Plantar hidradenitis in children induced by exposure to wet footwear

The Use of Footwear Insulation Values Measured on a Thermal Foot Model

The use of physiological data from human tests in modelling should consider background data, such as activity, environmental factors and clothing insulation on the whole body. The present paper focuses on local thermal comfort of feet with special attention on the effects of physical changes of footwear thermal properties. An alternative test method is available for footwear thermal testing besides the standard method. The possibility to use insulation values acquired on a thermal foot model in practice is shown here. The paper describes the correlation between cold and pain sensations, and foot skin temperatures of the subjects and relates these to insulation measured on a thermal foot model. Recommendations are made for footwear choice according to environmental temperature.

Therapy-resistant, spontaneously remitting generalized neutrophilic eccrine hidradenitis in a healthy patient decreases the expression of dermcidin in affected eccrine glands

We describe a healthy 69-year-old Japanese man with generalized neutrophilic eccrine hidradenitis (NEH). He visited our outpatient clinic with a 15-year history of disseminated pruritic papules on his trunk and extremities; the eruptions, however, were limited to the summer months. Histological findings reveal a dense accumulation of neutrophils around the sweat glands with degenerated secretary coils. Interestingly, immunohistochemical staining showed that the expression of dermcidin on the secretory portion of eccrine glands was significantly decreased in the affected lesion. To our knowledge, this is the first report in English of generalized NEH in a healthy adult that shows the downregulation of the expression of dermcidin in affected eccrine glands.

Neutrophilic dermatoses in children

The neutrophilic dermatoses are rare disorders, especially in children, and are characterized by neutrophilic infiltrates in the skin and less commonly in extracutaneous tissue. The neutrophilic dermatoses share similar clinical appearances and associated conditions, including inflammatory bowel disease, malignancies, and medications. Overlap forms of disease demonstrating features of multiple neutrophilic dermatoses may be seen. The manuscript attempts to provide an up-to-date review of (i) classical neutrophilic dermatoses, focusing on distinctive features in children and (ii) neutrophilic dermatoses which may largely be pediatric or genodermatosis-associated (Majeed, SAPHO [synovitis, severe acne, sterile palmoplantar pustulosis, hyperostosis, and osteitis] syndrome, PAPA (pyogenic sterile arthritis, pyoderma gangrenosum, and acne), PFAPA (periodic fever with aphthous stomatitis, pharyngitis, and cervical adenopathy), and other periodic fever syndromes, and congenital erosive and vesicular dermatosis healing with reticulated supple scarring).

[Pseudomonas eccrine hidradenitis in a child revealing acute lymphoblastic leukemia]

INTRODUCTION

We report the case of a Pseudomonas (P.) aeruginosa eccrine hidradenitis in a child, or a "Pseudomonas Hot Foot Syndrome", revealing an acute lymphoblastic leukemia.

OBSERVATION

A 10 year-old girl consulted for the sudden onset of painful and necrotic palmoplantar nodules in a context of fever and shivering. Histology of a cutaneous biopsy found necrosis of the eccrine glands and, on culture, P. aeruginosa. The blood count revealed pancytopenia and the myelogram acute lymphoblastic leukemia. All the hemocultures and other microbiological samples were negative. The cutaneous signs had appeared 48 hours after bathing in an aquatic amusement park. Diagnosis of Pseudomonas eccrine hidradenitis, or "Pseudomonas Hot Foot Syndrome" was retained, although the local sanitary authorities were not able to demonstrate P. aeruginosa contamination of the water in the park.

COMMENTS

Lesions evoking juvenile Pseudomonas aeruginosa eccrine hidradenitis without obvious traumatic factor must lead to the search for P. aeruginosa contamination from water and the subsequent sanitary and epidemiological consequences. Furthermore, severe P. aeruginosa cutaneous infections in children must also lead to the search for an underlying immunosuppression and notably an acute leukemic process.

Recurrent palmoplantar hidradenitis with exclusive palmar involvement and an association with trauma and exposure to aluminum dust

Recurrent palmoplantar hidradenitis is a benign, self-limited inflammatory skin condition that has been reported to occur on the soles and palms of otherwise healthy children and young adults. Patients with the disease present with tender, erythematous and edematous plaques and nodules on the palmoplantar skin. We describe a child who had recurrent palmoplantar hidradenitis that occurred after trauma and exposure to aluminum dust and manifested as lesions localized to only the palmar surfaces. This case is presented to add exclusive palmar involvement to the diagnostic spectrum of recurrent palmoplantar hidradenitis and to review the proposed pathogenesis of the disease.

The pseudomonas hot-foot syndrome

BACKGROUND

Between March and May 1998, there was an outbreak of a clinically distinct skin eruption on the soles of the feet of children who used a community wading pool.

METHODS

We reviewed the medical records of 40 children in whom this syndrome developed between March and May 1998. We treated 17 children and advised the attending physicians on the care of the other 23. Follow-up data were obtained for up to one year.

RESULTS

Exquisitely painful erythematous plantar nodules developed in 40 children (age, 2 to 15 years) within 40 hours after they had used a wading pool whose floor was coated with abrasive grit. Culture of the plantar pustules from one child yielded Pseudomonas aeruginosa with a pattern on pulsed-field gel electrophoresis that was identical to that of a strain of P. aeruginosa cultured from the pool water. A skin-biopsy specimen from this patient showed a perivascular and perieccrine neutrophilic infiltrate, and a specimen from another patient showed a dermal microabscess. Thirty-seven patients were treated symptomatically; three others were treated with cephalexin. All patients recovered within 14 days, but three children had recurrences of the painful plantar nodules within 24 hours after using the pool again. Folliculitis developed in one patient.

CONCLUSIONS

The "pseudomonas hot-foot syndrome" is characterized by the acute onset in children of exquisitely tender plantar nodules and a benign, self-limited course. This community outbreak developed after exposure to pool water containing high concentrations of P. aeruginosa.