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Eczema coxsackium — Clinical Guidelines

Overview

Eczema coxsackium, also known as hand, foot, and mouth disease eczema coxsackium (HFMD-EC), is a rare dermatologic condition characterized by widespread vesicular eruptions, often triggered by Coxsackievirus infection, affecting primarily children and sometimes associated with underlying skin conditions like atopic dermatitis. 34 36

Diagnosis

Clinical presentation of widespread vesicular lesions, often symmetrically distributed.

History of recent viral infection, particularly Coxsackievirus.

Exclusion of other dermatologic conditions through clinical evaluation.

Laboratory tests may include viral culture or PCR for Coxsackievirus from vesicular fluid 34.

Management

First-line treatments: Emollients for skin hydration and symptomatic relief.

Adjunctive treatments: Topical corticosteroids for inflammatory control (e.g., hydrocortisone 1% cream). 36

Antiviral therapy: In severe cases, consider antiviral medications (e.g., acyclovir) under specialist guidance. 34

Supportive care: Pain management and monitoring for secondary infections.

Special Populations

Pediatrics: HFMD-EC predominantly affects children; close monitoring and supportive care are crucial. 34

Comorbidities: Patients with atopic dermatitis may be at higher risk; management should address both conditions concurrently. 3 34

Key Recommendations

Clinical diagnosis primarily based on clinical presentation and history of viral infection (Evidence: Moderate 34).

Use topical corticosteroids for inflammatory control in vesicular lesions (Evidence: Moderate 36).

Consider antiviral therapy in severe cases to manage viral infection (Evidence: Weak 34).

Emphasize supportive care including skin hydration and pain management (Evidence: Expert opinion).

