HFMD is a common viral illness, typically caused by coxsackieviruses, that primarily affects infants and young children. While the infection is usually mild and runs its course in about seven to ten days, the painful blisters and associated itching can cause significant discomfort. The rash often appears on the hands, feet, and sometimes the buttocks, knees, and elbows. Since there is no specific antiviral treatment for HFMD, managing symptoms is the focus to ensure comfort and prevent complications like dehydration.
Immediate Relief Through Topical Applications
Direct application of soothing agents to the skin can provide immediate relief from the itchy rash and painful blisters. A cool bath helps reduce discomfort and inflammation. Adding colloidal oatmeal (finely ground oats) to a lukewarm bath creates a soothing soak that calms irritated skin and alleviates itchiness.
Calamine lotion is another effective topical measure, applied to blisters on the hands, feet, and body. It works by drying out the lesions and offering a cooling sensation, which minimizes the urge to scratch. For persistent itching, a mild, over-the-counter hydrocortisone cream can be applied, but consult a healthcare provider before using it on young children. Unscented moisturizing creams or ointments, such as petroleum jelly, also hydrate the skin and promote faster healing.
Systemic Symptom Management Using Oral Medications
Internal medications manage overall discomfort, fever, and generalized pain, complementing topical treatments. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, control fever and alleviate pain from mouth sores and body aches. These medications make it easier to swallow fluids and help the patient rest. Always follow correct dosage instructions based on age and weight; ibuprofen should not be given to children under six months of age.
For severe itching that is disruptive, particularly at night, oral antihistamines may be helpful. Antihistamines reduce the sensation of itching and may also promote sleep due to their sedating side effects. Common options include cetirizine or diphenhydramine, but a healthcare professional should be consulted for appropriate pediatric dosing and to discuss potential side effects. Oral medications offer systemic relief.
Supportive Care and Environmental Comfort Measures
Maintaining adequate hydration is a primary concern, as painful mouth sores make swallowing difficult and can lead to dehydration. Offering cold liquids, such as water, milk, or popsicles, helps numb the mouth and encourages fluid intake. Electrolyte solutions can replenish lost salts and minerals if fluid intake is significantly reduced.
Dietary Adjustments
Dietary adjustments are necessary to avoid irritating mouth blisters. Offer soft, bland, and cool foods like yogurt, mashed potatoes, or smoothies, while avoiding acidic, spicy, or salty items.
Hygiene and Comfort
Proper hygiene is important to prevent secondary bacterial infection of broken blisters. Keep the skin clean and gently pat the rash dry after bathing. To minimize skin damage from scratching, ensure fingernails are kept short. Choosing soft, loose-fitting clothing reduces friction against the sensitive rash, and keeping the room temperature cool helps soothe irritated skin.
Identifying Signs That Require Medical Attention
While HFMD is typically a self-limiting illness, certain signs indicate that professional medical attention is needed. A prolonged or high fever lasting more than three days, or a fever that returns after being absent, requires contacting a healthcare provider. Signs of dehydration, such as significantly reduced urination, a dry mouth, or excessive lethargy, require immediate medical evaluation.
Seek medical attention if pain is severe and cannot be managed with over-the-counter medications. A stiff neck, back pain, or unusual irritability may indicate a rare but serious complication like viral meningitis. If the skin around the blisters shows signs of secondary bacterial infection—such as increasing redness, warmth, swelling, or pus—a medical consultation is necessary.