Atopic juvenile plantar dermatosis L20.8

Macie, RM 1976

Chronic, non-allergic, cumulatively toxic eczema reaction with mostly severe sebostasis and atopic diathesis.

Especially occurring in children. Less common in adults.

Slightly inflammatory laminar redness (may also be completely absent) with uniform, broken, fine-lamellar scaling (not removable or strippable) especially in the plantar and/or palmar parts of individual or all toes and the sole parts of the forefoot (analogous description on the hands). The skin is parchment-like changed, dust-dry, provided with a delicate (atrophic) shine which becomes noticeable when viewed from the side.

Especially at the tip of the toes (also at the fingertips) painful rhagades (S.u. Pulpitis sicca) can develop, which are resistant to therapy and tend to secondary infection.

Tinea pedum: acute onset, maceration, fungal detection:

Contact allergic dermatitis: history; epicutaneous testing.

Localized epidermolysis bullosa simplex (Weber-Cockayne): familiality, blistering, polysomatic genotype

Acral peeling skin syndrome: familiality, blistering, genotype - mutation in TGM5

In case of dry parchment skin: Bland care with refatting externals such as Eucerin cum aq., Linola fat, ash base cream/ointment, Excipial almond oil ointment, Lipoderm lotion, Eucerin Omega. If necessary also with added urea (e.g. R102, Excipial U Lipolotio).

In case of firmly adhering hyperkeratoses: cream/ointments containing urea (e.g. Nubral, Basodexan), during the day 2-5% as nourishing external cream (see above). At night 5-10 min. warm soap bath (addition of liquid soap or curd soap) or oil bath (20 ml olive oil, with 10 ml milk, 5 l warm water). Immediately afterwards, apply a thick layer of cream/ointment containing 5-10% urea (e.g. Basodexan ointment, alternatively external products containing salicylic acid, e.g. Squamasol), cover with occluding household foil for 2-3 hours, fixation with cotton socks or cotton gloves.

In case of deep rhagades: Apply glucocorticoid-containing fat ointments such as 0.1% mometasone f uroate (e.g. Ecural fat ointment) in a thick layer on rhagades and surrounding area. Possibly combination of steroid/salicylic acid, e.g. Diprosalic. Apply a self-adhesive hydrocolloidal occlusive dressing (e.g. Varihesive extra thin), which is renewed daily to every 2nd day. Carry out treatment for 2-3 days. Subsequently monotherapy with hydrocolloid dressings. Avoid occluding footwear.

1. Gibbs NF (2004) Juvenile plantar dermatosis. Can sweat cause foot rash and peeling? Post Grade Med 115: 73-75
2. Kean JR (2007) Foot problems in the adolescent. Adolesc Med State Art Rev 18:182-191
3. Mackie RM et al (1976) Juvenile plantar dermatosis. a new entity. Clin Exp Dermatol 1: 253-260
4. Shipley DR et al (2006) Juvenile plantar dermatosis responding to topical tacrolimus ointment. Clin Exp Dermatol 31:453-454
5. Zagne V et al (2014) Histopathological aspects of juvenile plantar dermatosis. At J Dermatopathol 36: 359-361