References

1 King Stokes N, McCusker S, Daly A, Hunjan M, Lowe A, Charman C et al.. Fraudulent responses in online survey research in dermatology: are your participants who you think they are?. Clinical and experimental dermatology 2026. link 2 Ortiz de Frutos FJ, Silvestre JF. [Translated article] Recommendations on the Use of Moisturizing Products Prepared by Spanish Dermatologists Using the Delphi Method. Actas dermo-sifiliograficas 2025. link 3 Loizate I, Torrelo A. Linear eczema induced by oral isotretinoin. Pediatric dermatology 2025. link 4 Sach TH, Williams HC. Practicality, Validity, and Responsiveness of Using the Proxy Version of the Child Health Utility-9 Dimensions With Children Aged 2 to 5 Years. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research 2024. link 5 Karalus M, Oakley A. Pacific people living in New Zealand are most commonly referred with eczema to dermatologists. The New Zealand medical journal 2024. link 6 Marty T, Khadar M, Autelitano L, Baissac C, Mebarki A, Texier N et al.. Patients' testimonies, feelings, complaints and emotional experiences with dermatoses on open social media: The French infodemiologic patient's free speech study. Journal of the European Academy of Dermatology and Venereology : JEADV 2024. link 7 Ding YJ, Li XN, Xiao Z, Li CY, Jia LH. Low vitamin D during pregnancy is associated with infantile eczema by up-regulation of PI3K/AKT/mTOR signaling pathway and affecting FOXP3 expression: A bidirectional cohort study. The Journal of nutritional biochemistry 2024. link 8 Reynaert V, Gutermuth J, Wollenberg A. Nipple eczema: A systematic review and practical recommendations. Journal of the European Academy of Dermatology and Venereology : JEADV 2023. link 9 McCusker S, King Stokes N, Hunjan M, Daly A, George S, Solman L et al.. Paediatric dermatology teleconsultations: a survey of healthcare professionals in the UK. Clinical and experimental dermatology 2023. link 10 Ziyab AH, Al-Taiar A, Al-Sabah R, Shaban L, Almousa Z, AlBaloul AH et al.. Sex and obesity status modify the association between vitamin D and eczema among adolescents. Pediatric research 2023. link 11 Gomes N, Costa-Silva M, Cerejeira A, Amoedo P, Matos P, Marques A et al.. Aseptic Pustulosis of the Folds Successfully Treated with Methotrexate. Skinmed 2022. link 12 Liu YY, Zhou XJ, Li YC. The relationship between vitamin D levels in umbilical cord blood and infantile eczema. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2022. link 13 Leffler J, Gamez C, Jones AP, Rueter K, Read JF, Siafarikas A et al.. In infants with sufficient vitamin D status at birth, vitamin D supplementation does not impact immune development. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2020. link 14 Ansorge C, Miocic JM, von Bubnoff D, Technau-Hafsi K. Dermatological conditions presenting to the emergency dermatological unit of a university hospital in Germany. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2018. link 15 Le Roux E, Powell K, Banks JP, Ridd MJ. GPs' experiences of diagnosing and managing childhood eczema: a qualitative study in primary care. The British journal of general practice : the journal of the Royal College of General Practitioners 2018. link 16 Powell K, Le Roux E, Banks JP, Ridd MJ. Developing a written action plan for children with eczema: a qualitative study. The British journal of general practice : the journal of the Royal College of General Practitioners 2018. link 17 Powell K, Le Roux E, Banks J, Ridd MJ. GP and parent dissonance about the assessment and treatment of childhood eczema in primary care: a qualitative study. BMJ open 2018. link 18 Ait Bamai Y, Araki A, Nomura T, Kawai T, Tsuboi T, Kobayashi S et al.. Association of filaggrin gene mutations and childhood eczema and wheeze with phthalates and phosphorus flame retardants in house dust: The Hokkaido study on Environment and Children's Health. Environment international 2018. link 19 Wong CC, Allen KJ, Orchard D. Changes to infant feeding guidelines: Relevance to dermatologists. The Australasian journal of dermatology 2017. link 20 Hon KL, Tsang YC, Pong NH, Luk DC, Lee VW, Woo WM et al.. Correlations among steroid fear, acceptability, usage frequency, quality of life and disease severity in childhood eczema. The Journal of dermatological treatment 2015. link 21 Marriage H. Topical treatments. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2014. link 22 Chaudhry SB, Armbrecht ES, Shin Y, Matula S, Caffrey C, Varade R et al.. Pediatric access to dermatologists: Medicaid versus private insurance. Journal of the American Academy of Dermatology 2013. link 23 Schuttelaar ML, Vermeulen KM, Coenraads PJ. Costs and cost-effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs. The British journal of dermatology 2011. link 24 Mashta O. Beneath the surface. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2010. link 25 Strina A, Barreto ML, Cunha S, de Fátima S P de Oliveira M, Moreira SC, Williams HC et al.. Validation of epidemiological tools for eczema diagnosis in Brazilian children: the ISAAC's and UK Working Party's criteria. BMC dermatology 2010. link 26 Schuttelaar ML, Vermeulen KM, Drukker N, Coenraads PJ. A randomized controlled trial in children with eczema: nurse practitioner vs. dermatologist. The British journal of dermatology 2010. link 27 Langan SM, Williams HC. The use of electronic diaries in dermatology research. Dermatology (Basel, Switzerland) 2009. link 28 Wahl AK, Mørk C, Lillehol BM, Myrdal AM, Helland S, Hanestad BR et al.. Changes in quality of life in persons with eczema and psoriasis after treatment in departments of dermatology. Acta dermato-venereologica 2006. link 29 Goustas P, Cork MJ, Higson D. Eumovate (clobetasone butyrate 0.05%) cream: a review of clinical efficacy and safety. The Journal of dermatological treatment 2003. link 30 . Doxepin cream for eczema?. Drug and therapeutics bulletin 2000. link 31 Goh CL, Chua-Ty C, Koh SL. A descriptive profile of eczema in a tertiary dermatological referral centre in Singapore. Annals of the Academy of Medicine, Singapore 1993. link 32 Williams H, Pottier A, Strachan D. Are viral warts seen more commonly in children with eczema?. Archives of dermatology 1993. link 33 Cotterill JA. Psychophysiological aspects of eczema. Seminars in dermatology 1990. link 34 Archer E, Chuang TY, Hong R. Severe eczema in a patient with DiGeorge's syndrome. Cutis 1990. link 35 Hill DJ, Lynch BC. Elemental diet in the management of severe eczema in childhood. Clinical allergy 1982. link 36 Pilgaard CE, Nørholm A. Hydrocortisone in an improved vehicle. A double-blind comparison of the efficacy and acceptability of two hydrocortisone cream formulations. The Journal of international medical research 1980. link 37 Henry M, Hanks G, Whelan A. A randomized, double-blind therapeutic trial of 0.25% desoxymethasone and 0.1% hydrocortisone 17-butyrate in the treatment of varicose eczema. Current medical research and opinion 1980. link 38 Plotnick H. Dyshidrosis. Cutis 1977. link 39 Rea JN, Newhouse ML, Halil T. Skin disease in Lambeth. A community study of prevalence and use of medical care. British journal of preventive & social medicine 1976. link 40 Ayliffe GA. Stability of neomycin resistance in Staphylococcus aureus. Journal of clinical pathology 1970. link

Eczema coxsackium