eMedicine Specialties > Dermatology > Viral Infections

Hand-Foot-and-Mouth Disease: Treatment & Medication

Author: Brad S Graham, MD, Consulting Staff, Dermatology Associates of Tyler
Contributor Information and Disclosures

Updated: Aug 3, 2009

Treatment

Medical Care

Usually, no medical care is necessary for hand-foot-and-mouth disease (HFMD).

Medication

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.9 Low-level laser therapy has also been shown to shorten the duration of painful oral ulcers.10

Anesthetic agents, topical

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


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.

Adult

Apply 0.5% or 1% solution to ulcers q2h prn pain; not to exceed 200 mg, or 40 mL of 0.5% solution or 20 mL of 1% solution

Pediatric

Administer as in adults; adjust for body weight

Coadministration with St. John's wort may cause an increased risk of cardiovascular collapse and/or delayed emergence from anesthesia

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Severe shock, AV heart block, or central nervous system depression or excitation possible with overdosing; may increase risk of aspiration (impairs swallowing); caution in shock or heart block


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.

Adult

Apply to oral ulcers with cotton-tip applicator prn pain

Pediatric

Administer as in adults; adjust for body weight

Coadministration with cimetidine or beta-blockers increases toxicity; coadministration with procainamide and tocainide may result in additive cardiodepressant action; may increase effects of succinylcholine

Documented hypersensitivity; Adams-Stokes syndrome and Wolf-Parkinson-White syndrome; severe sinoatrial, AV, or intraventricular block (if artificial pacemaker is not used)

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Complete anesthesia of mouth and pharynx with possible choking on food and aspiration and biting of tongue or buccal mucosa; overdose may cause toxicity (lightheadedness, euphoria, tinnitus, nausea, vomiting, seizures, coma, bradycardia, hypotension, cardiac arrest)

Antihistamines

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)

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.

Adult

Symptomatic pain control of oral ulcers: Combine in cocktail or elixir with aluminum and magnesium hydroxide (Mylanta), viscous lidocaine and/or sucralfate (Carafate); swish and spit out several times qd prn pain

Pediatric

Administer as in adults; adjust for body weight

Potentiates effect of CNS depressants; do not give syrup with medications that can cause disulfiramlike reactions (due to alcohol content); may also interact with tricyclic antidepressants, MAOIs, antimuscarinics, amantadine, and procainamide

Documented hypersensitivity; MAOIs

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Xerostomia; may exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction, GI obstruction, hepatic disease, ileus, prostatic hypertrophy, and COPD

Antacid/antiulcer agents

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


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.

Adult

Symptomatic pain control for oral ulcers: Combine in cocktail or elixir with aluminum and magnesium hydroxide (Mylanta), viscous lidocaine and diphenhydramine; swish and spit out several times qd prn pain

Pediatric

Administer as in adults; adjust for body weight

May decrease effects of ketoconazole, ciprofloxacin, tetracycline, phenytoin, warfarin, quinidine, theophylline, and norfloxacin; antacids, reduces H2 blockers, digoxin, lansoprazole, levothyroxine, phenytoin, and theophylline absorption

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in renal failure and conditions that impair excretion of absorbed aluminum; high aluminum levels possible, especially if used with aluminum-containing antacids


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.

Adult

Symptomatic pain control for oral ulcers: Combine in a cocktail or elixir with viscous lidocaine, diphenhydramine and/or sucralfate; swish and spit out several times daily prn pain

Pediatric

Administer as in adults; adjust for body weight

Reduces efficacy of fluoroquinolones, corticosteroids, benzodiazepines, and phenothiazines; aluminum and magnesium potentiate effects of valproic acid, sulfonylureas, quinidine, and levodopa

Documented hypersensitivity; renal impairment may lead to high aluminum levels and further osteomalacia

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in severe renal impairment and recent massive upper GI hemorrhage

More on Hand-Foot-and-Mouth Disease

Overview: Hand-Foot-and-Mouth Disease
Differential Diagnoses & Workup: Hand-Foot-and-Mouth Disease
Treatment & Medication: Hand-Foot-and-Mouth Disease
Follow-up: Hand-Foot-and-Mouth Disease
Multimedia: Hand-Foot-and-Mouth Disease
References
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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. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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.

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  11. Adams SP. Dermacase. Hand-foot-and-mouth disease. Can Fam Physician. May 1998;44:985, 993. [Medline].

  12. Ferson MJ, Bell SM. Outbreak of Coxsackievirus A16 hand, foot, and mouth disease in a child day-care center. Am J Public Health. Dec 1991;81(12):1675-6. [Medline].

  13. 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.

  14. 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.

  15. Thomas I, Janniger CK. Hand, foot, and mouth disease. Cutis. Nov 1993;52(5):265-6. [Medline].

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Further Reading

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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.

Medical Editor

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.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

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.

CME Editor

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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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