Juvenile Plantar Dermatosis

• This is cracking and peeling of the weight bearing areas of the soles of children between the ages of 3 of 14.¹
• It occurs in boys more often than girls and is most common between the ages of 4 and 8.
• It is worst in the summer.
• The affected children usually complain of the painful fissures.
• The sole becomes shiny and glazed. Usually the heel is unaffected but it may be involved and occasionally the palms are affected too. The web spaces between the toes are spared. It is the weight bearing surface of the sole that is most involved.
• The skin becomes scaly.
• Painful fissures develop. They are usually under the toes and on the ball of the foot. They may take many weeks to heal.

The age of the child and the shiny macerated skin is typical. The DermNet NZ link at the end shows some good illustrations. Differential diagnosis includes:

• Atopic eczema
• Contact dermatitis
• Psoriasis
• Keratolysis exfoliative
• Fungal infection

Tinea pedis does not cause cracking or peeling of the weight bearing areas. Instead it may cause fine scaling over the instep, or maceration between the 4th & 5th toes.

Skin scapings for mycology and patch testing for contact dermatitis may be indicated.

It is thought that friction and sweating are important and the consensus of opinion is very much that socks and shoes made of synthetic materials are to blame. The condition was first described in the 1970s.²

There is a predisposition in atopic children.

The evidence base for management is very poor and all is at the level of expert opinion with no RCTs.³

Non-Drug

• Advise leather shoes and cotton socks rather than synthetic materials.
• Days with little or no walking to allow the fissures to heal.
• Greasy moisturisers such as soft paraffin (Vaseline™), can be helpful. Apply after a bath and before bed. Dimeticone barrier creams are easier to use during the day. They are applied every four hours.
• It seems that fissures heal faster when occluded. Sticky plasters are usually adequate but a "liquid bandage" or nail glue can be applied to the fissure and will relieve the pain.

Drugs

• Antifungal agents are of no value.
• Potent topical steroid creams may be beneficial but should be used for only a short time and may be reserved for intermittent use during flare-ups.

The condition tends to improve in cooler weather but may recur the following summer. From the age of about 8 it tends to improve and has usually disappeared by 15.

It has been reported in young adults up to the age of 25⁴ but the paper comes from Singapore that is almost on the equator.

Referral is not usually required.