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Dermacademy Challenge - Clinical Case #8 - Dr. Philippe Beaulieu
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Clinical case shared by Dr. Philippe Beaulieu
Clinical Presentation
A young, 10-year-old boy was brought to paediatric emergency services for diffuse pain in the arches of both feet. The child is in pain and cannot put his feet on the ground, leading to a functional loss of use of his feet. He cannot stand contact with the sheets. Lesions appeared progressively in 48 hours.
A clinical examination found he was in good general condition and apyrexia.
Physical Examination
Skin lesions are composed of many painful reddish-purple papules and nodules on both arches of the feet.
He does not remember being bitten or walking barefoot in grass.
He plays different sports at school and during his free time rides horses.
No drugs have been taken recently.
Lymph nodes are not enlarged. No hint of sore throat.
Developments
The diagnosis provided was idiopathic eccrine hidradenitis.
Local corticotherapy was initiated.The condition improved rapidly with rest and non-steroidal anti-inflammatories in a few days.
Diagnosis
The diagnosis retained was idiopathic eccrine hidradenitis. Given the very evocative clinical picture, a skin biopsy was not necessary.
Management and outcome
Full recovery was achieved after 2-3 days of taking NSAIDs and resting.
Teaching points
Idiopathic eccrine hidradenitis in children is not very well understood.
- It is bilateral and leads to significant and surprising functional incapacity.
- It is characterised by erythematous papulonodules ranging from 0.5 to 1 cm in diameter located on the soles of both forefeet with cutaneous hyperesthesia (intense pain upon a light touch) making walking impossible.
- Functional incapacity contrasts with the lack of increased volume of the ganglions, lack of a fever, and a good overall condition.
- The evolution is spontaneously and rapidly favourable.
- Treatment with NSAIDs (and in one case paracetamol) and rest.
- A suggestion of local trauma is often found such as prolonged walking with exposure to a cold, humid environment (most traditionally walking in winter after skiing).
Bibliography
- Simon M Jr., Cremer H, von den Driesch P. Idiopathic recurrent palmoplantar hidradenitis in children. Report of 22 cases. Arch Dermatol 1998;134:76-9.2.
- Weigl L, Eberlein-Konig B, Ring J, Abeck D. Is recurrent plantar hidradenitis in children induced by exposure to a wet and cold milieu ? Br J Dermatol 2000;142: 1048-50.3.
- Fiorillo L, Zucker M, Sawyer D, Lin AN. The pseudomonas hot-foot syndrome. N Engl J Med 2001;345: 335-8.
