Plantar Lesions Research Articles

Automated Nonlinear Feature Generation and Classification of Foot Pressure Lesions

Plantar lesions induced by biomechanical dysfunction pose a considerable socioeconomic health care challenge, and failure to detect lesions early can have significant effects on patient prognoses. Most of the previous works on plantar lesion identification employed the analysis of biomechanical microenvironment variables like pressure and thermal fields. This paper focuses on foot kinematics and applies kernel principal component analysis (KPCA) for nonlinear dimensionality reduction of features, followed by Fisher's linear discriminant analysis for the classification of patients with different types of foot lesions, in order to establish an association between foot motion and lesion formation. Performance comparisons are made using leave-one-out cross-validation. Results show that the proposed method can lead to approximately 94% correct classification rates, with a reduction of feature dimensionality from 2100 to 46, without any manual preprocessing or elaborate feature extraction methods. The results imply that foot kinematics contain information that is highly relevant to pathology classification and also that the nonlinear KPCA approach has considerable power in unraveling abstract biomechanical features into a relatively low-dimensional pathology-relevant space.

Plantar Melanoma That Mimics Melanocytic Nevi: A Report of 4 Cases With Lymph Node Metastases and With Review of Positive and Negative Controls

We report 4 cases of melanoma localized on the sole with some striking histological similarities to the compound nevi. One case showed inguinal lymph node metastases after a diagnosis of compound nevus made 5 years earlier. The other 3 cases were sent to us in consultation as suspected plantar lesions; a diagnosis of melanoma mimicking compound nevus was proposed: the sentinel lymph node technique was accordingly performed and resulted positive. These 4 index cases were compared with 26 cases of ordinary plantar melanoma and with 117 cases of benign compound plantar nevi. Histologically, the similarity of areas of these 4 cases of plantar melanoma to compound plantar nevi (namely Miescher, Clark, or acral lentiginous nevus) is so close that it may prove misleading in the diagnostic pathway. In such cases, an erroneous diagnosis of benign lesion may be made. The correct diagnosis of melanoma can, however, be done by combining the clinical and pathological findings. In fact, this deceptive form of melanoma mimicking a compound nevus is characterized by patients' advanced age (>45 years), large lateral diameters (>10 mm), and significant depth of the lesion (>1 mm). In our 4 cases, such features were combined with one or more of the following histological clues: lentiginous (ie, continuous) proliferation of enlarged and hyperchromatic melanocytes aligned in single units at the dermoepidermal junction; extensive eccrine duct melanocytic infiltration; dermal melanocytes with slight nuclear enlargement, nuclear membrane thickening and folding, and conspicuous central nucleoli; and cellular pleomorphism of the epidermal and dermal component. Moreover, mitotic figures were an inconstant but decisive indication of malignancy. In conclusion, a small group of plantar melanoma has striking similarities with compound nevi. Only the correlation of clinical data (old age of the patient and large size of the lesion) with subtle architectural and cytological alterations (depth of the lesion, lentiginous melanocytic epidermal and eccrine proliferation, and cellular alteration and mitoses) allows a correct diagnosis.

