Hand, Foot, and Mouth Disease (HFMD) is a common, highly contagious viral illness. The infection is usually caused by an enterovirus, most frequently Coxsackievirus A16, and is characterized by a fever, malaise, and a distinctive rash. While the condition is generally mild and self-limiting, resolving within seven to ten days, the accompanying rash of small, fluid-filled blisters can cause significant discomfort. This discomfort often presents as intense itching on the palms of the hands, soles of the feet, and sometimes the buttocks.
Immediate Topical Relief
Applying agents directly to the skin can provide immediate, localized relief. Over-the-counter calamine lotion is frequently recommended, as its main ingredient, zinc oxide, helps dry out weeping blisters and soothe irritation. For optimal effect, calamine should be dabbed onto clean, intact skin lesions using a cotton swab to avoid rupturing the blisters.
Mild hydrocortisone creams, typically 1% strength, may also be used to reduce localized inflammation and itching, but only on the skin rash. Avoid applying this cream to open sores or broken skin unless specifically directed by a healthcare provider. Another simple, yet effective method involves applying cool, wet compresses to the most intensely itchy areas for short periods, as the reduced temperature temporarily dampens nerve signals responsible for the itch.
For general skin comfort, unscented moisturizing creams or petroleum jelly can be gently applied to hydrate the skin barrier. This is particularly helpful once the blisters have begun to dry and crust over, reducing the tightness and cracking. Resist the urge to pierce or pop the blisters, as the fluid inside is infectious and breaking the skin increases the risk of a secondary bacterial infection.
Systemic Relief Through Oral Medication
Oral medications offer a systemic approach, especially beneficial for nighttime relief. Antihistamines, which block histamine release, are the primary internal medication targeting the itch. A sedating antihistamine, such as diphenhydramine, can be helpful at bedtime because its drowsy side effect may promote better sleep.
Non-sedating antihistamines, like cetirizine or loratadine, may be preferred during the day to help manage the itch without causing excessive drowsiness. Parents should always consult a pediatrician to confirm the appropriate medication and dosage, particularly for young children, as dosing is strictly based on weight or age.
General pain relievers, such as acetaminophen or ibuprofen, address the fever and pain associated with the mouth sores, which can contribute to generalized irritability. By managing the overall pain, these medications can indirectly reduce the perception of discomfort. It is essential to use the correct age-appropriate formulation and to never administer aspirin to children or teenagers recovering from a viral illness due to the risk of Reye’s syndrome.
Comfort Measures and Preventing Secondary Infection
Simple changes in daily care routines help prevent complications from scratching. Soothing baths, specifically using lukewarm water mixed with colloidal oatmeal or baking soda, can coat the skin and temporarily calm widespread itching. After any bath, the skin should be gently patted dry rather than rubbed, to avoid irritating the sensitive blisters.
Clothing choices should prioritize soft, loose-fitting fabrics, such as cotton, to minimize friction against the skin lesions. To physically prevent scratching, which is the main cause of secondary bacterial infection, fingernails should be kept trimmed short and filed smooth. For infants and toddlers, covering the hands with soft mittens or socks, especially during sleep, creates a protective barrier.
Distraction techniques, such as engaging in quiet activities like reading or watching a movie, can help shift focus away from the persistent itching. Additionally, maintaining a cool, humid environment can prevent the skin from drying out, which often intensifies the urge to scratch.
Knowing When to Seek Medical Guidance
While Hand, Foot, and Mouth Disease is typically a mild illness, certain symptoms warrant immediate communication with a healthcare provider. Dehydration is the most common concern, often resulting from painful mouth sores making it difficult to swallow liquids. Signs of dehydration include significantly decreased urination, a dry or sticky mouth, a lack of tears when crying, or excessive lethargy.
A persistent high fever (above 101°F or 38.3°C) for more than three days or one that does not respond to fever-reducing medication is a cause for medical consultation. Extreme irritability, unusual lethargy, or signs of neurological involvement, such as a stiff neck or severe headache, should be addressed urgently. Monitor the rash for signs of a bacterial superinfection, including increasing redness, swelling, warmth, or the presence of pus draining from the blisters.