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DERMATOPHILE ANSWERS
From the questions on page 75. ANSWER TO QUESTION 1 The answer is F, Tinea pedis. Tinea pedis is the most prevalent dermatophyte infection encountered in practice,1–3 which is mostly caused by Trichophyton rubrum and Trichophyton mentagrophytes.1 It has three common presentations.2 The interdigital form of tinea pedis is the most common and, just like the case above, it is characterised by fissuring, maceration and desquamation in the interdigital spaces of the toes.2 Clinically, the moccasin-like form presents with hyperkeratosis and erythema of the soles and sides of the feet.2 The vesiculobullous form of tinea pedis is characterised by the development of vesicles, pustules and bullae, usually on the distal plantar skin.2 Tinea pedis frequently accompanies onychomycosis.2 3 Transmission can occur through direct contact with infected skin or by contact with contaminated items, such as socks, towels, shoes or shower stalls.1 2 Fungal culture confirms the diagnosis.1 2 Application of an antifungal cream in the interdigital area is the indicated treatment. In order to avoid relapses, it is important to guide disinfection of footwear, controlling hyperhidrosis, wearing absorbent socks and non-occlusive shoes.2 ANSWER TO QUESTION 2 The answer is B, juvenile plantar dermatosis. Juvenile plantar dermatosis is usually a self-limited disease that generally resolves at puberty.4 As the case reported, plantar surface of the toes and the sole of the forefoot are the sites most frequently affected.4 5 The characteristic that allows us to differentiate it from tinea pedis is that the interdigital area is spared.4 Lesions are usually symmetric, dry, desquamative, erythematous and shiny.5 In chronic cases, lesions can appear with painful fissures (figure 4).5 Treatment of juvenile plantar dermatosis is multifactorial, including lubricating dry skin with greasy moisturisers right after taking off the shoes, controlling hyperhidrosis, wearing cotton socks and non-occlusive shoes.4 Topical corticosteroids can be used during short periods, especially when there is an inflammatory episode.4 ANSWER TO QUESTION 3 The answer is D, palmoplantar psoriasis. Psoriasis is a chronic inflammatory skin disease that can affect children.6 Psoriasis predominantly affecting palms and soles can present in three forms: erythematous scaly plaques as those of psoriasis elsewhere in the body, generalised thickening and scaling (keratoderma) or sheets of tiny pustules ( palmoplantar pustulosis).7 8 The most common presentation is the one reported above, with scaly plaques associated with hyperkeratotic
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Figure 4 Chronic juvenile plantar dermatosis, presenting desquamation and fissures on the plantar surface of the toes and distal sole.
areas and painful cracking and fissuring affecting palms and soles.6 8 The characteristic feature of this disease is that the lesions are usually symmetric and can be present at the plantar hollow.8 Palmoplantar lesions in patients with psoriasis often occur along with psoriasis elsewhere in the body or, less commonly, in isolation, and in this case, the presence of nail dystrophy and scalp desquamation are diagnosis clues.7 8 Although benign, the social impact induced by psoriasis can be major, especially in children.6 7 9 Topical treatment, such as corticosteroids and keratolytics, can be used. Other treatment options include systemic retinoids, methotrexate, ciclosporin and psoralen-UVA ( psoralen combined with ultraviolet A).6–8 Division of Pediatric Dermatology, Hospital de Clínicas da UFPR, Curitiba, Paraná, Brazil Correspondence to Mayara Schulze Cosechen Rosvailer, Rua José Izidoro Biazetto, 845, Ap 302 Torre 1, Curitiba, Paraná, Brazil, CEP 81200-240; [email protected]
Competing interests None. Patient consent Obtained. Ethics approval Ethics Committee of ‘Hospital de Clínicas – Universidade Federal do Paraná’. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Cosechen Rosvailer MS, Carvalho VO, Robl R, et al. Arch Dis Child Educ Pract Ed 2015;100:112–113. Accepted 18 September 2014 Published Online First 23 October 2014
Cosechen Rosvailer MS, et al. Arch Dis Child Educ Pract Ed 2015;100:112–113. doi:10.1136/archdischild-2014-307341a
Downloaded from http://ep.bmj.com/ on November 13, 2015 - Published by group.bmj.com
Dermatophile REFERENCES 1 Peres NTA, Maranhão FC, Rossi A, et al. Dermatophytes: host-patogen interaction and antifungal resistence. An Bras Dermatol 2010;85:657–67. 2 Hainer BL. Dermatophyte infections. Am Fam Physician 2003;67:101–8. 3 Woodfolk JA. Allergy and dermatophytes. Clin Microbiol Rev 2005;18:30–43. 4 Bikowski J. Barrier disease beyond eczema: Management of juvenile plantar dermatosis. Practical Dermatology for Pediatrics 2010 July/August:28-31. 5 Brar KJ, Shenoi SD, Balachandran C, et al. Clinical profile of forefoot eczema: A study of 42 cases. Indian J Dermatol Venereol Leprol 2005;71:179–81.
