Cracked feet in a child

The skin on the soles of the feet and the palms of a person is noticeably different from the skin on other parts of the body. And although in childhood the stratum corneum of the epidermis is thinner than in adults, cracks on the feet of a child appear quite often.

Causes Cracked feet in a child

When considering the etiology of cracked skin on the feet, we will omit their localization on the heels: this problem is dedicated to a separate publication - Cracked heels in children.

Doctors conventionally divide the most probable causes of cracks in the skin of the soles of the feet, on the toes, under the toes and between the toes of a child 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 on the skin inside the shoe due to overheating and the occlusive effect of closed shoes (preventing sweat evaporation);
• increased sweating of the feet;
• increased dryness of the skin on the legs (despite the fact that there are no sebum-producing glands on the soles of the feet);
• the effects of skin cleansers and water that is too hot.

All of the above leads to a common chronic skin condition of the feet in children aged 3 to 14 years – juvenile plantar dermatosis. Since 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 of it.

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

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

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

• allergic contact dermatitis to shoe material; [ 3 ]
• deficiency of vitamins (A and D) and/or some essential fatty acids (alpha- and gamma-linolenic);
• plantar psoriasis; [ 4 ]
• palmoplantar keratoderma, including congenital; [ 5 ]
• mycosis or athlete's foot - a skin infection caused by the fungi Trichophyton interdigitale, Trichophyton rubrum or Epidermophyton floccorum. [ 6 ]

Due to increased mechanical pressure, overweight children may develop cracked skin in the area of the fat pads of the feet (transitioning to the lateral surfaces of the foot). Dry cracked skin on the feet, as well as cracks in the toes of a child, may be due to hypothyroidism or metabolic disorders associated with diabetes.

Longitudinal cracks in a child's toenails may be the result of trauma (severe bruising), shoes that are too tight, increased fragility of the nails, or a fungal infection - onychomycosis. Dermatophyte damage to the nails 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 the slightly alkaline side. During the first five to six years of a child's life, the formation of all layers of the skin and the transformation of its structure - from cellular to fibrous - continues.

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

In addition, foreign studies have proven the presence in children with hypertrophic skin reactions of an atopic nature of disorders of the metabolism of linoleic acid, which is necessary to maintain the level of hydration of the epidermis, and the suppression of 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 (of which there are most on the plantar surfaces of the feet and palms).

Symptoms Cracked feet in a child

The first signs of cracking of the skin can be noticed by the deepening of the folds of the skin in the folds of the joints between the phalanges of the fingers - from the side of the sole. Apart from the heels, the crack most often appears on the big toe of the child. It can be quite deep, very painful and bleeding.

Cracks under the toes in children, affecting the flexor grooves between the metatarsus and the first phalanges of the toes (from the flexor side of the metatarsophalangeal joints), appear in cases of juvenile plantar dermatosis (in which the load-bearing surfaces of the sole also turn red and shiny), elementary hyperhidrosis, atopic dermatitis or keratoderma.

And with a fungal infection, wet and itchy cracks are observed between the toes of a child.

Complications and consequences

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

Complications are associated with secondary infection and the development of bacterial inflammation, in which the skin turns red, the subcutaneous tissue swells, and there may be oozing or suppuration.

Diagnostics Cracked feet in a child

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

However, tests and labs such as skin scrapings (to rule out fungal infections), blood tests for sugar, thyroid hormones and antibodies may be required. Read more - Skin examination

Differential diagnosis

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

Treatment Cracked feet in a child

Treatment of cracks is carried out using topical agents. These are medications in the form of ointments, creams, cream-balms, creams on a hydrophilic basis (gels):

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

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

If the crack is infected, you should use an ointment with an antibiotic: Levomekol, synthomycin emulsion, Baneocin, Nitacid, Isotrexin (for children over 12 years old) or antiseptic creams such as REPAIRcream,

For deep cracks, liquid (hydrocolloid) dressings for the skin are effective; before applying them, the damaged area of the skin is treated with a solution of furacilin, Betadine, Mramistin or Chlorhexidine.

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

Homeopathy offers such ointments for cracks as Boro Plus, Calendula and Cikaderm.

Physiotherapy treatment (electrophoresis with Hydrocortisone) may be prescribed by a dermatologist if a child over two years of age has deep cracks due to atopic dermatitis - that is, not associated with a fungal infection, and not infected with bacteria.

The doctor may recommend giving children vitamins A and D.

Try folk remedies – lubricate the crack with sea buckthorn or rosehip oil, fish oil or lanolin, aloe leaf or viburnum berry juice, mumiyo or propolis solutions.

As a rule, herbal treatment is limited to foot baths or lotions with decoctions and water infusions of chamomile, stinging nettle, and calendula.

Prevention

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

• daily washing of feet with mild soap and thorough drying of the skin between the toes;
• wearing shoes and socks made from natural materials;
• regular change of socks;
• frequent walking around the house barefoot;
• moisturizing dry skin on your feet (using a moisturizing foot cream after a bath or shower);
• use of effective remedies for sweaty feet;
• timely treatment of dermatomycosis and antifungal treatment of shoes.

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

Forecast

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

And juvenile plantar dermatosis usually goes away during puberty in adolescents.