Distribution and correlates of plantar hyperkeratotic lesions in older people

BackgroundPlantar hyperkeratotic lesions are common in older people and are associated with pain, mobility impairment and functional limitations. However, little has been documented in relation to the frequency or distribution of these lesions. The aim of this study was to document the occurrence of plantar hyperkeratotic lesions and the patterns in which they occur in a random sample of older people.MethodsA medical history questionnaire was administered to a random sample of 301 people living independently in the community (117 men, 184 women) aged between 70 and 95 years (mean 77.2, SD 4.9), who also underwent a clinical assessment of foot problems, including the documentation of plantar lesion locations, toe deformities and the presence and severity of hallux valgus.ResultsOf the 301 participants, 180 (60%) had at least one plantar hyperkeratotic lesion. Those with plantar lesions were more likely to be female (χ2 = 18.75, p < 0.01; OR = 2.86), have moderate to severe hallux valgus (χ2 = 6.15, p < 0.02; OR = 2.95), a larger dorsiflexion range of motion at the ankle (39.4 ± 9.3 vs 36.3 ± 8.4°; t = 2.68, df = 286, p < 0.01), and spent more time on their feet at home (5.1 ± 1.0 vs 4.8 ± 1.3 hours, t = -2.46, df = 299, p = 0.01). No associations were found between the presence of plantar lesions and body mass index, obesity, foot posture, dominant foot or forefoot pain. A total of 53 different lesions patterns were observed, with the most common lesion pattern being "roll-off" hyperkeratosis on the medial aspect of the 1st metatarsophalangeal joint (MPJ), accounting for 12% of all lesion patterns. "Roll-off" lesions under the 1st MPJ and interphalangeal joint were significantly associated with moderate to severe hallux valgus (p < 0.05), whereas lesions under the central MPJs were significantly associated with deformity of the corresponding lesser toe (p < 0.05). Factor analysis indicated that 62% of lesion patterns could be grouped under three broad categories, relating to medial, central and lateral locations.ConclusionPlantar hyperkeratotic lesions affect 60% of older people and are associated with female gender, hallux valgus, toe deformity, increased ankle flexibility and time spent on feet, but are not associated with obesity, limb dominance, forefoot pain or foot posture. Although there are a wide range of lesion distribution patterns, most can be classified into medial, central or lateral groups. Further research is required to determine whether these patterns are related to the dynamic function of the foot or other factors such as foot pathology or morphology.

Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial.

BackgroundFalls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article describes the design of a randomised trial to evaluate the efficacy of a multifaceted podiatry intervention to reduce foot pain, improve balance, and reduce falls in older people.MethodsThree hundred community-dwelling men and women aged 65 years and over with current foot pain and an increased risk of falling will be randomly allocated to a control or intervention group. The "usual cae" control group will receive routine podiatry (i.e. nail care and callus debridement). The intervention group will receive usual care plus a multifaceted podiatry intervention consisting of: (i) prefabricated insoles customised to accommodate plantar lesions; (ii) footwear advice and assistance with the purchase of new footwear if current footwear is inappropriate; (iii) a home-based exercise program to strengthen foot and ankle muscles; and (iv) a falls prevention education booklet. Primary outcome measures will be the number of fallers, number of multiple fallers and the falls rate recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the Medical Outcomes Study Short Form 12 (SF-12), the Manchester Foot Pain and Disability Index, the Falls Efficacy Scale International, and a series of balance and functional tests. Data will be analysed using the intention to treat principle.DiscussionThis study is the first randomised trial to evaluate the efficacy of podiatry in improving balance and preventing falls. The trial has been pragmatically designed to ensure that the findings can be generalised to clinical practice. If found to be effective, the multifaceted podiatry intervention will be a unique addition to common falls prevention strategies already in use.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12608000065392

The evidenced-based approach to treating podiatric conditions with Marigold therapy and homeopathy

It is acknowledged that a number of podiatric disorders seen in foot clinics are relieved only in the short term by traditional treatments, necessitating regular attendance every few weeks. Some chronic conditions do not respond to traditional treatments. The chemical and surgical treatments commonly used in podiatric practice are invasive and can cause pain or discomfort, especially in the case of post-operative complications of surgery. Some treatments are contraindicated for patients who are at risk, e.g. diabetics and the elderly. Homeopathic podiatry is a method of treatment for conditions of the skin, bones and nails that were developed by Dr. M. Taufiq Khan, combining homeopathy with podiatric practice. An integral part of the speciality is Marigold therapy, a painless, non-invasive form of topical treatment, which has been researched and developed by combining homeopathic medicinal plants such as Symphytum officinalis, Thuja occidentalis, Ruta graveolens, Rosemary officinalis, Bellis perennis, Hypericum perforatum and Calendula officinalis with different species of Tagetes . Homeopathic and biochemical medicines are prescribed orally when indicated. The topical preparations are in the form of paste, tincture, oil, ointment and cream. Treatment consists of weekly applications of the paste for 2–4 weeks, followed by the use of tincture, oil, ointment or cream applied by the patient as a preventative measure. The effectiveness and safety in the treatment of foot disorders have been demonstrated clinically and in double-blind placebo-controlled trials. Double-blind placebo-controlled studies to investigate hyperkeratotic plantar lesions, hallux valgus and verruca pedis have shown a level of significance giving P

