Published on 19/03/2015 by admin
Filed under Dermatology
Last modified 22/04/2025
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Stephen K. Jones
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Juvenile plantar dermatosis (JPD) is a specific condition comprising symmetrical erythema (with a polished ‘billiard ball’ appearance), scaling and fissuring, primarily of the pressure areas of the foot. Vesiculation is never found. The commonest sites involved are the plantar aspects of the great toe, forefoot, heel, and rarely the fingertips and palms. The instep and interdigital skin are rarely affected. The condition occurs almost exclusively in children, and clears around puberty.
JPD usually presents between 4 and 7 years of age. Most series suggest that it is a ‘disease of school years,’ with clearing in most by puberty. It is uncommon in adults. Spontaneous resolution occurs in the majority of patients.
The main etiologic factor is thought to be the occlusive effect of ‘trainer’ sports shoes and man-made 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/families and, indeed, this condition was first referred to as ‘atopic winter feet.’ It has been argued that the atopic diathesis predisposes the skin of the foot to the traumatic effects of sport and vigorous activity, and the effects of alternating hyperhidrosis and dehydration. Other series, however, have found no increased incidence of atopy.
Investigations are unlikely to be helpful but positive patch tests have been found 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 socks or ‘open’ footwear has been proposed as a therapeutic maneuver. Emollients, both to reduce fissuring and to reduce the dehydration occurring on removing occlusive footwear, are reported to be helpful. Topical corticosteroids 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 the above 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.
Patch tests
Mackie RM, Hussain SL. Clin Exp Dermatol 1976; 1: 253–60.
Thirteen of 102 patients showed a positive patch test. Eight were reactions to footwear constituents but subsequent changes in footwear did not affect the clinical outcome.
Guenst BJ. J Pediatr Health Care 1999; 13: 68–71.
A practical review differentiating the various forms of tinea pedis and shoe dermatitis from JPD.
Darling MI, Horn HM, McCormack SK, Schofield OM. Pediatr Dermatol 2011; 29: 254–7.
Of 14 children with JPD, 29% had clinically relevant reactions.
Jones SK, English JSC, Forsyth A, Mackie RM. Clin Exp Dermatol 1987; 12: 5–7.
Of 50 patients traced, the condition had resolved in 38. The mean age of remission was 14 years.
Gibbs NF. Postgrad Med 2004; 115: 73–5.
A review of the disease, its etiology, and its treatment.
Graham RM, Verbov JL, Vickers CFH. Br J Dermatol 1987; 12: 468–70.
Although there was no association with any particular sport, intensive exercise causing skin cracking, soreness, and bleeding was a common complaint; 75% of parents said that a change in footwear had not been helpful.
In contrast to Jones et al. above, only 30% of cases in this series had resolved (mean age 11.8 years), though the ages of the remaining 70% were not stated.
Shipley DR, Kennedy CTC. Clin Exp Dermatol 2005; 31: 453–4.
Topical tacrolimus twice daily in conjunction with a regular emollient produced improvement within 4 weeks with the feet appearing almost normal after 2 months. Intermittent tacrolimus was useful for relapses.
Occlusion with zinc paste or ichthammol-impregnated bandages was among the most beneficial of treatments.
Shrank AB. Br J Dermatol 1979; 100: 641–8.
Bed rest or avoidance of shoes/hosiery for 3 weeks resulted in disease clearance. (Thought to be related to the time taken for the sweat duct apparatus in the foot to regrow.)
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Await spontaneous resolution
Change to non-occlusive footwear
Sport avoidance
Emollients
Topical corticosteroids
Rotation of topical agents
Topical tacrolimus
Zinc oxide/impregnated bandages
Bed rest/footwear avoidance
