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ADC Online First, published on November 18, 2014 as 10.1136/archdischild-2014-307336
Images in paediatrics
Eczema coxsackium
A 10-month-old boy with mild eczema presented in autumn
with 5 days of worsening eczema, 1 day of fever and decreased
oral intake. His parents described ‘spots’ on his chest that
spread to his face and mouth, and concurrent eczema flare-up
on his limbs. Treatment was with cephalexin, increased cortico-
steroid ointment, and pimecrolimus cream on his face. Skin
swabs cultured scanty Staphylococcus aureus and were herpes
simplex virus negative. His eczema worsened over 3 days,
involving face and limbs with satellite lesions and a brown
discolouration (figure 1). One toe had a vesicle. Further
history identified an outbreak of hand, foot and mouth disease
at childcare. Vesicle fluid PCR detected coxsackievirus A6.
Corticosteroids were reduced and moisturiser was increased to
four times daily and optimised with nocturnal wet wraps. Four
weeks later his eczema completely resolved.
‘Eczema coxsackium’ was recently coined to describe vesiculo-
bullous eruption in areas of eczema caused by coxsackievirus
A6.1 2 Lesions are generally painless and children remain rea-
sonably well. We have noted a brown discolouration to the
lesions at our institution, although this has not been previously
described. Differential diagnoses of vesicular eruptions in
eczema flare-ups include eczema herpeticum (itchy, painful,
sometimes blood-stained blisters in an unwell child) or bacterial
infection (often with weeping golden crusts). Vesicle fluid enter-
oviral PCR allows for early diagnosis, potentially avoiding anti-
biotics or aciclovir. Increasing steroids is often unhelpful, with
aggressive moisturising the key to treatment.3 Parents should be
reassured it is a self-limiting eruption, but the erythema may
take weeks to subside.
Figure 1 Widespread atopic dermatitis with papular satellite lesions and discrete perioral and hand lesions, with flexural flare-up, all with brown
discolouration in a well-looking child.
Bryant PA, et al. Arch Dis Child Month 2014 Vol 0 No 0
Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd (& RCPCH) under licence.
Penelope A Bryant,1,2,3,4 Suzanne L Boyce,2 Emma King5
1
Infectious Diseases Unit, Department of General Medicine, The Royal Children’s
Hospital Melbourne, Victoria, Australia
2
RCH@Home Department, The Royal Children’s Hospital Melbourne, Melbourne,
Victoria, Australia
3
Murdoch Children’s Research Institute, The Royal Children’s Hospital Melbourne,
Melbourne, Victoria, Australia
4
Department of Paediatrics, University of Melbourne, The Royal Children’s Hospital
Melbourne, Melbourne, Victoria, Australia
5
Dermatology Department, The Royal Children’s Hospital Melbourne, Melbourne,
Victoria, Australia
Correspondence to Dr Penelope Bryant, Department of General Medicine,
The Royal Children’s Hospital Melbourne, Flemington Road, Parkville, VIC 3052,
Australia; penelope.bryant@rch.org.au
Contributors PAB made the diagnosis, managed the patient and drafted the
manuscript. SLB and EK managed the patient and edited the manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
To cite Bryant PA, Boyce SL, King E. Arch Dis Child Published Online First: [ please
include Day Month Year] doi:10.1136/archdischild-2014-307336
Accepted 24 October 2014
Arch Dis Child 2014;0:1. doi:10.1136/archdischild-2014-307336
REFERENCES
1 Lott JP, Liu K, Landry ML, et al. Atypical hand-foot-and-mouth disease associated
with coxsackievirus A6 infection. J Am Acad Dermatol 2013;69:736–41.
2 Mathes EF, Oza V, Frieden IJ, et al. ‘Eczema coxsackium’ and unusual cutaneous
findings in an enterovirus outbreak. Pediatrics 2013;132:e149–57.
3 Johnson VK, Hayman JL, McCarthy CA, et al. Successful treatment of eczema
coxsackium with wet wrap therapy and low-dose topical corticosteroid. J Allergy Clin
Immunol Pract 2014. Published Online First: 14 September 2014.
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Eczema coxsackium

Penelope A Bryant, Suzanne L Boyce and Emma King

Arch Dis Child published online November 18, 2014

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Child health (3325)
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Dentistry and oral medicine (123)
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Immunology (including allergy) (1742)
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