Dermatologic Manifestations of Hand-Foot-and-Mouth Disease Medication

  • Author: Brad S Graham, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 21, 2012
 

Medication Summary

The topical application of anesthetics is beneficial. Viscous lidocaine, dyclonine solution, or diphenhydramine (Benadryl) may be used to treat painful oral ulcers. Antipyretics may be used to manage fever, and analgesics may be used to treat arthralgias.

A case report of severe hand-foot-and-mouth disease (HFMD) from enterovirus infection in an immunocompromised patient described a faster resolution of symptoms and lesions with oral acyclovir.[18] Low-level laser therapy has also been shown to shorten the duration of painful oral ulcers.[19]

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Anesthetic agents, topical

Class Summary

These agents provide symptomatic relief of pain as a result of mucosal lesions.

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Dyclonine (Dyclone)

 

Topical anesthetic available in a solution, spray, or lozenge. Affects cell membrane permeability and blocks impulses at peripheral nerve endings in the skin.

Viscous lidocaine (Dilocaine; DermaFlex Gel)

 

Topical anesthetic. Decreases permeability to sodium ions in neuronal membranes and results in inhibition of depolarization, blocking transmission of nerve impulses.

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Antihistamines

Class Summary

Antihistamines act by means of the competitive inhibition of histamine at the H1 receptor. This effect mediates wheal and flare reactions, bronchial constriction, mucous secretion, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.

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Diphenhydramine (Benadryl, Benylin, Diphen, AllerMax)

 

Ethanolamine class, histamine receptor type 1 blocker. Has significant anticholinergic and sedative properties that causes some degree of topical anesthesia by impairing the transmission of nerve impulses.

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Antacid/antiulcer agents

Class Summary

These agents are used for the symptomatic treatment of acid-induced gastritis and the treatment of GI ulcers.

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Sucralfate (Carafate)

 

Aluminum complex antacid that may help in the treatment of oral mucosal ulcerations. Similar to its effects on GI ulcers, sucralfate forms a viscous adhesive substance that protects the GI lining against pepsin, peptic acid, and bile salts. Binds and covers the ulcer, promoting healing.

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Aluminum hydroxide, magnesium hydroxide, simethicone (Mylanta)

 

Lowers gastric pH and covers ulcer bases. Similar to its effect on GI ulcers, may cover the ulcer base, allowing more rapid healing. Magnesium and/or aluminum antacid mixtures are used to prevent bowel function changes.

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Contributor Information and Disclosures
Author

Brad S Graham, MD  Consulting Staff, Dermatology Associates of Tyler

Brad S Graham, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernice R Krafchik, MBChB, FRCPC  Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto

Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Zhu Z, Xu WB, Xu AQ, et al. Molecular epidemiological analysis of echovirus 19 isolated from an outbreak associated with hand, foot, and mouth disease (HFMD) in Shandong Province of China. Biomed Environ Sci. Aug 2007;20(4):321-8. [Medline].

  2. Yan XF, Gao S, Xia JF, Ye R, Yu H, Long JE. Epidemic characteristics of hand, foot, and mouth disease in Shanghai from 2009 to 2010: Enterovirus 71 subgenotype C4 as the primary causative agent and a high incidence of mixed infections with coxsackievirus A16. Scand J Infect Dis. Dec 18 2011;[Medline].

  3. Yang C, Deng C, Wan J, Zhu L, Leng Q. Neutralizing antibody response in the patients with hand, foot and mouth disease to enterovirus 71 and its clinical implications. Virol J. 2011;8:306. [Medline].

  4. Chang LY, King CC, Hsu KH, et al. Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics. Jun 2002;109(6):e88. [Medline]. [Full Text].

  5. Chong CY, Chan KP, Shah VA, et al. Hand, foot and mouth disease in Singapore: a comparison of fatal and non-fatal cases. Acta Paediatr. Oct 2003;92(10):1163-9. [Medline].

  6. Yu JG, Liu YD, Qiao LY, Wang CJ. [Epidemiological study and clinical analysis of 931 children with hand foot and mouth disease in Yantai]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. Oct 2011;25(5):374-6. [Medline].

