You are correct. Hand-foot-mouth dz (HFMD) caused by coxsackie virus A6 (CVA6) was confirmed on serology. Similar to herpes simplex virus, CVA6 displays a proclivity for damaged skin, due to the loss of epidermal integrity and dermal vasodilation resulting from internal or external insults. The same mechanism of superinfection in injured areas that is seen in eczema coxsackium and eczema herpeticum may explain the tendency of atypical HFMD to manifest in traumatized areas such as perioral and diaper regions. Consider HFMD among the DDx of viral eruptions affecting the diaper area.

Archives of Disease in Childhood 2018;103:846