Cracks in the legs of 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 stratum corneum of the epidermis is thinner than in adults, cracks in the legs of a child appear quite often.

Causes Cracks in the legs of a child

Considering the etiology of cracking 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 the formation of cracks on the skin of the soles of the soles, on the fingers, under the fingers and between the toes in a child, physicians are conditionally divided into exogenous (external) and endogenous (internal), and also indicate physiological risk factors associated with the characteristics of children's skin.

Exogenous causes include:

• physical stress of the skin inside the shoes due to overheating and the occlusive effect of closed shoes (preventing the evaporation of sweat);
• increased  sweating of the legs ;
• increased  dryness of the skin on the legs  (despite the fact that the glands that produce sebum on the soles of the feet are absent);
• exposure to skin cleansers and too 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 old - juvenile plantar dermatosis. Because there are seasonal fluctuations and the condition can be exacerbated by wearing synthetic socks and shoes, 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 in the legs of a child can also appear in the summer: in open shoes, the feet can be subjected to intense friction, especially if they sweat.

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

• allergic contact dermatitis on shoe material; [3]
• lack of vitamins (A and D) and / or some essential fatty acids (alpha and gamma linolenic);
• plantar psoriasis ; [4]
• palmar-plantar keratoderma , including congenital; [5]
• mycosis or  epidermophytosis of the feet  - skin damage by fungi Trichophyton interdigitale, Trichophyton rubrum or Epidermophyton floccorum. [6]

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

Longitudinal cracks in the toenails of a child can be the result of trauma (severe bruising), too narrow shoes, increased fragility of nails, fungal infection -  onychomycosis . Damage to nails by dermatophytes is manifested by thickening and violation 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 or 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 - continue.

Explaining the pathogenesis of atopic skin reactivity, characteristic of a sufficient number of children, experts note a certain role of genetic predisposition. This applies both to congenital disorders of cornification of keratinocytes caused by mutations in transcription factor genes (proteins involved in cell differentiation) and changes in the gene for 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 shown that children with hypertrophied atopic skin reactions have disorders in the metabolism of linoleic acid, which is necessary to maintain the level of hydration of the epidermis, and 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 exposure to sunlight), and dermcidin, produced by the eccrine sweat glands (which are most found on the plantar surfaces of the feet and palms).

Symptoms Cracks in the legs of a child

You can notice the first signs of cracking of the skin by deepening the folds of the skin in the folds of the joints between the phalanges of the fingers - from the side of the sole. Except for the heels, most often a crack occurs 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 grooves between the metatarsus and the first phalanges of the fingers (on the flexor side of the metatarsophalangeal joints), appear in cases of juvenile plantar dermatosis (in which the bearing surfaces of the sole also become red and shiny), elementary hyperhidrosis, atopic dermatitis or keratoderma.

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

Complications and consequences

With the formation of deep cracks, the consequences are manifested by a sensation of pain when walking and damage to the capillaries with their bleeding.

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

Diagnostics Cracks in the legs of a child

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

However, tests and laboratory tests such as skin scrapings (to rule out a fungal infection), blood tests for sugar, thyroid hormones, and antibodies may be needed. Read more –  Skin examination

Differential diagnosis

Differential diagnosis is important in all cases, but especially in fungal skin lesions, since its treatment requires the appointment of antimycotic drugs, as well as in plantar psoriasis or keratoderma, which are treated with topical corticosteroids.

Treatment Cracks in the legs of a child

Cracks are treated using topical agents. These are medicines in the form of ointments, creams, cream-balms, hydrophilic creams (gels):

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

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

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

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

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

Homeopathy offers crack ointments such as Boro plus, Calendula and Cycaderm.

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

A doctor may recommend giving children vitamins A and D.

Try folk treatment - lubricating a crack with sea buckthorn or rosehip oil, fish oil or lanolin, juice of aloe leaves or viburnum berries, solutions of mummy or propolis.

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

Prevention

No one claims that the appearance of cracks 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:

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

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

Forecast

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

And juvenile plantar dermatosis usually resolves during puberty.