What is the treatment approach for an adult diagnosed with Hand, Foot, and Mouth Disease (HFMD)?

Treatment for Hand, Foot, and Mouth Disease in Adults

Hand, foot, and mouth disease in adults is managed with supportive care only, as there is no antiviral therapy recommended for routine use. 1

Symptomatic Pain and Fever Management

• Use oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 1 These are the first-line analgesics for constitutional symptoms.
• Fever typically resolves within 3-5 days of onset. 2

Oral Lesion Management

The oral lesions are often the most troublesome symptom in adults and require a stepwise approach:

Basic Oral Care (All Patients)

• 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
• Use mild toothpaste and gentle oral hygiene practices. 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 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. 1
• Barrier preparations such as Gengigel mouth rinse or gel or Gelclair are helpful for pain control. 1
• Dilution of mouthwashes (by 50%) may be necessary to reduce discomfort. 1

Dietary Modifications

• Eliminate tomatoes, citrus fruits, hot drinks, and spicy, hot, raw, or crusty foods that can exacerbate oral pain. 1
• Drink ample fluids to keep the mouth moist. 1

Hand and Foot Lesion Management

Skin Care

• Apply intensive skin care with moisturizing creams, particularly urea-containing products (urea cream/ointment), to hands and feet. 1
• Avoid friction and heat exposure to affected areas. 1
• Apply zinc oxide in a thin layer to soothe inflamed areas and reduce itchiness. 1 Zinc oxide works as a protective barrier and has immune-modulating properties. 1
• Avoid applying zinc oxide to open or weeping lesions. 1
• For nighttime relief, consider applying zinc oxide followed by loose cotton gloves to create an occlusive barrier. 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 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. 1
• Do not use chemical agents or plasters to remove any associated corns or calluses. 1

Monitoring for Complications

While HFMD is typically self-limiting in adults, certain complications require vigilance:

Secondary Bacterial Infection

• Monitor for signs of secondary infection, including increased redness, warmth, purulent drainage, or worsening pain. 1
• Treat any secondary bacterial infections that develop. 1

Severe Neurological Complications (Rare in Adults)

Adults can rarely develop severe complications, particularly with Enterovirus 71. 3 Watch for:

• Impaired consciousness, ptosis, or limb weakness suggesting encephalomyelitis. 3
• Acute flaccid myelitis or acute flaccid paralysis. 1

If severe neurological complications develop, prompt IVIG therapy (single dose) should be considered, as this has been shown to help reduce fever, skin lesions, and recovery time. 3 This represents the only scenario where treatment beyond supportive care is indicated.

Follow-Up 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

Critical Differential Diagnoses

Distinguish HFMD from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not. 1 Also rule out:

• Drug hypersensitivity reactions, which can present with palmar-plantar rash. 1
• Kawasaki disease (HFMD has vesicular lesions vs. diffuse erythema). 1
• Chemotherapy-induced hand-foot syndrome, which requires different treatments such as urea creams and high-potency steroids. 4

Expected Course and Late Manifestations

• The disease is self-limiting, with symptoms typically remitting in 7 days. 5
• Beau's lines (deep transverse nail grooves) may appear approximately 1-2 months after fever onset. 1
• Periungual desquamation typically begins 2-3 weeks after onset of fever. 1

Infection Control

• Avoid close contact with others until fever resolves and mouth sores heal. 1
• Practice meticulous hand hygiene with soap and water (more effective than alcohol-based sanitizers). 6
• Avoid sharing utensils, cups, or food. 1, 6
• Clean and disinfect contaminated surfaces regularly, as the virus remains viable on objects for hours. 6

Common Pitfalls to Avoid

• Do not prescribe antiviral therapy for routine HFMD cases, as no generally recommended antiviral therapy exists. 2 Antivirals like ribavirin are reserved only for severe cases requiring mechanical ventilation. 2
• Do not exclude patients from work based solely on healing skin lesions; by the time HFMD is diagnosed, viral shedding has likely occurred for weeks. 1
• Do not overlook immunocompromised patients, who may experience more severe disease and require closer monitoring. 1