  7. McMinn P, Stratov I, Nagarajan L, Davis S. Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis. Jan 15 2001;32(2):236-42. [Medline].

  8. Ooi MH, Wong SC, Mohan A, et al. Identification and validation of clinical predictors for the risk of neurological involvement in children with hand, foot, and mouth disease in Sarawak. BMC Infect Dis. Jan 19 2009;9:3. [Medline]. [Full Text].

  9. Sutton-Hayes S, Weisse ME, Wilson NW, Ogershok PR. A recurrent presentation of hand, foot, and mouth disease. Clin Pediatr (Phila). May 2006;45(4):373-6.

  10. Wei SH, Huang YP, Liu MC, Tsou TP, Lin HC, Lin TL. An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. BMC Infect Dis. 2011;11:346. [Medline].

  11. Lee TC, Guo HR, Su HJ, Yang YC, Chang HL, Chen KT. Diseases caused by enterovirus 71 infection. Pediatr Infect Dis J. Oct 2009;28(10):904-10. [Medline].

  12. Tsao KC, Chang PY, Ning HC, et al. Use of molecular assay in diagnosis of hand, foot and mouth disease caused by enterovirus 71 or coxsackievirus A 16. J Virol Methods. Apr 2002;102(1-2):9-14. [Medline].

  13. Zhang X, Yan HP, Huang C, et al. [The etiology and clinical manifestations of 70 patients with hand-foot-mouth disease]. Zhonghua Yu Fang Yi Xue Za Zhi. Oct 2009;43(10):872-4. [Medline].

  14. Li J, Chen F, Liu T, Wang L. MRI Findings of Neurological Complications in Hand-Foot-Mouth Disease by Enterovirus 71 Infection. Int J Neurosci. Feb 20 2012;[Medline].

  15. Yang Y, Wang H, Gong E, et al. Neuropathology in 2 cases of fatal enterovirus type 71 infection from a recent epidemic in the People's Republic of China: a histopathologic, immunohistochemical, and reverse transcription polymerase chain reaction study. Hum Pathol. Apr 22 2009;[Medline].

  16. Yang Y, Zhang L, Fan X, Qin C, Liu J. Antiviral effect of geraniin on human enterovirus 71 in vitro and in vivo. Bioorg Med Chem Lett. Mar 15 2012;22(6):2209-11. [Medline].

  17. Liu J, Yang Y, Xu Y, Ma C, Qin C, Zhang L. Lycorine reduces mortality of human enterovirus 71-infected mice by inhibiting virus replication. Virol J. 2011;8:483. [Medline].

  18. Faulkner CF, Godbolt AM, DeAmbrosis B, Triscott J. Hand, foot and mouth disease in an immunocompromised adult treated with aciclovir. Australas J Dermatol. Aug 2003;44(3):203-6. [Medline].

  19. Toida M, Watanabe F, Goto K, Shibata T. Usefulness of low-level laser for control of painful stomatitis in patients with hand-foot-and-mouth disease. J Clin Laser Med Surg. Dec 2003;21(6):363-7. [Medline].

  20. Chen S, Yang Y, Yan X, Chen J, Yu H, Wang W. Influence of vitamin A status on the antiviral immunity of children with hand, foot and mouth disease. Clin Nutr. Dec 22 2011;[Medline].

  21. Ruan F, Yang T, Ma H, Jin Y, Song S, Fontaine RE. Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing. Pediatrics. Apr 2011;127(4):e898-904. [Medline].

  22. Hood AF, Mihm MC. Hand-foot-and-mouth disease. In: Fitzpatrick TB, Austen KF, Wolff K, Eisen AZ, Freedberg IM, eds. Dermatology in General Medicine. 4th ed. New York, NY: McGraw-Hill; 1993:2521-3.

  23. Hurwitz S. The exanthematous diseases of childhood. In: Hurwitz, ed. Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 2nd ed. Philadelphia, Pa: WB Saunders; 1993:359-61.

 
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The lower lip has an ulcer with an erythematous halo.
The tongue has an ulcer with an erythematous halo.
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