What Is Eczema Coxsackium?

Eczema coxsackium (EC), sometimes referred to as atypical hand, foot, and mouth disease (HFMD), is a viral infection usually affecting children with atopic dermatitis (a form of eczema). It was first described in 1968.

EC and classic HFMD are both caused by an enterovirus. But classic HFM is most often associated with coxsackievirus A16 (CVA16) or enterovirus 71, while EC is generally caused by coxsackievirus A6 (CVA6) and less often by coxsackievirus A16.

EC causes a rash consisting of vesicles (small fluid-filled blisters), bullae (large fluid-filled blisters), and lesions (patches of wounded skin) that ulcerate and scab. While the classic HFM rash tends to stay localized to the hands, feet, mouth, and occasionally the buttocks or limbs, the rash from EC appears in the areas that are currently or have been affected by eczema.

EC is self-limiting (clears up on its own) and typically resolves without long-term or serious complications. Treatment involves skin care measures to address eczema, such as moisturizing, and sometimes topical steroids and wet wraps.

This article will discuss eczema coxsackium, what to look for, causes, diagnosis, and what to do if your child has it.

Eczema Coxsackium Symptoms

Eczema coxsackium involves a rash that forms in areas of skin that have been damaged by eczema or another skin condition. Characteristics of the EC rash include:

• Small blisters (more common in older children)
• Larger blisters (more common in infants under age one year)
• Blisters can progress to sores that scab
• Crusted papules (raised area on the skin, smaller than 1 centimeter wide)
• Rash can be painful
• Can affect any area, but usually involves the hands, feet, face, torso, and buttocks/groin
• Oral ulcers can occur, but less commonly than with classic HFMD
• May also occur in areas not affected by eczema, but is usually more prominent in areas that are affected
• Spreads quickly (may initially look like rapidly worsening eczema)

Other symptoms may include:

• Fever
• Mouth and/or throat pain
• Irritability
• Fatigue
• Cough or runny nose (before skin involvement)
  

Causes

Eczema can damage the epidermis (top layer of the skin) and lower protection within the skin. This puts eczema-affected skin at a higher risk for bacterial, viral, and fungal infections.

EC is caused by an enterovirus, most commonly CVA6 and sometimes CVA16. EC affects all sexes and usually develops in preschool-age children, although cases in adults have been reported.

EC commonly affects children who have eczema, but it can occur with non-eczema conditions that affect the skin barrier, including:

• Injury to the skin, such as lacerations or scars
• Sunburn
• Diaper rash
• Contact dermatitis (irritated skin from contact with a substance)
• Tinea pedis (athlete's foot, a fungal infection)
• Intertrigo (a rash caused by moisture and friction, usually in skin folds)
• Darier's disease (genetic skin disorder that causes wartlike blemishes on the body)
• Epidermolytic ichthyosis (hereditary skin disorder that causes blistering and scaling of the skin)

Diagnosis

To make a diagnosis of EC, a healthcare provider will:

• Ask about symptoms
• Get a medical history and possibly a family history
• Do a physical exam
• Run tests using fluid from inside the blisters, stool, and/or oropharyngeal (back of the throat) swabs to look for enterovirus or other possible conditions such as eczema herpeticum (a serious infection caused by a herpesvirus)
  

Treatment

Eczema coxsackium is self-limiting, meaning it goes away on its own, usually within one to two weeks.

There are currently no specific medications used to treat enteroviral infections. Treatment for EC is supportive care, such as:

• Nonmedicated moisturizers to treat active eczema
• Keeping hydrated (children may drink less if they have painful mouth sores, so monitoring for dehydration is important; if necessary, intravenous rehydration should be provided in the hospital)
• Pain control (do not give children aspirin)
• Monitoring for secondary bacterial infections (uncommon)
• If necessary, topical corticosteroid medications (after the fever is gone)
  

Some healthcare professionals recommend wet wrapping to help relieve pain or itching associated with the eczema.

To do wet wrapping with your child:

1. Bathe them, apply moisturizer, and, if applicable, medication.
2. Gather clean cotton (preferably white) pajamas or a sweatsuit and cotton wrap dressing or a roll of gauze.
3. If treating hands and/or feet, get cotton gloves or socks for the wet layer. You can use plastic food wrap or vinyl gloves as the dry layer.
4. Using warm water, moisten the dressing until it is slightly damp.
5. Wrap the moist dressing around the areas that need to be treated.
6. Wrap a dry dressing around the wet layer.
7. Put on pajamas or a sweatshirt and sweatpants, being careful not to disturb the bandages.
8. Leave bandages on overnight (or for several hours).

Prognosis

EC clears up without scarring, and serious complications are rare. Skin peeling on the palms or soles may occur as the rash heals.

For some people, nail changes can happen one to two months after the infection, including:

• Horizontal ridging (will slowly grow out)
• Painless loss of nails

Summary

Eczema coxsackium Is a condition characterized by a blistering rash in areas affected by eczema or other damaged skin tissue. It is caused by an enterovirus, primarily coxsackievirus A6. It usually affects preschool-age children.

EC goes away on its own, and serious complications are rare. Treatment includes addressing the underlying eczema by moisturizing, treating pain, preventing dehydration, and sometimes topical corticosterioids and/or wet wrapping.

EC looks very similar to a serious condition called eczema herpeticum, which requires immediate treatment. Suspected cases of EC should be seen right away by a healthcare provider to rule out eczema herpeticum.