Young girl presents with peeling soles on her feet

January 1, 2010

A 6-year-old girl has peeling soles on her feet. Although the peeling is not usually symptomatic, her feet become cracked, fissured, tender, and occasionally infected during the middle of the winter and summer.

Key Points

The Case

Diagnosis

CLINICAL FINDINGS

Juvenile palmar-plantar dermatosis (JPD), sometimes referred to as "sweaty sock syndrome," is a common dermatosis of infancy and childhood characterized by asymptomatic symmetrical, red, glazed, smooth appearance of the anterior surface of the soles and sometimes the palms.1 The dermatitis usually develops in the late fall or winter and involves primarily the distal aspects of the soles and toes, with sparing of the interdigital spaces.1,2 The pink, scaly patches may crack and fissure and disrupt normal epidermal skin markings.1 Although most eruptions are not symptomatic, cracking and fissuring can cause pain with movement and secondary infection occurs occasionally.

PATHOGENESIS

DIFFERENTIAL DIAGNOSIS

The differential diagnosis for JPD includes allergic/shoe contact dermatitis, tinea pedis, chronic atopic dermatitis, palmoplantar psoriasis, and pityriasis rubra pilaris. Unlike JPD, allergic contact dermatitis of the feet tends to involve the dorsum of the feet and often arises because of allergy to rubber components, chromates, or adhesives.1,3,4 Juvenile palmar-plantar dermatosis can be distinguished from tinea pedis by a negative potassium hydroxide scraping and culture. Moreover, tinea pedis tends to involve the web spaces of the feet, particularly the fourth web space, followed by the instep.1 Psoriatic plaques are usually thicker than the scaling seen in JPD, and most patients with psoriasis will demonstrate lesions on the elbows, knees, scalp, and/or sacrum. Pityriasis rubra pilaris presents with salmon-colored, thick scaly palms and soles and, like psoriasis, is less likely to be confined to the feet.

TREATMENT

As the repeated wetting and drying of the skin appears to contribute to the development of JPD, measures that keep the skin persistently moist or dry will interrupt this cycle. Treatment should include the use of cotton socks, avoidance of occlusive footwear, frequent sock changes, and footwear rotation.1-3 Liberal use of emollients, and occasionally topical steroids when there is a superimposed contact irritant component, may result in rapid improvement. Antibiotics may be necessary for secondary infection.1 In some children, the condition may improve during the summer with the use of open footwear, and it often disappears in adolescence.3

DR STEWART is a dermatologist at the National Naval Medical Center, Bethesda, Maryland. MS PACE is a fourth-year medical student at the Boston University School of Medicine, Boston. DR COHEN, the section editor for Dermatology: What's Your DX?, is director, Pediatric Dermatology and Cutaneous Laser Center, and associate professor of pediatrics and dermatology, Johns Hopkins University School of Medicine, Baltimore. The authors and section editor have nothing to disclose regarding affiliation with, or financial interest in, any organization that may have an interest in any part of this article. Vignettes are based on real cases which have been modified to allow the author and editor to focus on key teaching points. Images may also be edited or substituted for teaching purposes.

Disclaimer: The views expressed on this article are those of the authors and do not reflect the official policy of the Department of Army, Navy, Department of Defense, or US government.

REFERENCES

1. Paller AS, Mancini AJ. Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 3rd ed. Philadelphia: Elsevier Saunders; 2006.

2. Guenst BJ. Common pediatric foot dermatoses. J Pediatr Health Care. 1999;13(2):68-71.

3. Cohen BA. Pediatric Dermatology. 3rd ed. London: Mosby; 2005.

4. Shackelford KE, Belsito DV. The etiology of allergic-appearing foot dermatitis: a 5-year retrospective study. J Am Acad Dermatol. 2002;47(5):715-721.