Juvenile plantar dermatosis (Fig. 7.29)
This condition is thought to be related to the imper-meability of modern socks and shoe linings with subsequent sweat gland blockage, and so has been called the ‘toxic sock syndrome’! Some feel the condi-tion is a manifestation of atopy.
The skin of the weight-bearing areas of the feet, particularly the forefeet and undersides of the toes, becomes dry and shiny with deep painful fissures that make walking difficult. The toe webs are spared. Onset can be at any time after shoes are first worn, and even if untreated the condition clears in the early teens.
Much time has been wasted in patch testing and scraping for fungus.
The child should use a commercially available cork insole in all shoes, and stick to cotton or wool socks. An emollient such as emulsifying ointment or 1% ichthammol paste, or an emollient containing lactic acid, is as good as a topical steroid.
The most common type of napkin eruption is irritant in origin, and is aggravated by the use of waterproof plastic pants. The mixture of faecal enzymes and ammonia produced by urea-splitting bacteria, if allowed to remain in prolonged contact with the skin, leads to a severe reaction. The overgrowth of yeasts is another aggravating factor. The introduction of modern disposable napkins has, over the last few years, helped to reduce the number of cases sent to our clinics.
The moist, often glazed and sore erythema affects the napkin area generally (Fig. 7.30), with the exception of the skin folds, which tend to be spared.
Superinfection with Candida albicans is common, and this may lead to small erythematous papules or vesicopustules appearing around the periphery of the main eruption.
The sparing of the folds helps to separate this condition from infantile seborrhoeic eczema and candidiasis.
It is never easy to keep this area clean and dry, but this is the basis of all treatment. Theoretically, the child should be allowed to be free of napkins as much as possible but this may lead to a messy nightmare. On both sides of the Atlantic disposable nappies (diapers) have largely replaced washable ones. The superab-sorbent type is best and should be changed regularly, especially in the middle of the night. When towelling napkins are used they should be washed thoroughly and changed frequently. The area should be cleaned at each nappy change with aqueous cream and water. Protective ointments, e.g. zinc and castor oil ointment, or silicone protective ointments, are often useful, as are topical imidazole prepara-tions that stop yeast growth. Potent steroids should be avoided but combinations of hydrocortisone with antifungals or antiseptics are often useful.