Cracked feet in a child

The skin on the soles of the feet and palms of a person differs markedly from the skin of other parts of the body. And although in childhood the horny layer of the epidermis is thinner than in adults, cracks on a child's feet appear quite often.

Causes Cracked feet in a child

Considering the etiology of cracking of the skin of the feet, we will omit their localization on the heels: a separate publication is devoted to this problem - Cracked heels in children.

The most likely causes of cracks on the skin of the pads of the soles, on the fingers, under the toes and between the toes of the child medics conditionally divide into exogenous (external) and endogenous (internal), and also point to physiological risk factors associated with the characteristics of children's skin.

Exogenous causes include:

• Physical stress to the skin inside the shoe due to overheating and the occlusive effect of closed shoes (preventing sweat from evaporating);
• increased sweating of the feet;
• increasing dry skin on the feet (even though there are no sebum-producing glands on the soles of the feet);
• Exposure to skin cleansers and excessively hot water.

All of the above leads to a common chronic condition of the skin of the feet in children from 3 to 14 years of age - juvenile plantar dermatosis. Because there are seasonal variations and the condition can be aggravated by wearing socks and shoes made of synthetic material, this dermatosis is called atopic winter foot or sweaty sock dermatitis, and, in fact, painful cracks are considered a complication.

Dermatologists have concluded that in many cases, the cause of dry skin and cracking skin lines on the soles of a child's feet is atopic dermatitis, which is a multisystem disease and part of the body's state of hyperreactivity to various environmental factors. [1], [2]

So cracks on the child's feet can also appear in summer: in open shoes, the feet can be exposed to intense friction, especially if they sweat.

Also conditions that cause symptoms such as cracked skin on the feet include:

• Allergic contact dermatitis to the shoe material; [3]
• deficiency of vitamins (A and D) and/or certain essential fatty acids (alpha- and gamma-linolenic acid);
• plantar psoriasis; [4]
• palm and plantar keratoderma, including congenital; [5]
• mycosis or epidermophytosis of the feet - a skin lesion caused by the fungi Trichophyton interdigitale, Trichophyton rubrum or Epidermophyton floccorum. [6]

Increased mechanical pressure in overweight children may cause cracking of the skin in the area of the fatty pads of the feet (with a transition to the lateral surfaces of the feet). Dry cracked skin on the feet, as well as cracks on the toes of the child may be in hypothyroidism or metabolic disorders associated with diabetes.

Longitudinal cracks on the toenails of a child can be the result of trauma (severe bruising), too tight shoes, increased fragility of the nails, fungal infection - onychomycosis. Lesion of nails by dermatophytes is manifested by thickening and disruption of the integral structure of their horny plates, which begin to crumble, crack or peel off. [7]

Pathogenesis

At any age, the skin performs barrier functions, but children's skin is thinner and looser, and the skin barrier is more permeable: even the pH of the hydrolipid mantle is shifted to a slightly alkaline side. During the first five to six years of a child's life, the formation of all skin layers and the transformation of its structure, from cellular to fibrous, continues.

In explaining the pathogenesis of atopic skin reactivity, which is characteristic of a sufficient number of children, experts note a certain role of genetic predisposition. This applies both to congenital keratinocyte keratinization disorder caused by mutations in the genes of transcription factors (proteins involved in cell differentiation) and changes in the gene for the filaggrin protein (FLG). It is formed in keratohyalin granules of the granular layer of the epidermis (Stratum granulosum) and not only binds keratins of the stratum corneum, but also ensures the release of natural moisturizing and acid-base factors of the skin during its cleavage.

In addition, foreign studies have shown that children with hypertrophic skin reactions of atopic nature have impaired metabolism of linoleic acid, which is necessary to maintain the level of hydration of the epidermis, and suppressed the functions of skin antimicrobial proteins: cathelicidin (its activity is regulated by vitamin D3, which is synthesized in the body from vitamin D under the influence of sunlight), and dermcidin produced by eccrine sweat glands (which are most abundant on the plantar surfaces of the feet and palms).

