mild toothpaste and maintain gentle oral hygiene practices 1
- Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort 1
- Barrier preparations such as Gengigel® mouth rinse or gel or Gelclair® are helpful for pain control 2
Topical Treatments for Severe Oral Involvement
Anti-inflammatory Rinses
- 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
Corticosteroid Mouthwashes (for more severe cases)
- Consider betamethasone sodium phosphate 0.5 mg dissolved in 10 mL of water as a 2-3 minute rinse-and-spit solution one to four times daily for more severe oral involvement 2, 1
- Dilution of mouthwashes (by 50%) may be necessary to reduce discomfort 2
Dietary Modifications
Avoid Painful Stimuli
- Eliminate foods such as tomatoes, citrus fruits, hot drinks, and spicy, hot, raw, or crusty foods that can exacerbate oral pain 2
- Drink ample fluids to keep the mouth moist 2
Important Clinical Considerations
Duration and Self-Limited Nature
- HFMD is typically self-limited with symptoms resolving within 7-10 days 3, 4
- Early intervention for oral lesions is recommended, with consideration of delaying normal activities until symptoms resolve for severe oral ulcers 1
When to Consider Alternative Diagnoses
- Distinguish HFMD from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not 1
- Rule out drug hypersensitivity reactions and other conditions like Kawasaki disease, which can present with similar oral findings 1
Special Populations
- Immunocompromised patients may experience more severe disease and prolonged course, requiring closer monitoring 1, 5
- In rare cases of immunocompromised adults with prolonged HFMD, there may be a role for systemic aciclovir (200 mg five times daily), though this is not standard practice 5
Common Pitfalls to Avoid
- Do not prescribe antibiotics for uncomplicated HFMD, as it is a viral illness 1, 6
- Avoid using topical antiseptic or antimicrobial dressings routinely, as these are not recommended for standard HFMD lesions 1
- Do not rely solely on exclusion from daycare based on healing oral lesions; children can return once fever resolves and mouth sores heal 1
Monitoring and Follow-Up
- Monitor for signs of secondary bacterial infection, including increased redness, warmth, or purulent drainage 1
- Reassess after 2-4 weeks if lesions are not improving with standard care 1
- Be aware of potential neurological complications (encephalitis, meningitis) particularly with Enterovirus 71, which may require urgent evaluation 1