Figure 1. Showing cracking and scaly lesions, mainly on plantar surfaces of big toe.

Abstract

Juvenile plantar dermatosis is a common skin problem presenting in children and adolescents. The authors present here a typical patient and discuss its likely etiology and management.

Case Presentation

A 4-year-old girl was brought into consult for non-painful and nonitchy skin lesions on both feet. She had history of atopic dermatitis of mild severity. Examination revealed cracking and scaly lesions mainly on plantar surfaces of bilateral big toes (Fig. 1). Further history taking revealed that her mother had been keeping her feet in tight occlusive footwear during the daytime. She walked at home barefoot in the evening and the house was air-conditioned throughout the night. Juvenile plantar dermatosis (JPD) was diagnosed based on clinical findings. We counseled the mother on the possible causative roles of occlusive footwear and extremes of temperature and humidity. A liberal application of emollients for the atopic dermatitis and her feet was advised. The child was seen by us again two months later. Almost complete remission of the lesions was seen without need for active intervention.

Discussion

JPD is a clinical diagnosis and usually no investigations are necessary. If the condition is prolonged or recalcitrant to treatment, skin scraping for potassium hydroxide preparation and fungal culture may be considered to exclude dermatophytic infections. Patch testing might be considered in certain cases to exclude allergic contact dermatitis due to footwear.

The cause of JPD is unknown. Extremes of humidity and prolonged occlusive footwear may be precipitating factors.1 Many children with JPD also have atopic dermatitis and some dermatologists might consider JPD to be a variant of atopic dermatitis. The child described has only mild JPD. The mother was compliant to our advice and outcome was excellent.

However, the management of this apparently mild dermatosis can be difficult. No treatment is unequivocally proven to be effective.2 Mild JPD is usually asymptomatic, and the quality-of-life of these children is usually unaffected.3 Simple explanation and reassurance for the parents may thus be adequate, and no active treatment is indicated. Atopic dermatitis should be assessed for and appropriately managed. General advice for children with JPD is to protect the feet from trauma and friction. This includes the wearing of well-fitted shoes, wearing cotton socks to reduce friction and avoiding walking barefooted. The liberal application of emollients might be helpful, especially during the winter season. At times, fissuring might predispose to secondary bacterial infection, which then would need antibacterial therapy. For children with symptomatic (mainly pruritic) JPD, mild to mid-potency topical corticosteroids and antihistamines are prescribed for acute flare-ups for limited durations. Parents should be reminded that these should not be applied on a long-term basis.

References

1. Lachapelle JM, Tennstedt D. Juvenile plantar dermatosis: a report of 80 cases. Am J Ind Med 1985;8:291-5.
2. Ashton RE, Jones RR, Griffiths A. Juvenile plantar dermatosis. A clinicopathologic study. Arch Dermatol 1985;121:225-8.
3. Chuh AAT. Quality of life in children with juvenile plantar dermatosis in primary care settings – A prospective case-control study. 6th Australian Conference on quality-of-life Melbourne Nov. 2004.