How is juvenile plantar dermatosis treated ?

 JUVENILE PLANTAR  DERMATOSIS { SWEATY SOCK SYNDROME } :

Juvenile plantar dermatosis presents as a red, scaly lesion that affects the weight-bearing regions of the sole of the foot. The initial lesions are symmetrical, red macules with a somewhat shiny appearance that can be found on the bottom of the foot. These macules eventually coalesce to form many erythematous patches with associated scaling. Fissuring and cracking of the skin is very common. One unique finding in JPD is that the toe webs are spared.





uvenile plantar dermatosis (JPD), also known as "wet and dry foot syndrome”, is a skin disorder of the feet that commonly affects children from ages 3 to 14. JPD is frequently seen in children with eczema but it is not a requirement for diagnosis.

The primary underlying mechanism involved in the development of JPD is a cycle of excessive moisture followed by rapid drying, which leads to cracking and fissuring of the plantar surfaces of the feet. The keratin layers of the feet become excessively hydrated from sweat or water exposure, and then with rapid drying they become super-dehydrated. Repeated exposure to this cycle results in the accumulation of micro-damage to the bottom of the feet. Sweaty sock syndrome (juvenile plantar dermatosis) is a condition where the skin becomes scaly and red on the soles of the feet of children and young teenagers.

The cause of sweaty sock syndrome is unknown, though alternating moist and dry conditions may lead to the condition. It tends to be a long-lasting (chronic) condition, lasting, on average, about 3 years. Sweaty sock syndrome usually goes away when a child reaches puberty.

WHAT ARE THE SIGNS AND SYNDROME OF JUVENILE PLANTAR DERMATOSIS ?



The most common locations for sweaty sock syndrome include:

  • Big toe
  • Ball of the foot
  • Heel

The creases between the toes (toe webs) are not usually affected.

Sweaty sock syndrome occurs as shiny, red patches on the weight-bearing surfaces of the feet. The skin appears tight and smooth. Occasionally, painful cracks (fissures) may be present. Even though children may complain of heavy sweating, the skin feels dry and scaly. 

  • Juvenile plantar dermatosis is cracking and peeling of the weight-bearing areas of the soles of children.
  • It occurs in boys more often than girls.
  • It is common between the ages of 3 and 14 with most cases occurring between the ages of 4-8 years.
  • However, onset in adulthood can occur.
  • It is worst in the summer.
  • 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.
  • Other sites affected infrequently are the dorsal surface of the toes, the heels and the fingertips.
WHAT ARE THE CAUSES OF JUVENILE PLANTAR DERMATOSIS ?

Juvenile plantar dermatosis may be caused by:


  • Repetitive frictional movements, as the foot moves up and down in a shoe
  • The occlusive effect of covered footwear, especially synthetic shoes (eg, nylon or vinyl)
  • Excessive sweating (hyperhidrosis), which when followed by rapid drying leads to cracking and fissuring
  • Genetic sensitivity of the skin 
  • Climatic changes: with worsening during the summer months due to heat and sweating, and in colder months due to the wearing of winter boots. Hence there is no consistent seasonal variation.

HOW TO TREAT JUVENILE  PLANTAR DERMATOSIS ?

Doctor will probably check your child for a fungal infection (athlete’s foot) by scraping a small amount of surface skin (scale) and examining it under a microscope. If fungus is not seen, the doctor will probably consider the diagnosis of sweaty sock syndrome.

However, athlete’s foot is much more common than sweaty sock syndrome, so the physician may want to try a course of topical antifungal creams before concluding that your child has the later.

Once the diagnosis of sweaty sock syndrome has been confirmed, the doctor may recommend the following in addition to the self-care measures mentioned above:

  • Prescription-strength topical corticosteroid (cortisone) cream
  • Antihistamine pills, if itching is severe

There is no consistently useful treatment. General recommendations include the following without supporting studies to show benefit.

Reduce friction

  • Wear well fitting shoes, preferably leather, to minimise friction.
  • Wearing two or more pairs of cotton or woollen socks can also help reduce friction.
  • Avoid wearing shoes and socks made of synthetic materials.
  • Change socks regularly.

Lubricate the dry skin

  • Apply moisturising cream containing urea or petrolatum, after bath and before bed.
  • Barrier cream (containing dimeticone) are easier to wear during the day and should be applied every 4 hours.

Have a rest daily

  • Schedule quiet times with little or no walking to allow fissures to heal.

Cover cracks

  • Fissures heal faster when occluded. Adhesive plasters are usually satisfactory.
  • Spray or liquid acrylate glue can be applied to the fissures to relieve pain.

Prescription ointments

When applied once or twice daily for courses of up to 4 weeks, these rarely prove more effective than simple emollients. 

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