Juvenile Plantar Dermatosis & Common Foot Issues in Kids
Juvenile plantar dermatosis (JPD) is a dermatological condition also called Sweaty sock Syndrome that primarily affects children and young adolescents. It is characterized by symmetric, shiny erythema (redness of the skin), along with superficial desquamation (skin peeling) and fissuring (cracking) of the weight-bearing surfaces of the feet. This condition is generally self-limiting, meaning that it tends to resolve on its own, and most affected individuals experience relief by the time they reach 12 to 16 years of age.
CAUSES
The exact cause of Juvenile plantar dermatosis is not entirely clear, but it is often seen in children with a personal history of atopy. Atopy refers to a genetic predisposition to develop allergic diseases like asthma, hay fever, and atopic dermatitis. It is thought that a combination of factors contributes to the development of this condition.
One key factor is sweat
Children’s sweat glands can be more active than those of adults, and the occlusive footwear they wear can trap sweat, creating a moist environment within their shoes. This excess moisture can lead to skin maceration, where the skin becomes soft and breaks down. Additionally, the shearing force across the weight-bearing epidermis, or the outermost layer of the skin, displaces sweat ducts, leading to temporary cessation of sweat release. This process results in dry, scaly skin with a glazed appearance.
History
Juvenile plantar dermatosis typically affects children between the ages of 3 and 15, with the highest frequency occurring in boys aged 4 to 8. It is often exacerbated during the summer months when the weather is warmer. The increased temperature and moisture inside footwear can intensify the condition.
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Clinical Findings
Distribution The condition predominantly affects the plantar surfaces of the toes and the weight-bearing regions of the soles of the feet, especially the forefoot and volar (underside) surfaces of the toes. Less commonly, it can also affect the dorsal (upper) surfaces of the toes and the fingertips. Notably, the spaces between the toes are usually spared in this condition, which distinguishes it from other dermatological issues like tinea (athlete’s foot).
Morphology
Affected areas of the skin become dry, red, and shiny. In chronic cases, scaling and fissuring may develop. These fissures can be painful and may take several weeks to heal, causing discomfort to affected individuals.
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Management
Juvenile plantar dermatosis tends to resolve on its own as children grow older. Most patients experience the condition for about 2 to 4 years, and it typically disappears around puberty. While medical intervention is not always necessary, there are some practical steps that can be taken to alleviate symptoms and reduce the risk of recurrence:
- Proper Footwear; Encourage children to wear well-fitting shoes that minimize friction. Choosing footwear made of breathable materials like leather, rather than synthetic fibers, can help prevent excessive sweating.
- Socks: Recommend the use of cotton socks and changing them when they become damp to maintain a dry environment within the shoes.
- Barefoot Time: Encourage children to remove their shoes and walk barefoot whenever possible, especially indoors.
- Emollients: Apply a moisturizing cream containing urea to the affected areas when socks and shoes are removed. This can help prevent excessive dryness.
- Topical Steroids: In cases where the skin is erythematous (red and inflamed) and itchy, a mild to moderately potent topical steroid can be applied thinly for a few days to relieve symptoms.
- Management of Fissures: If fissures (cracks) develop, it is advisable to avoid strenuous exercise for a few days. Covering the fissures with a plaster or using steroid-impregnated treatments can be beneficial. These treatments are typically left on for up to 24 hours before reapplication
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Juvenile plantar dermatosis is a common skin condition in children and young adolescents. While it can be uncomfortable, it often resolves naturally over time. By following some simple management strategies, parents and caregivers can help alleviate symptoms and ensure the affected child’s comfort.
Conclusion
Juvenile plantar dermatosis (JPD) is a common skin condition primarily affecting children, characterized by redness, peeling, and cracking on the soles of the feet. Atopy, a genetic predisposition to allergic diseases, is a common factor. JPD often self-resolves by adolescence. Excessive sweating within occlusive footwear contributes to skin maceration and dry, scaly skin. It is most prevalent in boys aged 4 to 8, exacerbated in warm weather. Treatment involves well-fitting, breathable shoes, cotton socks, moisturizing creams, and, if necessary, mild topical steroids. Fissures can be managed with plaster or steroid-impregnated treatments. JPD typically disappears around puberty.