Lésions dégénératives du complexe métatarso-sésamoïdo-phalangien

The aim of this work was to determine the frequency and the location of the degenerative lesions of the hallucal metatarsophalangeal joint in an elderly population. Our results help us to precise the anatomic characteristics of that articular complex. Our material comprised 21 feet from embalmed cadaver specimens. We studied the morphometrical parameters for the anatomic description of the first metatarsophalangeal joint of the forefoot. After complete dissection, a specific articular zone-mapping was made with a quantitative evaluation of the chondral lesions. The measurements of the morphometrical parameters were in accordance with the literature data. The sesamoidal chondral lesions were more frequent for the medial sesamoid and at the proximal zone of the articular surface. The plantar metatarsal lesions were very frequent with diffuse or distal groove damage, and crista damage linked to the sesamoidal strap dislocation. The lesions involving the metatarsophalangeal compartment were less frequent and rather at the dorsal zone. The degenerative lesions of the metatarso-sesamoido-phalangeal complex are nearly systematic in n elderly population. The morphological aspect of these lesions is very characteristic of the articular function and allows us to precise the biomechanic constraints.

Acral lentiginous melanoma of the foot and ankle: A case series and review of the literature

BackgroundAcral lentiginous melanoma (ALM) is an uncommon, cutaneous malignant tumour which may arise on the foot. Its relative rarity, atypical appearance and late presentation frequently serve as poor prognostic indicators.MethodsAt a tertiary skin tumour centre, a retrospective review was undertaken of all patients diagnosed with the tumour at the level of ankle or below.ResultsOver a six year period, 27 cases (20 female, 7 male) were identified with positive histology confirming the disease. The age ranged from 35–96 years of age (mean 62.7 years). The majority of the cohort were white (59%) with plantar lesions (62%). 33% of patients were initially were diagnosed incorrectly. The average time taken from the point of recognition, by the patient, to the lesion being correctly diagnosed was around 13.5 months.ConclusionEarlier diagnosis of ALM requires education at both a patient and practitioner level.

Videodermatoscopy Enhances the Diagnostic Capability of Palmar and/or Plantar Psoriasis

To determine if videodermatoscopy (VD), by evaluation of superficial vascular patterns, may be helpful in the diagnosis of psoriasis in a series of subjects affected by palmar and/or plantar dermatoses with no readily apparent diagnostic features. Thirty-two subjects (12 male/20 female, mean age 50 years, range 20-72 years) were sequentially enrolled in an open-label study involving a single visit. Inclusion criteria were the presence of clinically nonspecific, active, and untreated palmar and/or plantar erythematous scaly lesions with no other skin involvement. Exclusion criteria were the presence of co-morbid disorders, excessive hyperkeratosis and/or pustular lesions, and the use of systemic and/or topical drugs within 4 and 2 weeks of study entry, respectively. A videodermatoscope equipped with a zoom lens that allowed magnifications from x50 to x200 was used for vascular pattern evaluation. A skin biopsy for hematoxylin and eosin staining was taken from each patient. In 15 subjects, VD examination at magnification x50 showed the presence of pinpoint-like capillaries linearly arranged along the furrows of dermatoglyphics; at magnification x200, the same capillaries appeared to be dilated and tortuous, with a 'bushy' homogeneous aspect in all examined fields, suggesting a diagnosis of psoriasis, as confirmed by histologic examination. In the remaining 17 subjects, no evidence of 'bushy' capillaries was present at magnification x200 VD examination; in these patients, a diagnosis of eczema was established by histology. Although further investigations in larger series are necessary to confirm these findings, and to provide further information about the specificity and sensitivity of the method, our study has indicated that analysis of superficial vascular patterns by VD may represent a promising, non-invasive diagnostic tool in palmar and/or plantar psoriasis.

Paracoccidioidomycosis presenting in the U.K.