6 Mahé E, Gnossike P, Sigal M-L. Le psoriasis de l’enfant. Arch Pédiatr 2014;21:778–86. 7 Carrascosa JM, Plana A, Ferrándiz C. Eficacia y seguridad en terapia con psoralen-UVA (PUVA) tópica en psoriasis palmoplantar. Experiencia en una serie de 48 pacientes. Actas Dermosifiliogr 2013;104:418–25. 8 Di Lernia V, Guareschi E. Successful treatment of hand and foot psoriasis with infliximab. Dermatol Online J 2010;168. 9 Farley E, Masrour S, McKey J, et al. Palmoplantar psoriasis: a phenotypical and clinical review if introduction of a new quality-of-life assessment tool. J Am Acad Dermatol 2009;60;1024–31.
Cosechen Rosvailer MS, et al. Arch Dis Child Educ Pract Ed 2015;100:112–113. doi:10.1136/archdischild-2014-307341a
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Not only athlete's foot survives in feet Mayara Schulze Cosechen Rosvailer, Vânia Oliveira Carvalho, Renata Robl, Marjorie Uber, Kerstin Taniguchi Abagge and Leide Parolin Marinoni Arch Dis Child Educ Pract Ed 2015 100: 112
doi: 10.1136/archdischild-2014-307341a Updated information and services can be found at: http://ep.bmj.com/content/100/2/112
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This article cites 8 articles, 1 of which you can access for free at: http://ep.bmj.com/content/100/2/112#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Dermatology (79) Child health (317) Competing interests (ethics) (46) Oncology (93) Drugs: infectious diseases (108) Journalology (56) Reproductive medicine (80)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
DERMATOPHILE ANSWERS
From the questions on page 75. ANSWER TO QUESTION 1 The answer is F, Tinea pedis. Tinea pedis is the most prevalent dermatophyte infection encountered in practice,1–3 which is mostly caused by Trichophyton rubrum and Trichophyton mentagrophytes.1 It has three common presentations.2 The interdigital form of tinea pedis is the most common and, just like the case above, it is characterised by fissuring, maceration and desquamation in the interdigital spaces of the toes.2 Clinically, the moccasin-like form presents with hyperkeratosis and erythema of the soles and sides of the feet.2 The vesiculobullous form of tinea pedis is characterised by the development of vesicles, pustules and bullae, usually on the distal plantar skin.2 Tinea pedis frequently accompanies onychomycosis.2 3 Transmission can occur through direct contact with infected skin or by contact with contaminated items, such as socks, towels, shoes or shower stalls.1 2 Fungal culture confirms the diagnosis.1 2 Application of an antifungal cream in the interdigital area is the indicated treatment. In order to avoid relapses, it is important to guide disinfection of footwear, controlling hyperhidrosis, wearing absorbent socks and non-occlusive shoes.2 ANSWER TO QUESTION 2 The answer is B, juvenile plantar dermatosis. Juvenile plantar dermatosis is usually a self-limited disease that generally resolves at puberty.4 As the case reported, plantar surface of the toes and the sole of the forefoot are the sites most frequently affected.4 5 The characteristic that allows us to differentiate it from tinea pedis is that the interdigital area is spared.4 Lesions are usually symmetric, dry, desquamative, erythematous and shiny.5 In chronic cases, lesions can appear with painful fissures (figure 4).5 Treatment of juvenile plantar dermatosis is multifactorial, including lubricating dry skin with greasy moisturisers right after taking off the shoes, controlling hyperhidrosis, wearing cotton socks and non-occlusive shoes.4 Topical corticosteroids can be used during short periods, especially when there is an inflammatory episode.4 ANSWER TO QUESTION 3 The answer is D, palmoplantar psoriasis. Psoriasis is a chronic inflammatory skin disease that can affect children.6 Psoriasis predominantly affecting palms and soles can present in three forms: erythematous scaly plaques as those of psoriasis elsewhere in the body, generalised thickening and scaling (keratoderma) or sheets of tiny pustules ( palmoplantar pustulosis).7 8 The most common presentation is the one reported above, with scaly plaques associated with hyperkeratotic
112
Figure 4 Chronic juvenile plantar dermatosis, presenting desquamation and fissures on the plantar surface of the toes and distal sole.
