Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

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

  • Author: Brad S Graham, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 12, 2016
 

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.[17] Low-level laser therapy has also been shown to shorten the duration of painful oral ulcers.[18]

Next

Anesthetic agents, topical

Class Summary

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

Dyclonine (Dyclone)

 

Dyclonine is a topical anesthetic available in a solution, spray, or lozenge. It affects cell membrane permeability and blocks impulses at peripheral nerve endings in the skin.

Viscous lidocaine (Dilocaine; DermaFlex Gel)

 

Viscous lidocaine is a topical anesthetic. It decreases permeability to sodium ions in neuronal membranes and results in inhibition of depolarization, blocking the transmission of nerve impulses.

Previous
Next

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.

Diphenhydramine (Benadryl, Benylin, Diphen, AllerMax)

 

Diphenhydramine is in the ethanolamine class, a histamine receptor type 1 blocker. It has significant anticholinergic and sedative properties that causes some degree of topical anesthesia by impairing the transmission of nerve impulses.

Previous
Next

Antacid/antiulcer agents

Class Summary

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

Sucralfate (Carafate)

 

Sucralfate is an 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. It binds and covers the ulcer, promoting healing.

Aluminum hydroxide, magnesium hydroxide, simethicone (Mylanta)

 

The combination of aluminum hydroxide, magnesium hydroxide, and simethicone lowers gastric pH and covers ulcer bases. Similar to its effect on GI ulcers, it may cover the ulcer base, allowing more rapid healing. Magnesium and/or aluminum antacid mixtures are used to prevent bowel function changes.

Previous
 
 
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, Texas Dermatological Society, American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, 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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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. 2007 Aug. 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. 2011 Dec 18. [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. 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. 2011 Oct. 25(5):374-6. [Medline].

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

  6. 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].

  7. Chung WH, Shih SR, Chang CF, Lin TY, Huang YC, Chang SC, et al. Clinicopathologic analysis of coxsackievirus a6 new variant induced widespread mucocutaneous bullous reactions mimicking severe cutaneous adverse reactions. J Infect Dis. 2013 Dec. 208(12):1968-78. [Medline].

  8. Mathes EF, Oza V, Frieden IJ, Cordoro KM, Yagi S, Howard R, et al. "Eczema coxsackium" and unusual cutaneous findings in an enterovirus outbreak. Pediatrics. 2013 Jul. 132(1):e149-57. [Medline].

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

  10. 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. 2002 Apr. 102(1-2):9-14. [Medline].

  11. 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. 2009 Oct. 43(10):872-4. [Medline].

  12. 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. 2012 Feb 20. [Medline].

  13. 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. 2009 Apr 22. [Medline].

  14. 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. 2012 Mar 15. 22(6):2209-11. [Medline].

  15. 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].

  16. Harada YU, Lekcharoensuk P, Furuta T, Taniguchi T. Inactivation of Foot-and-Mouth Disease Virus by Commercially Available Disinfectants and Cleaners. Biocontrol Sci. 2015. 20 (3):205-8. [Medline].

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

  18. 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. 2003 Dec. 21(6):363-7. [Medline].

  19. 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. 2011 Dec 22. [Medline].

  20. 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. 2011 Apr. 127(4):e898-904. [Medline].

  21. Li Y, Dang S, Deng H, Wang W, Jia X, Gao N, et al. Breastfeeding, previous Epstein-Barr virus infection, Enterovirus 71 infection, and rural residence are associated with the severity of hand, foot, and mouth disease. Eur J Pediatr. 2013 May. 172(5):661-6. [Medline].

  22. Mao QY, Wang Y, Bian L, Xu M, Liang Z. EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD). Expert Rev Vaccines. 2016 Jan 14. 1-8. [Medline].

  23. Harada Y, Lekcharoensuk P, Furuta T, Taniguchi T. Inactivation of Foot-and-Mouth Disease Virus by Commercially Available Disinfectants and Cleaners. Biocontrol Sci. 2015. 20 (3):205-8. [Medline].

  24. Agrawal R, Bhan K, Balaggan K, Lee RW, Pavesio CE, Addison PK. Unilateral acute maculopathy associated with adult onset hand, foot and mouth disease: case report and review of literature. J Ophthalmic Inflamm Infect. 2015. 5:2. [Medline].

  25. Hayman R, Shepherd M, Tarring C, Best E. Outbreak of variant hand-foot-and-mouth disease caused by coxsackievirus A6 in Auckland, New Zealand. J Paediatr Child Health. 2014 Aug 15. [Medline].

  26. Vuorinen T, Osterback R, Kuisma J, Ylipalosaari P. Epididymitis caused by coxsackievirus A6 in association of hand, foot and mouth disease. J Clin Microbiol. 2014 Sep 17. [Medline].

  27. Jia HL, He CH, Wang ZY, et al. MicroRNA expression profile in exosome discriminates extremely severe infections from mild infections for hand, foot and mouth disease. BMC Infect Dis. 2014 Sep 17. 14(1):506. [Medline].

  28. Li X, Li Q, Li J, et al. Elevated levels of circulating histones indicate disease activity in patients with hand, foot, and mouth disease (HFMD). Scand J Infect Dis. 2014 Sep 8. 1-8. [Medline].

  29. 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. 2002 Jun. 109(6):e88. [Medline]. [Full Text].

  30. 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. 2003 Oct. 92(10):1163-9. [Medline].

  31. 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. 2001 Jan 15. 32(2):236-42. [Medline].

  32. 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. 2009 Jan 19. 9:3. [Medline]. [Full Text].

  33. Kim SJ, Kim JH, Kang JH, Kim DS, Kim KH, Kim KH, et al. Risk factors for neurologic complications of hand, foot and mouth disease in the Republic of Korea, 2009. J Korean Med Sci. 2013 Jan. 28(1):120-7. [Medline]. [Full Text].

Previous
Next
 
The lower lip has an ulcer with an erythematous halo.
The tongue has an ulcer with an erythematous halo.
A typical cutaneous lesion has an elliptical vesicle surrounded by an erythematous halo. The long axis of the lesion is oriented along the skin lines.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.