Conflicts of interest: none declared. Sir, A 51‐year‐old British man presented to the Hospital for Tropical Diseases with a 7‐month history of plantar pruritus and painful cutaneous lesions on his legs, face and feet. The lesions had bled and discharged at times. He had also lost 20 kg in weight and complained of cough and dyspnoea. There was no significant medical history and he was not taking any medications. He smoked 30 cigarettes per day and drank moderate amounts of alcohol. He had worked as an accountant in Maracaibo and Caracas in Venezuela for 20 years and had visited rural areas on business. He returned to the U.K. 2 months after the onset of this illness. On examination, he was afebrile, cachectic but in no acute distress. There were tender erythematous and purpuric macules and exophytic verrucous nodules on the legs and feet bilaterally (Fig. 1a, b). A hyperkeratosis of both plantar regions was noted. The oral cavity was normal but there were small hyperkeratotic nodules adjacent to the commissures. Respiratory examination revealed widespread coarse crackles and wheeze throughout both lung fields. The liver was palpable 4 cm below the right costal margin.

The effect of urea 40% nail film on digital and plantar foot hyperkeratotic lesions

The effect of urea 40% nail film on digital and plantar foot hyperkeratotic lesions

Abnormal radiographic findings in 865 French Standardbred trotters and their relationship to racing performance

Developmental orthopaedic lesions are commonly found in French Standardbred horses. One of the main questions asked by trainers, owners and veterinarians is what impact these lesions have on the racing career and racing performances of horses. To study the prevalence and distribution of developmental orthopaedic lesions in young French Standardbred trotters and to relate them to racing performance. Feet, fetlock, tarsus and stifle regions were radiographed in 865 two-year-old French Standardbred trotters. Abnormal radiographic findings (ARF) were evaluated for 12 anatomical sites identified in these areas, and a severity index given. Performance criteria were: success in qualification for racing, maximal and mean index of trot (ITR), an annual index calculated on the basis of the logarithm of earnings per starts, total earnings at 5 years, placed races compared to starts and longevity of the racing career. Analysis of variance were calculated to study the relationships between racing performance and the number of ARF or the severity index. A total of 363 horses (42.0%) showed ARF. Prevalence of ARF was 18.3% in the plantar aspect of the hind fetlock and 10.6% in the proximal tarsus. Among the total population, 833 horses were considered for performance evaluation, 478 of them were qualified for racing. The number of ARF significantly affected racing longevity. However, the number of ARF did not affect performance categories according to maximal ITR. Concerning distribution of ARF, the number of plantar lesions in the fetlock significantly affected mean ITR. The index of severity did not provide more information for prognosis than the number of ARF. Longevity is the only criteria affected by ARF. When evaluating different sites, only the plantar fetlock region showed a significant relationship with mean ITR. Number of ARF and radiographic score (RS) affect mean ITR and longevity but do not affect maximal ITR. A horse with a good racing ability will be a good performer but might have a racing career shortened because of orthopaedic problems in relation to developmental orthopaedic lesions.

Risk Factors for Erysipelas of the Leg in Tunisia: A Multicenter Case-Control Study

Background: Risk factors for erysipelas (cellulitis) were rarely evaluated in controlled studies. Regional variations of these risk factors have never be assessed. Objective: To assess risk factors for erysipelas of the leg in Tunisia. Subjects and Methods: Case-control study in seven hospital centers in Tunisia. Cases were 114 consecutive patients with erysipelas of the leg [sudden onset (<24 h) of a well-demarcated dermo-hypodermatitis with fever or chills]. Two controls were matched to each case for age, sex, and hospital (n = 208). Main outcome measures are local and general suspected risk factors for erysipelas of the leg. Results: In multivariate analysis, disruption of the cutaneous barrier (i.e. traumatic wound, toe-web intertrigo, excoriated leg dermatosis or plantar squamous lesions) and leg edema were independently associated with erysipelas of the leg, with respective odds ratios of 13.6 (95% confidence interval: 6.0–31) and 7.0 (1.3–38). No association was observed with diabetes, alcoholism, or smoking. Conclusions: We confirmed the major role of local risk factors and the minor role of general risk factors for erysipelas of the leg, in a setting different than the one previously studied. Detecting and treating toe-web intertrigo and traumatic wounds should be considered in the prevention of erysipelas of the leg.

Acral (volar-subungual) melanoma in Auckland, New Zealand.

