Juvenile plantar dermatosis

Definition/diagnostic criteria Juvenile Plantar Dermatosis (JPD) is a skin condition primarily affecting children, characterised by dry, scaly and fissured skin on the weight-bearing areas of the feet. It often involves the balls of the feet and toes, sparing the arches, and is thought to be the result of sweating and occlusive footwear, especially in atopic children.

Epidemiology JPD primarily affects children between the ages of 3 and 14, with a peak incidence around 8 years. The condition is more common in boys than girls. There is no clear genetic predisposition identified for JPD. The exact prevalence in the UK is unknown, but it is thought to be common.

Diagnosis
Clinical features: JPD presents with symmetrical, well-demarcated, red, scaly and fissured skin lesions. The skin appears shiny and glazed, often with associated painful fissures.

• It predominantly affects the weight-bearing areas of the plantar surfaces, particularly the forefoot and toes.
• The arch and heel are typically spared, helping to distinguish it from atopic dermatitis or tinea pedis.

Investigations: Diagnosis is primarily clinical, based on history and examination. Typical abnormalities include the characteristic distribution and appearance of the lesions.

No specific laboratory tests or skin biopsies are typically required. However, a swab for bacterial culture and a skin scraping for fungal elements may be considered to rule out superinfection or tinea pedis, respectively.

Treatment Treatment of JPD is largely symptomatic and includes topical emollients and keratolytic agents.

• Urea-based creams can be helpful for their hydrating and keratolytic properties.
• Topical steroids are not typically recommended due to the non-inflammatory nature of JPD.
• Avoidance of exacerbating factors, such as occlusive footwear and excessive sweating, is crucial.
• The use of breathable, well-fitting shoes and socks made from natural fibres is advised.

Prognosis The prognosis for JPD is generally good, with most children outgrowing the condition by adolescence. However, the course can be chronic and relapsing, particularly if exacerbating factors are not addressed. Regular follow-up and education about skincare and footwear choices are important in management.