Eczema Coxsackium (EC) is a secondary skin infection affecting individuals with pre-existing eczema (atopic dermatitis). It is an atypical and more severe presentation of Hand, Foot, and Mouth Disease (HFMD). The condition develops when the skin’s compromised barrier allows the virus to spread extensively across the body, particularly in areas already affected by eczema. This interaction results in a widespread, painful rash distinct from a typical eczema flare-up.
Defining Eczema Coxsackium
Eczema Coxsackium (EC) is caused by the Coxsackievirus, a member of the enterovirus family. Strains like Coxsackievirus A6 (CVA6) and A16 (CVA16) are the most common culprits. These viruses also cause Hand, Foot, and Mouth Disease, but the presentation changes dramatically in a person with eczema.
The heightened vulnerability stems from the compromised skin barrier associated with atopic dermatitis. Eczema is often linked to a deficiency in the protein filaggrin, which maintains the skin’s structural integrity. This defect creates microscopic breaks in the skin’s outer layer, removing the body’s natural defense against pathogens.
When a person with a compromised skin barrier contracts the Coxsackievirus, the virus gains easy entry and spreads rapidly. Instead of being confined to typical HFMD areas, the virus localizes and multiplies in the eczematous skin. This rapid viral invasion leads to the widespread, blistering rash characteristic of Eczema Coxsackium.
Recognizing the Clinical Symptoms
Eczema Coxsackium often begins with systemic symptoms typical of a viral illness, including high fever, malaise, and fatigue. Some individuals may also experience a sore throat, cough, or runny nose before the skin eruption. The rash develops rapidly and spreads far beyond the localized presentation of classic Hand, Foot, and Mouth Disease.
The lesions typically begin as red, inflamed papules that quickly evolve into fluid-filled blisters (vesicles). These blisters may progress to painful erosions and scabs; larger blisters (bullae) are more common in infants. Unlike a regular eczema flare, the rash is widespread, concentrating heavily in active eczema areas like the face, neck, trunk, and limbs.
A significant difference from typical HFMD is the distribution, as EC covers a larger body surface area, sometimes causing confusion with infections like chickenpox. The lesions are painful and can coalesce in severe cases, though they may not be intensely itchy. Common oral ulcers can cause significant discomfort, making eating or drinking difficult.
Treatment and Recovery Approach
Eczema Coxsackium is generally a self-limiting viral infection that typically resolves on its own within one to two weeks. Management focuses heavily on supportive care to alleviate discomfort and prevent complications. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, are used to manage fever and systemic discomfort.
Maintaining hydration is a concern, especially if painful oral ulcers make drinking difficult, potentially necessitating medical admission for rehydration in severe cases. While specific anti-enteroviral medications are not available, a doctor may prescribe an antiviral like acyclovir if Eczema Herpeticum is suspected. This precaution is taken until lab tests confirm the Coxsackievirus, as Eczema Herpeticum is a more dangerous, similar-looking condition.
Management includes careful attention to the underlying eczema, using non-medicated emollients to maintain skin hydration. Topical corticosteroids are avoided during the acute viral phase but can be reintroduced after the fever subsides to treat the ongoing eczema flare. The most significant risk is a secondary bacterial infection of the open lesions, which may require oral antibiotics. Most individuals recover fully, though temporary changes like skin peeling or painless nail shedding can occur one to two months later.