Eczema coxsackium (EC) is a condition that occurs when a child with eczema develops an infection called hand, foot, and mouth disease (HFMD). Coxsackieviruses usually cause this infection.

The virus can exacerbate preexisting eczema, leading to severe and widespread rashes, blisters, and other symptoms that may differ from typical presentations of HFMD.

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While EC and HFMD are closely related, both involvingTrusted Source coxsackieviruses, there are distinct differences in their symptoms, affected populations, and clinical presentations.

ECHFMD
Underlying conditionsoccurs with eczemadoes not typically involve an underlying condition
Skin presentationcauses widespread and more severe blisters in eczema-affected areasproduces localized blisters on the hands, feet, and mouth
Causecoxsackieviruses (A16 or enterovirus 71), which spreadTrusted Source through contact with bodily fluids or contaminated surfacessame causes
Itching and discomfortEC tends to lead to more intense itchingHFMD generally causes less skin irritation
TreatmentEC requires treatment for eczema flare-ups along with supportive careHFMD typically only requires supportive care
Risk of transmissionhighly contagious, requiring good hygiene to prevent transmissionequal risk of transmission
Affected populationaffects children with eczematypically affects younger children, especially those under 5 years oldTrusted Source, but can occur at any age

EC is a severe form of HFMD in children with eczema, with more widespread and intense symptoms.

The characteristics of an EC rash include:

  • Widespread distribution: The EC rash often spreads beyond the typical HMFD areas to include the face, neck, trunk, arms, and legs, especially in areas eczema already affects.
  • Fluid-filled blisters: The rash consists of vesicles (blisters filled with clear fluid). These blisters may appear on eczema-prone skin and are more prominent and widespread than in regular HFMD.
  • Severe inflammation: The areas of rash on eczema-affected skin are usually more inflamed and irritated compared with HFMD. These lesions may beTrusted Source surrounded by erythema (redness) or appear red, brown, purple, or gray, depending on a person’s skin color.
  • Crusting and oozing: The blisters may eventually break open, leading to crusting or oozing as they heal. This can make the rash more uncomfortable and increase the risk of secondary bacterial infection.
  • Increased itchiness: The rash tends to be much itchier and more uncomfortable due to the underlying eczema. Scratching can worsen the rash, potentially leadingTrusted Source to skin damage or infection.
  • Painful lesions: The blisters may be painful, especially in areas where they rupture or become secondarily infected.

These characteristics make the EC rash more severe and extensive compared with the rash in HFMD alone, requiring more attentive treatment and care.

Read about eczema in children.

EC occurs when a child with eczema contracts an infection with an enterovirus, particularly coxsackievirus A6 or A16. These viruses typically spread through contact with contaminated surfaces, respiratory droplets, or bodily fluids.

Children with compromised skin barriers, such as those with eczema, are more susceptible to complications when they experience exposure to viral infections like HFMD.

Doctors diagnose EC by reviewing the child’s history of eczema, conducting a physical examination to identify characteristic lesions, and analyzing symptoms.

  • Reviewing medical history: Doctors will ask about the child’s history of eczema and possible recent exposures to HFMD. They will also ask about the onset of symptoms such as fever, rashes, or recent viral illnesses.
  • Conducting a physical examination: Doctors examine the skin for the fluid-filled blisters and red spots typical of HFMD. They also check for more widespread, inflamed blisters that often affect areas with eczema.
  • Analyzing symptoms: Doctors evaluate symptoms such as fever, mouth ulcers, and itchiness to confirm the viral nature of the illness. They observe how the rash spreads, particularly beyond the hands, feet, and mouth, to areas with eczema, which helps differentiate EC from regular HFMD.

Doctors will rule out other skin conditions and may order lab tests if necessary. Observing the response to treatment can also help confirm the diagnosis.

Treatment options for EC focus on managing the viral infection and addressing the exacerbation of eczema. While there is no specific antiviral treatment for coxsackieviruses, supportive care helps relieve symptoms.

Treatment options may include:

  • Moisturizers and emollients: Keeping the skin hydrated is important for managing eczema and preventing further irritation. Regular use of emollients helps soothe inflamed skin.
  • Topical corticosteroids: These can reduceTrusted Source inflammation and manage eczema flare-ups. Depending on the severity of the condition, a doctor may recommend a moderate to high potency corticosteroid.
  • Antiviral and pain relief medications: Over-the-counter (OTC) medications such as ibuprofen or acetaminophen can help reduce fever and pain. Some doctors may also recommend antiviral creams for localized blisters.
  • Hydration: It is best to ensure the child stays hydrated, particularlyTrusted Source if they have a sore throat or are experiencing difficulty eating and drinking due to mouth sores.
  • Hygiene: Since the condition is due to a viral infection, effective handwashing, disinfecting surfaces, and avoiding contact with individuals who have an infection can helpTrusted Source prevent it from spreading.

Complications of EC can include:

  • secondary bacterial infections
  • severe skin inflammation
  • dehydration
  • delayed healing of eczema
  • more serious viral complications in rareTrusted Source cases

Managing the condition promptly with appropriate medical care and supportive treatment can help reduce these risks.

A child with EC should stay off school until they are no longer contagious.

EC occurs due to coxsackieviruses, which are highly contagious and spread easily through contact with bodily fluids, such as saliva, mucus, or fluid from blisters. The virus can also spread through contaminated surfaces and objects.

General guidelines for returning to school include:

  • Lack of fever: The child should not have had a fever for at least 24 hoursTrusted Source without using fever-reducing medications.
  • Blisters dried up: The blisters should have dried up and stopped oozing, as the fluid from the blisters can contain the virus.
  • Reduced symptoms: The child should feel well enough to participate in regular activities.

The virus is most contagious in the first few days of illness. However, it can continue to shed through bodily fluids for several weeks.

Hygiene practices such as handwashing and avoiding close contact with others are important to prevent classmates or teachers from contracting the virus.

People should seek medical advice if a child shows signs of a severe infection, such asTrusted Source:

  • a high fever
  • difficulty swallowing
  • dehydration
  • a rash and blisters that become widespread

Signs of secondary bacterial infections also require prompt medical evaluation. These include:

  • increased redness or discoloration
  • warmth
  • pus

Eczema coxsackium (EC) is a viral skin condition that occurs when a child with eczema contracts hand, foot, and mouth disease (HFMD) due to a coxsackievirus.

EC leads to more severe and widespread rashes than typical HFMD, with blisters often appearing on eczema-affected areas of the body, such as the face, arms, and trunk.

The condition is usually self-limiting, resolving in 7 to 10 days, but eczema flare-ups may take longer to heal.