Eczema and hand, foot, and mouth disease are separate conditions that cause skin symptoms. Although their effects may be similar, they differ in several ways, including their causes, symptoms, diagnostic process, and treatment.

Hand, foot, and mouth disease (HFMD) is a common, contagious viral childhood illness that often leads to fever, sores around the mouth, and skin rashes.

Eczema is a group of inflammatory conditions that causes dry skin, scaly patches, rashes, and blisters. This article will refer to atopic dermatitis when using the term “eczema” unless otherwise stated, as this is the most common type. However, six other types can develop.

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The causes of eczema and HFMD are very different. The most apparent difference is that eczema is not contagious, whereas HFMD transmits easilyTrusted Source from one person to the next.

Eczema

Eczema symptoms occur due to gaps in a person’s protective skin barrier. These gaps can cause too much moisture to leave the skin and too many outside substances and pathogens to enter the body, causing an overactive immune response in the skin. The National Eczema Association notes that a person may develop eczema at any age.

The exact cause of eczema is not clear, and eczema affects every individual differently. However, eczema interacts with a person’s genes and environment to cause its characteristic flares of dry, scaly rashes.

Possible causes may include:

  • Genetics: Changes to specific genes that produce a skin-protective protein called filaggrin may lead to a “leaky” skin barrier. This may allow outside agents, including bacteria, viruses, or allergens, to enter the body. These gene changes can pass from parents to children.
  • Allergies: According to the American Academy of Dermatology Association, children with allergies, including asthma and hay fever, might also have a higher risk of eczema.
  • Environmental triggers: Certain environmental factors, such as irritating substances, extreme temperatures, or food allergies, may all connect to eczema flares. Stress can also trigger eczema symptoms. However, symptoms may occur several days after a trigger, making identification complex.

Hand, foot, and mouth disease

HFMD is a viral infection that usually develops due to a person — often a child — acquiring Coxsackievirus A16. Other viruses that can cause HFMD include:

  • Coxsackie A, including subtypes 5, 6, 7, 9, and 10
  • Coxsackie B, including subtypes 2 and 5
  • Enterovirus 71, which can cause more severe infections that might lead to heart, lung, and brain lining symptoms
  • Echoviruses

The virus transmits rapidly between individuals through blister fluid, breath droplets, saliva, or stool, usually in a school or home environment. Most people with HFMD are under 5 years oldTrusted Source.

Eczema and HFMD affect the skin differently.

Eczema

Atopic dermatitis often starts with an extreme itch, and scratching it can lead to a rash. Rashes can develop in more than one area. After symptoms have started, the following may develop:

  • further itching
  • dry, scaly patches
  • on lighter skin tones, a red rash
  • on darker skin tones, a dark brown, purple, or gray rash
  • warm skin
  • swelling
  • scratch marks and raw skin from scratching
  • fluid leaking from bumps or rashes
  • oozing, crusting blisters
  • darker or lighter skin patches at the site of the rash after healing

These symptoms might flare up on and off for many years. These flares may occur in one area while a previous flare heals, leading to thick cracked skin over time.

Hand, foot, and mouth disease

Most children with HFMD have symptoms for 7 to 10 daysTrusted Source, and they are often mild. These symptoms may take 3 to 6 days to develop once a child acquires the virus and may include:

  • high body temperature
  • a sore throat
  • painful, blistering mouth sores
  • a rash that often develops on the hands or feet

Many people with the virus do not feel ill but are likely aware of the rashes. Hand and foot blisters may feel tender and grow from flat, pink, or pale lesions to small, red, and grey blisters over time. Often, they are oval-shaped and peel off within 7 days. They do not leave scarring.

Blisters and ulcers may develop inside the throat, on the lips, and around the mouth, which can be painful and affect a person’s ability to eat.

HFMD can interact with eczema in a condition called eczema coxsackium. People who have or have had eczema may find that blisters develop elsewhere, including on the buttocks, legs, arms, and genitals. Those with severe HFMD may notice inflamed, crusty lesions that do not blister, along with more prominent blisters and lesions in the shape of a bulls-eye.

Doctors have different methods for diagnosing eczema and HFMD.

Eczema

If a person suspects eczema, they may attend a consultation with a dermatologist (a skin doctor) or another healthcare professional. The healthcare professional may ask about family history, symptoms, when they started, and where they appear.

The dermatologist may examine the skin closely, which may give them enough information to diagnose eczema. However, some people may require a biopsy.

Hand, foot, and mouth disease

A doctor will often be able to recognize the hallmark blisters of HFMD, but testing can confirm the diagnosis. Most people will only need a polymerase chain reaction (PCR) test, which can show the presence of viral DNA in nose swabs or stool specimens.

People with severe HFMD may need a blister biopsy, blood tests, or cerebrospinal fluid tests to rule out other conditions.

Eczema may require long-term management, whereas people with HFMD might not even need treatment.

Eczema

There is no cure for eczema. Treatment aims to reduce and soothe flare-ups, ease symptoms, prevent the condition from worsening, and provide skin care to hydrate the skin and keep it clean. Treatment also reduces the risk of thickened, constantly itchy skin.

A person may need to try combining several treatments or switching medications before finding an option that works. These might include:

  • Skin care: Regular moisturizing and occasional wet wrap therapy can help the skin retain moisture and reduce how often flare-ups occur. Gentle moisturizers and bathing may also help.
  • Trigger management: A dermatologist may help a person identify triggers for flare-ups and provide support in avoiding them.
  • Topical medications: Prescribed creams or ointments can reduce inflammation and improve skin barrier function. Depending on a person’s age and the severity of their eczema, these might include:
  • Advanced treatments: Light therapy and systemic medications, such as dupilumab (Dupixent), can help to reduce immune system reactions in moderate to severe eczema.

Dermatologists might also prescribe antimicrobials or bleach-bath therapy for people who develop skin infections due to eczema.

Hand, foot, and mouth disease

No specific antiviral medication or vaccine can treat or prevent HFMD. Instead, treatment focuses on relieving pain, promoting hydration, and caring for blisters.

This might include:

  • over-the-counter pain relief medications, such as acetaminophen or ibuprofen
  • antiseptic or anesthetic mouthwash
  • soothing creams and ointments
  • regularly offering children sips of water or juice
  • intravenous (IV) fluids for people who cannot consume fluids due to severe oral pain
  • cleaning and dressing blisters, but leaving them to dry naturally without picking at them

If a child is well enough to attend school, they do not need to stay home. The virus remains active and can spread through stools for up to a month after the symptoms have cleared. However, the disease is usually mild, so it may not be practical to keep them away from school for this long.

Regular handwashing for adults and children, disinfecting doorknobs, shared items, and common surfaces, and avoiding close contact with people who have HFMD can reduce the risk of transmission.

Eczema and HFMD have essential differences. HFMD is a contagious viral infection that often transmits to children. Eczema is a non-contagious inflammatory disorder with unclear causes that leads to gaps in the skin barrier and can develop at any age.

Eczema rashes start with an itch and occur in response to triggers. HFMD symptoms include localized blistering on the mouth and rashes on the hands and feet. HFMD can also trigger eczema in people who already have it.

Treatment for HFMD involves soothing symptoms while the virus passes. For eczema, treatment aims to make the immune reaction less severe, moisturize the skin, and maintain skin hygiene to prevent infection. Treatment for eczema may be lifelong or last for many years.

People should speak with a healthcare professional to learn more about both conditions.