We have retrospectively reviewed the charts of 34 acral melanoma patients (melanoma arising from the volar skin of the hands, feet or a subungual site) seen in the Auckland area between 1970 and 1985. These 34 patients constituted 3.5 per cent of the total number of patients (972) reviewed over this period. Six of the thirty-four patients were either Polynesian or Maori. There were 19 men and 15 women, and the mean age of the group was 59 years. The primary lesion arose from the plantar or palmar skin in 25 patients and 9 patients had subungual lesions. All lesions but one were pigmented. Most patients with plantar or palmar lesions presented with clinical stage 1, Clark's level 4 disease, while those with subungual lesions presented most commonly with stage 2, Clark's level 5 disease. Treatment was wide local resection for plantar and palmar lesions and amputation for subungual lesions. Regional lymph node dissection was performed in 10 patients with positive nodes at presentation and in 6 patients who developed metachronous nodal disease. Patients were followed for between 1 and 16 years, and 18 patients died in this period, 15 of metastatic melanoma (mean time 34 months). Subungual melanoma carried a worse prognosis than melanoma arising in palmar or plantar skin.

Plantar melanoma in black South Africans.

The outcome of treatment in 40 black patients (27 women, 13 men; mean age 62.9 years) with plantar melanoma over a 13-year period was analysed to evaluate the efficacy of wide local excision with split skin grafting. Substantial delay in seeking medical attention occurred in 35 patients. At presentation, 20 patients had stage I disease, one stage II, 15 stage III and four stage IV. Acral lentiginous melanoma (27 patients) was the most common histological type. The mean Breslow depth was 6.9 mm and 35 patients had lesions of Clark level IV or V. The mean surface area or plantar lesions was 13.3 cm2. Wide local excision with split skin grafting was used in 29 patients; four patients with neglected advanced plantar lesions had below-knee amputation and seven with metastatic disease did not undergo surgery. Graft sepsis occurred in six patients and local recurrence in two. Nine patients were alive at follow-up; the 5-year survival rate was 25 per cent. Delay in presentation and locally advanced disease may explain the poor prognosis of plantar melanoma in black South Africans.

Clinical Utility of Sonography in Diagnosing Plantar Fasciitis

The purpose of this study was to investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain. Seventy-seven patients with unilateral (n = 9) and bilateral (n = 68) heel pain were studied. Seventy-seven age- and sex-matched asymptomatic subjects served as a control group. Magnetic resonance imaging was used to establish a diagnosis of PF with sagittal T1-weighted, T2-weighted, and short tau inversion recovery sequences. The sonographic appearances of PF were compared with MRI findings. Plantar fascia and heel pad thickness were also measured on both imaging modalities. Compared with MRI, sonography showed 80% sensitivity and 88.5% specificity in assessing PF. A strong correlation was found between plantar fascia and fat pad thickness measurements done by sonography (P < .001; r = 0.854) and MRI (P < .001; r = 0.798). Compared with the asymptomatic volunteers, patients with PF had significant increases in plantar fascia and heel pad thicknesses, weight, and body mass index (P = .0001). Heel pad thickness was also significantly increased with pain duration (P = .021). Although MRI is the modality of choice in the morphologic assessment of different plantar fascia lesions, sonography can also serve as an effective tool and may substitute MRI in the diagnosis of PF.

Clinical characteristics and evolution of syphilis in 24 HIV+ individuals in Rio de Janeiro, Brazil

A total of 24 patients with syphilis and HIV infection were treated from January 1997 to March 2003 at the Infectious Dermatology Outpatient Clinic of the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. The caseload consisted of 20 males (83.3%) and four females (16.7%), with a mean age of 38.04 years and mean T CD4+ count of 389.5 cells/mL. Syphilis was diagnosed as secondary in 16 (62.5%) patients, late latent in eight (33.3%), and tertiary in one (4.2%). Manifestations of secondary syphilis were palmar and plantar erythematopapulous cutaneous lesions in nine (37.5%), papulous exanthema in four (16.7%), patchy alopecia in 3 (12.5%) and osteochondritis in one patient (4.2%). Tertiary syphilis was characterized by verrucous lesions. Neurosyphilis was diagnosed in four patients (16.7%), with headache as the only manifestation in two patients. Drugs used in treatment included benzathine penicillin, ceftriaxone, erythromycin, and crystalline penicillin. Cure was achieved in 18 patients (75%). Five patients (20.8%) were retreated, three of whom presented a history of re-exposure. This study confirms the importance of establishing the diagnosis of neurosyphilis in patients with HIV infection, in addition to performing follow-up on treatment for syphilis.

