Topical Steroids Are Not Recommended for Coxsackie (Hand, Foot, and Mouth Disease) Sores
Do not use topical corticosteroids for Coxsackie virus sores, as these medications increase susceptibility to viral infections and can worsen viral replication.
Why Topical Steroids Should Be Avoided
Increased Viral Susceptibility and Replication
- Topical corticosteroids have potent anti-inflammatory actions that increase susceptibility to bacterial, fungal, and viral infections, making them contraindicated when infection is the known cause of the disease 1.
- In animal models of viral conjunctivitis (adenovirus), topical corticosteroid administration led to prolonged viral shedding, suggesting steroids may extend the infectious period 2.
- The anti-inflammatory effects of corticosteroids suppress local immune responses that are critical for clearing viral infections 1.
Mechanism of Harm
- Corticosteroids work by suppressing chemical mediators of inflammation and inhibiting immune cell function 3.
- While this is beneficial for autoimmune inflammatory conditions, it is counterproductive in active viral infections where the immune response is needed to clear the pathogen 1.
- Children are particularly vulnerable to systemic effects from topical corticosteroids due to proportionately greater percutaneous absorption 1.
Appropriate Management of Coxsackie Sores
Supportive Care Only
- Coxsackie virus infections (hand, foot, and mouth disease) are self-limited viral infections that resolve without antiviral treatment 2.
- Focus on symptomatic relief with oral analgesics, cold compresses, and maintaining hydration 2.
- Avoid any immunosuppressive therapies including topical steroids during the active viral phase 1.
Important Clinical Caveat
The guideline evidence provided discusses topical steroid use for other viral infections (adenoviral conjunctivitis) and various inflammatory dermatoses (pompholyx, bullous pemphigoid, lichen planus), but none of these conditions are caused by active viral replication like Coxsackie 2, 4, 5. The adenovirus conjunctivitis data is most relevant here, showing that steroids prolong viral shedding 2. This principle applies to Coxsackie infections where active viral replication is occurring in the skin and mucous membranes.