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

Treatment of Hand, Foot, and Mouth Disease in Adults

The primary treatment for adults with HFMD is supportive care with oral analgesics (acetaminophen or NSAIDs) for pain and fever, combined with intensive oral hygiene measures and topical treatments for oral lesions. 1

Symptomatic Pain and Fever Management

• Use oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
• These medications address the constitutional symptoms that commonly occur with HFMD 1
• Continue analgesics as needed until fever resolves and symptoms improve 1

Oral Lesion Management (Critical for Adult Comfort)

Basic Oral 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
• Use mild toothpaste and gentle oral hygiene practices 1
• Use chlorhexidine oral rinse twice daily as an antiseptic measure 1

Anti-inflammatory Topical Treatments

• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
• For more 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 1
• Dilute mouthwashes by 50% if they cause discomfort 1

Barrier Preparations for Severe Cases

• Barrier preparations such as Gengigel mouth rinse/gel or Gelclair are helpful for pain control in severe oral involvement 1

Dietary Modifications

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

Skin Manifestations Management

Hand and Foot Lesions

• Apply intensive skin care with moisturizing creams, particularly urea-containing products 1
• Avoid friction and heat exposure to affected areas 1
• Do not use chemical agents or plasters to remove corns or calluses 1

For Itchiness

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

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 and worsens open sores 1
• Monitor for signs of secondary infection (increased redness, warmth, purulent drainage, or worsening pain) 1
• Treat any secondary bacterial infections that develop 1

When to Escalate Care

Red Flags Requiring Immediate Evaluation

• Severe headache, altered mental status, neck stiffness, or focal neurological deficits suggest potential encephalomyelitis and require urgent evaluation 2
• Acute onset of impaired consciousness, ptosis, or limb weakness warrants immediate hospitalization 2
• Severe respiratory symptoms or signs of pulmonary edema 3, 4

Severe Neurological Complications Management

• For confirmed enterovirus 71-induced encephalomyelitis, consider single-dose IVIG therapy, which can help reduce fever, skin lesions, and recovery time 2
• Obtain cerebrospinal fluid analysis and brain/spinal cord MRI to confirm central nervous system involvement 2
• RT-PCR of cerebrospinal fluid, throat swabs, skin lesions, and anal swabs can confirm enterovirus 71 2

Follow-Up and Monitoring

• 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
• Children with HFMD can return to work/activities once fever resolves and mouth sores heal, even if skin rash is still present 1

Important Caveats

• No specific antiviral therapy exists for HFMD 3, 5
• The disease is typically self-limited, resolving in 7-10 days without sequelae 5
• 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
• Immunocompromised patients may experience more severe disease and should be monitored closely 1
• Late manifestations include Beau's lines (deep transverse nail grooves) appearing 1-2 months after fever onset and periungual desquamation beginning 2-3 weeks after onset 1