Symptoms Cracked feet in a child

The first signs of skin cracking can be noticed by the deepening of the skin folds in the folds of the joints between the phalanges of the toes - on the sole side. If you do not count the heels, then most often there is a crack on the big toe in a child. It can be quite deep, very painful and bleeding.

Cracks under the toes in children, affecting the flexor furrows between the metatarsal and the first phalanges of the toes (on the flexor side of the metatarsophalangeal joints), appear in cases of juvenile plantar dermatosis (in which the bearing surfaces of the soles also become red and shiny), elementary hyperhidrosis, atopic dermatitis or keratoderma.

And in case of fungal infection, there are wet and itchy cracks between the toes of the child.

Complications and consequences

When deep cracks are formed, the consequences are manifested by a feeling of pain when walking and damage to capillaries with their bleeding.

And complications are associated with secondary infection and the development of bacterial inflammation, in which the skin turns red, swelling of the subcutaneous tissue, there may be wetting or suppuration.

Diagnostics Cracked feet in a child

Diagnosis is made based on clinical symptoms, examination of the lesion, and medical history.

However, tests and laboratory tests such as skin scraping (to rule out fungal infection), blood sugar, thyroid hormone and antibody tests may be required. Read more - Skin tests

Differential diagnosis

Differential diagnosis is important in all cases, but especially in fungal skin lesions, as their treatment requires the prescription of antimycotic drugs, as well as in plantar psoriasis or keratoderma, in the treatment of which topical corticosteroids are used.

Treatment Cracked feet in a child

Fissures are treated using topical agents. These are medications in the form of ointments, creams, balm creams, hydrophilic-based creams (gels):

Methyluracil, Reskinol, Panthenol (Bepanten, Pantoderm), Sudocrem, Spasatel, 911 Zazhivin, Gevol (Gehwo).

If the crack is wet, zinc ointment or paste is applied.

If the fissure is infected, an antibiotic ointment should be used: Levomekol, Syntomycin emulsion, Baneocin, Nitacid, Isotrexin (children over 12 years old) or antiseptic creams such as REPAIRcream,

With deep fissures are effective liquid (hydrocolloid) dressings for the skin, before the application of which the damaged skin area is treated with a solution of furacilin, Betadine, Mramistin or Chlorhexidine.

When cracks between the toes of a child are the result of mycosis, it is necessary to apply ointment for fungus between toes.

Homeopathy offers fissure ointments such as Boro plus, Calendula and Cicaderm.

Physiotherapeutic treatment (electrophoresis with Hydrocortisone) can be prescribed by a dermatologist if a child over two years of age has deep fissures in atopic dermatitis - that is, not associated with fungal infection, and not infected with bacteria.

Your doctor may recommend giving your child vitamins A and D.

Try folk treatment - lubricating the crack with sea buckthorn or rosehip oil, fish oil or lanolin, juice of aloe leaves or Kalina berries, solutions of mumie or propolis.

As a rule, herbal treatment is limited to foot baths or lotions with decoctions and aqueous infusions of chamomile apothecary, nettle dicot, calendula medicinal.

Prevention

No one claims that the appearance of a crack on the legs of a child can be prevented in all cases. However, prevention of the negative impact of exogenous factors is possible. And it includes:

• Washing your feet daily with mild soap and thoroughly drying the skin between your toes;
• Wearing shoes and socks made of natural materials;
• a regular change of socks;
• frequent barefooting at home;
• moisturizing the dry skin of the feet (using a moisturizing foot cream after a bath or shower);
• application effective remedies for sweaty feet;
• timely treatment of dermatomycoses and antifungal treatment of shoes.

With dry skin, children need essential fatty acids, in particular linolenic acid, which contains oily sea fish, chicken egg yolks, vegetable oils, nuts, sunflower seeds.

Forecast

Doctors confidently define the prognosis as good: most cracks heal within a week of treatment. Deep cracks on a child's feet can be healed in two weeks (using liquid skin dressings).

And juvenile plantar dermatosis usually occurs during the puberty of adolescents.