Juvenile plantar dermatosis

Management Strategy

JPD usually presents between 4 and 7 years of age. Spontaneous resolution occurs in most patients around puberty.

The main etiologic factor is thought to be the occlusive effect of ‘trainer’ sports shoes and manmade fibers in hosiery, resulting in hyperhidrosis. This, some suggest, washes away surface lipids, which are already reduced because of the relative lack of sebaceous glands on the plantar surface of the foot. This hyperhidrosis is, therefore, followed by rapid dehydration of the skin on removal of footwear. It is proposed that this maceration/dehydration renders the skin susceptible to trauma (e.g., from sport). Avoidance of vigorous exercise may therefore be helpful in these patients.

The role of atopy is debated. Some series have found an increased incidence of atopy in patients and families, and, indeed, this condition was first referred to as ‘atopic winter feet.’ It has been argued that the atopic diathesis and the associated filaggrin mutation predisposes the skin of the foot to the traumatic effects of sport and vigorous activity, and to the effects of alternating hyperhidrosis and dehydration.

Mycology should be undertaken if tinea pedis is considered. Patch testing may produce positive results in between 10% and 29% of cases. Even when these are to footwear-related allergens, however, there is debate as to whether allergen avoidance affects clinical outcome. Increased numbers of bacteria have been suggested to cause inflammation of the sweat ducts and thereby inhibit sweat secretion, but this has not been a consistent finding.

Changing to non-occlusive footwear along with cotton or woolen socks or open footwear has been proposed as a therapeutic maneuver. Rotating leather or cork insoles so that the sole of the shoe never becomes saturated with sweat may help. Emollients and lubricants containing dimethicone, both to reduce fissuring and to reduce the dehydration occurring on removing occlusive footwear, are reported to be helpful. Topical corticosteroids and tacrolimus may be beneficial if there is an inflammatory component. Occlusive bandages containing zinc ointment, ichthammol, or tar may help if hyperkeratosis and fissuring are a prominent feature. All these often only help temporarily, and regular rotation of emollients may be required.

It is the impression of most dermatologists that this condition has become less common in recent years, possibly related to changes in teenage fashion and footwear materials.