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.
