Eczema coxsackium

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What is it eczema coxsackium?

Eczema coxsackium is an enteroviral infection affecting children with atopic dermatitis (eczema). It is characterized by a eruption of vesicles, bullas and erosions affecting areas of active or inactive atopic dermatitis.

Eczema coxsackium has also been described as atypical hand, foot and mouth disease (HFM). Both conditions are caused by enteroviruses. However, eczema coxsackium is more extended than hand, foot, and mouth disease, and presents with vesiculobullous Lesions that ulcerate and crust over. The term eczema coxsackium was coined by Nahmias et al in 1968 [1].

See images of hand foot and mouth disease.

Who Gets Coxsackium Eczema?

Coxsackium eczema most commonly affects preschool children with atopic dermatitis [2]. It affects both boys and girls, and usually occurs in late spring to early summer [3–4]. Cases have been reported in adults [2,5].

Enterovirus infection can also be localized to sites of epidermal barrier breakdown that is not caused by eczema. Reported cases of noeczematous Conditions prone to enterovirus infection include [2,5–10]:

Lacerations / scars
Sun tanning
Irritating Contact dermatitis (napkin dermatitis, thumb sucking dermatitis, lip licking dermatitis, and drug-induced dermatitis)
Ringworm of the foot
Intertrigo
Darier's disease
Epidermolytic mosaic ichthyosis
Human immunodeficiency virus (HIV) infection.

What Causes Coxsackium Eczema?

Coxsackiev virus A6 and A16 are the most common causes of coxsackium eczema.

The reason why the enterovirus localizes to sites with atopic dermatitis remains unclear. The mechanism is believed to be similar to eczema herpeticum, where affected patients appear to have impaired immunity against the virus and the barrier. dysfunction at affected sites [9]. This mechanism may explain how non-eczematous conditions, such as Darier's disease, have also presented with a generalized viral infection that erupts preferentially at the sites of the skin disease. [8].

What are the clinical features of eczema coxsackium?

Coxsackium eczema presents with vesicles, blisters, and erosions.

The vesicles are relatively monomorphic and it can be painful, but they are generally not pruritus.
Blisters are more common in infants under 1 year of age compared to older children, who present with vesicles [2].
Vesicles and blisters can progress to erosions and scabs.
Any site can be affected, but the hands, feet, face, torso, and buttocks / groin are generally involved.
The lesions are preferably localized to sites affected by atopic dermatitis or other skin disease. Lesions may also be present on unaffected skin or on skin previously affected by eczema.
Oral ulcers may be present These are less common than with hand, foot, and mouth disease.
Fever and oropharyngeal Pain is common.
The course of the disease is similar to the classic hand disease, foot-and-mouth disease and not long-term. aftermath.

How is eczema coxsackium diagnosed?

Reverse transcription-Polymerase chain reaction (RT-PCR) Sequencing of bleb fluid, stool, and oropharyngeal swabs can be used to confirm enterovirus. The Coxsackiev virus is difficult to culture Live. Therefore, viral culture is not useful and has a high probability of a false negative result.

Which is the differential diagnosis for coxsackium eczema?

The main differential diagnosis for coxsackium eczema is herpetic eczema.

Herpetic eczema due to herpes simplex tends to itch more than coxsackium eczema and is less likely to have oral lesions.
Bullous Impetigo can also cause blisters and itchy blisters in areas of eczema. Typically, there is honey yellow crust with staphylococcal impetigo
A primary immunobulous disease is more generalized and does not preferentially affect areas of eczema.

What is the treatment for coxsackium eczema?

Coxsackium eczema resolves on its own and generally does not require hospital admission.

While waiting for microbiological confirmation, oral antiviral Therapy (for example, acyclovir or valacyclovir) may be prescribed to treat herpes simplex but the enterovirus does not respond to this. Currently no specific enterovirus drugs or vaccines are available for enterovirus (2020).

Children can become dehydrated if they do not drink due to painful oral ulcers and may need admission for intravenous or nasogastric rehydration.

Not medicated emollients They are recommended to treat active eczema. Current steroids are generally not recommended during acute disease, but can be reintroduced to treat eczema once the child has a fever.

What are the complications of eczema coxsackium?

Common complications during the convalescent phase of coxsackium eczema include peeling of the palms and soles and nail changes.

Nail changes occur 1 to 2 months after acute infection and include:

Slowly growing horizontal ridges (Beau's lines)
Pain-free nail shedding (onychomadesis)

Unlike other enteroviral infections, multi-organ involvement is rare in children with cutaneous coxsackievirus A6 / 16 infection (such as pneumonitis, myocarditisand meningitis)

Does the child have to stay out of school?

There have been numerous outbreaks of enteroviruses around the world. Enterovirus is highly infectious and spreads easily through vesicle fluids, respiratory secretions and fecal-oral contamination. Children should be excluded from school until all blisters have dried.

Good hand hygiene is essential to prevent the spread of other body secretions. Stool remains infectious for up to a month after acute illness.