Differential diagnoses: Skin conditions of the feet

Dr Nigel Stollery compares key clinical features when diagnosing foot conditions.

Plantar pustular psoriasis

Presentation

  • Pustules of varying colour on the plantar surface of the feet and/or the palms
  • Often on a background of erythema and scaling
  • Pustules are sterile on swabbing
  • Associated with plaque psoriasis in 25% of cases
  • Strong association with smoking
  • Most common between 40-60 years of age in females

Management

  • Treatment can be difficult
  • Keratolytic agents can help reduce the scale
  • Calcipotriol or a moderately potent topical steroid can help
  • In severe cases methotrexate or acitretin can be used

Tinea pedis

Presentation

  • Rash usually unilateral, starting between the toes and spreads out across the foot
  • Pruritus is common
  • Relatively common condition, acute onset, but may recur
  • Raised scaly leading edge seen with central clearing
  • In severe cases vesicles may be present

Management

  • In mild cases a topical antifungal should be used
  • Where the diagnosis is unsure skin scrapings should be sent for mycology
  • In more severe cases an oral antifungal may be required.
  • Where nails are affected treatment may be required for three to six months

Juvenile plantar dermatosis

Presentation

  • Usually occurs in children between seven and 14 years of age
  • Plantar surface of the foot is bright red and shiny
  • Foot maybe itchy with fissures
  • Associated with sweaty feet secondary to wearing synthetic footwear

Management

  • Spontaneous remission usually occurs after puberty
  • It is important to keep feet dry
  • Avoid trainers and synthetic footwear
  • Regular use of emollient ointments is helpful
  • A mild keratolytic, such as 10% urea cream, can be helpful

Atopic eczema

Presentation

  • Rash usually symmetrical and bilateral
  • Other areas are commonly affected
  • Chronic history often starting in childhood
  • Maybe associated with asthma, hayfever and allergies
  • Skin usually dry and itchy

Management

  • Use of emollients very important
  • Avoidance of irritants
  • Moderately potent topical steroids often required
  • If secondary infection is present antibiotics should be given
  • If contact dermatitis is suspected patch testing can be helpful

For more clinical images to compare and diagnose, click here

  • Dr Stollery is a GP in Kibworth, Leicestershire and clinical assistant in dermatology at Leicester Royal Infirmary.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

UK COVID-19 vaccination programme tracker

UK COVID-19 vaccination programme tracker

GPs across the UK are playing a leading role in the largest-ever NHS vaccination...

GP-led sites behind almost three quarters of COVID-19 jabs in England

GP-led sites behind almost three quarters of COVID-19 jabs in England

GP-led vaccination sites have delivered nearly three quarters of COVID-19 vaccine...

GPs should ignore calls to throw away usable COVID-19 vaccine, says RCGP

GPs should ignore calls to throw away usable COVID-19 vaccine, says RCGP

Suggestions that vaccination sites should throw away usable doses of COVID-19 vaccine...

GPs urged to use influence to dispel COVID-19 vaccine myths and boost BAME uptake

GPs urged to use influence to dispel COVID-19 vaccine myths and boost BAME uptake

GPs have been encouraged to use their ‘huge influence’ to bust misinformation around...

Six in 10 over-80s vaccinated against COVID-19 as figures expose regional variation

Six in 10 over-80s vaccinated against COVID-19 as figures expose regional variation

Six in 10 people aged over 80 in England received a first dose of COVID-19 vaccine...

Summary of changes to the GP contract 2021/22

Summary of changes to the GP contract 2021/22

The BMA and NHS England have agreed minor changes to the GP contract for 2021/22....