Juvenile plantar dermatosis versus pitted



Juvenile plantar dermatosis
Clinical features

  • Occurs in children, usually between the ages of seven and 14.
  • Affects the soles of the feet.
  • Shiny, glazed appearance.
  • Skin becomes cracked and scaly.
  • Children complain of painful, itching fissures.
  • Toe webs not usually affected.

Management

  • Avoidance of occlusive socks and shoes. Cotton socks and leather shoes or open sandals to be encouraged.
  • Liberal application of emollients such as white soft paraffin.
  • Occlusion of fissures helps healing. Cover with plasters or apply liquid bandage or nail glue.
  • Topical steroids are not recommended.
  • Expect gradual improvement as the child gets older.

Pitted keratolysis
Presentation

  • Small, punched-out erosions on the soles of both feet.
  • Bacterial infection that may occur at any age.
  • Feet so malodorous they may be socially embarrassing.
  • Feet are sweaty and may feel slimy.
  • The instep is rarely affected.
  • Occasionally affects the palms of the hand.
  • May be symptomless, but occasionally sore and itchy.

Management

  • A clinical diagnosis can usually be made based on the odour and appearance of the feet.
  • Avoid occlusive footwear; use absorbent cotton socks.
  • Apply an antiperspirant, such as 20 per cent aluminium chloride solution, twice a week.
  • Topical antibiotics (erythromycin or clindamycin solution) twice a day should clear the infection in three to four weeks.
  • Oral erythromycin for resistant or persistent cases.
Dr Jean Watkins, a GP locum in Hampshire

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