Focal palmoplantar and gingival keratosis: A distinct palmoplantar ectodermal dysplasia with epidermolytic alterations but lack of mutations in known keratins

Focal palmoplantar and gingival keratosis is a rare autosomal dominant disease whose clinical features, and in particular, pathologic alterations and molecular etiology remain to be well defined. Recently we observed a German family affected by the disease in at least 3 consecutive generations. The 4 patients examined showed circumscribed and painful hyperkeratosis at the weight-bearing plantar skin since infancy, rather mild palmar hyperkeratosis, and continuous leukokeratosis confined to the maxillary and mandibulary attached gingiva. There were no nail changes, subungeal keratoses, or follicular hyperkeratosis. Light and electron microscopy of the plantar and gingival lesions revealed alterations of epidermolytic hyperkeratosis. Mutations in the known keratin genes were excluded by linkage analysis using microsatellite markers. We conclude that focal palmoplantar and gingival keratosis is a clinically distinct palmoplantar ectodermal dysplasia that is pathologically characterized by epidermolytic alterations, but is most probably not caused by a mutation in a keratin gene.

Topical 0.25% Methotrexate Gel in a Hydrogel Base for Palmoplantar Psoriasis

Palmoplantar psoriasis (PPP) is a chronic, disfiguring condition, and its management is difficult. The systemic side effects of methotrexate can be avoided if it is effective topically. We studied the efficacy and safety of a recently marketed topical methotrexate (0.25%) preparation in a hydrogel base in patients with palmoplantar lesions. A total of 14 adult patients diagnosed clinically as plaque type of palmoplantar psoriasis (>30% of the palm and/or sole areas involved) were included in the study. Topical methotrexate 0.25% in a hydroxygel base was applied twice daily to the lesions for twelve weeks. The lesions were assessed for degree of erythema, scaling, induration and fissuring (ESIF) and were scored on a severity score of 0-3 (0--clear, 1--mild, 2--moderate, 3--severe) every two weeks. The most severe condition was given 12 points; 0 denoted no disease. The response at the end of the study was graded as minimal if there was up to 25% reduction in the EISF score, mild as 26-50% reduction, moderate improvement as 51-75% reduction in score, and marked improvement as >75% reduction in score. The average age of the 11 male and female patients was 41.5 years (18-57 years) with the duration of the disease varying from 2 months to 15 years. Ten patients had both palmar and plantar lesions; two each had only palmar lesions or plantar lesions. The ESI score at baseline was 5.8 +/- 0.9 for the palms and 6.8 +/- 0.5 for the soles. The scores at the end of the study were 3.5 +/- 0.7 for palms and 4.8 +/- 0.2 for the soles. The average time taken for improvement was at least six weeks. None of the patients had complete clearance of lesions. The drug was well tolerated by all patients. Methotrexate 0.25% in a hydrophilic gel is well tolerated but is not very effective in controlling the lesions of psoriasis on the palms and soles. A higher concentration in a different base with better penetration could possibly provide better results.

Arcuate plantar plaques as the initial sign of chronic cutaneous lupus in a child

A 9-year-old girl was initially seen with bilateral mildly pruritic plantar skin lesions. Skin biopsy demonstrated a superficial and deep perivascular lymphoid infiltrate with mucin but was not specific. Laboratory evaluation revealed a mildly elevated antinuclear antibody and mild leukopenia. Over the following year, an annular skin lesion developed in the preauricular area, her antinuclear antibody titer rose, and she was found to have positive anti-SS-B antibodies. She responded to oral hydrochloroquine with resolution of her skin lesions. This report highlights the unusual presentation of a case of chronic cutaneous lupus with a plantar skin eruption.

Tinea nigra: relato de seis casos no Estado do Paraná

Seis casos de Tinea nigra diagnosticados no Serviço de Dermatopediatria do Hospital de Clínicas de Curitiba, UFPR, no período entre 1978 e 2001 são descritos. Trata-se de quatro crianças em idade escolar que tiveram contato com areia da praia e dois adolescentes. Em um dos casos as lesões são de localização plantar bilateral, configurando o primeiro desse tipo relatado na literatura nacional.