areas and painful cracking and fissuring affecting palms and soles.6 8 The characteristic feature of this disease is that the lesions are usually symmetric and can be present at the plantar hollow.8 Palmoplantar lesions in patients with psoriasis often occur along with psoriasis elsewhere in the body or, less commonly, in isolation, and in this case, the presence of nail dystrophy and scalp desquamation are diagnosis clues.7 8 Although benign, the social impact induced by psoriasis can be major, especially in children.6 7 9 Topical treatment, such as corticosteroids and keratolytics, can be used. Other treatment options include systemic retinoids, methotrexate, ciclosporin and psoralen-UVA ( psoralen combined with ultraviolet A).6–8 Division of Pediatric Dermatology, Hospital de Clínicas da UFPR, Curitiba, Paraná, Brazil Correspondence to Mayara Schulze Cosechen Rosvailer, Rua José Izidoro Biazetto, 845, Ap 302 Torre 1, Curitiba, Paraná, Brazil, CEP 81200-240; [email protected]
Competing interests None. Patient consent Obtained. Ethics approval Ethics Committee of ‘Hospital de Clínicas – Universidade Federal do Paraná’. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Cosechen Rosvailer MS, Carvalho VO, Robl R, et al. Arch Dis Child Educ Pract Ed 2015;100:112–113. Accepted 18 September 2014 Published Online First 23 October 2014
Cosechen Rosvailer MS, et al. Arch Dis Child Educ Pract Ed 2015;100:112–113. doi:10.1136/archdischild-2014-307341a
Downloaded from http://ep.bmj.com/ on November 13, 2015 - Published by group.bmj.com
Dermatophile REFERENCES 1 Peres NTA, Maranhão FC, Rossi A, et al. Dermatophytes: host-patogen interaction and antifungal resistence. An Bras Dermatol 2010;85:657–67. 2 Hainer BL. Dermatophyte infections. Am Fam Physician 2003;67:101–8. 3 Woodfolk JA. Allergy and dermatophytes. Clin Microbiol Rev 2005;18:30–43. 4 Bikowski J. Barrier disease beyond eczema: Management of juvenile plantar dermatosis. Practical Dermatology for Pediatrics 2010 July/August:28-31. 5 Brar KJ, Shenoi SD, Balachandran C, et al. Clinical profile of forefoot eczema: A study of 42 cases. Indian J Dermatol Venereol Leprol 2005;71:179–81.
6 Mahé E, Gnossike P, Sigal M-L. Le psoriasis de l’enfant. Arch Pédiatr 2014;21:778–86. 7 Carrascosa JM, Plana A, Ferrándiz C. Eficacia y seguridad en terapia con psoralen-UVA (PUVA) tópica en psoriasis palmoplantar. Experiencia en una serie de 48 pacientes. Actas Dermosifiliogr 2013;104:418–25. 8 Di Lernia V, Guareschi E. Successful treatment of hand and foot psoriasis with infliximab. Dermatol Online J 2010;168. 9 Farley E, Masrour S, McKey J, et al. Palmoplantar psoriasis: a phenotypical and clinical review if introduction of a new quality-of-life assessment tool. J Am Acad Dermatol 2009;60;1024–31.
Cosechen Rosvailer MS, et al. Arch Dis Child Educ Pract Ed 2015;100:112–113. doi:10.1136/archdischild-2014-307341a
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Downloaded from http://ep.bmj.com/ on November 13, 2015 - Published by group.bmj.com
Not only athlete's foot survives in feet Mayara Schulze Cosechen Rosvailer, Vânia Oliveira Carvalho, Renata Robl, Marjorie Uber, Kerstin Taniguchi Abagge and Leide Parolin Marinoni Arch Dis Child Educ Pract Ed 2015 100: 112
doi: 10.1136/archdischild-2014-307341a Updated information and services can be found at: http://ep.bmj.com/content/100/2/112
These include:
References Email alerting service
Topic Collections
This article cites 8 articles, 1 of which you can access for free at: http://ep.bmj.com/content/100/2/112#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Dermatology (79) Child health (317) Competing interests (ethics) (46) Oncology (93) Drugs: infectious diseases (108) Journalology (56) Reproductive medicine (80)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
