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.

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