When A Pediatric Patient Has Severe Itching On Her Heels

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Key Questions To Consider

1. What essential questions does one still need to ask to help make the diagnosis?
2. What is the tentative diagnosis?
3. Can you list at least three differential diagnoses?
4. What features of this condition differentiate it from other conditions in your differential?
5. What is the suitable treatment of this condition?

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By William Fishco, DPM, FACFAS

In Conclusion
History is the most important element in unraveling the diagnosis of skin disorders. Studying pictures of rashes and lesions is helpful for recognition of various disorders. However, many skin conditions can have the same features. For example, fine scaling rashes can include tinea pedis, seborrheic keratosis, stucco keratosis, pityriasis alba, psoriasis, lichen planus and cutaneous drug reactions, just to name a few.
Considerations in a differential diagnosis should include the characteristics of the rash (symmetry, primary/secondary lesions), color, location and history. In this case, a preadolescent girl with a past medical history of allergic rhinitis and environmental allergies presented with a symmetrical, pruitic skin disorder with xerosis on her heels. Tinea pedis and xerosis are relatively rare in very young children.

Dr. Fishco is board-certified in foot surgery and reconstructive rearfoot and ankle surgery by the American Board of Podiatric Surgery. He is in private practice in Phoenix. He is also a faculty member of the Podiatry Institute.

For related articles, see “What You Should Know About Atopic Dermatitis” in the September 2005 issue of Podiatry Today. Also check out the archives at www.podiatrytoday.com.

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