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.