Photo Quiz: Pediatric itching of the lower extremities

Al Kline, DPM1

The Foot & Ankle Journal 1 (5): 7

ISSN 1941-6806
doi: 10.3827/faoj.2008.0105.0007

Case History

An 8 year old male and his 11 year old brother presented to the office with a long history of severe scaling, rash and itching of both ankles. There are itchy, red patches along the back of the knees. (Figs. 1,2)


Figure 1   Areas of scaling, rash and lichenification along the posterior and anterior ankle. (a,b)  The flexural regions of the knees are also affected. (c) (11 year old boy)


Figure 2   Rash, skin dryness and scaling along the posterior leg (a).  Anterior leg scaling with eczematous features (b).  (8 year old boy)

The child’s parents relate to the brothers having the scaling on and off since the children were about 4 or 5 years old. Flare-ups would often be exacerbated during the summer and winter months. In the summer, the children would often swim in the family pool and develop severe regions of itching to both extremities. It was particularly severe in areas of skin folds, particularly to the anterior ankle and back of the knees. In the winter months, the skin would not stay hydrated enough, and the skin would typically get very itchy and secondarily infected from scratching. This would leave the skin with crusts and lichenified regions of skin after scratching.

The children would often have areas of skin that would not tan or pigment after these flare-ups. (Fig. 3)


Figure 3   Regions of post inflammatory hypopigmentation to the arms.    (8 year old boy)

Question: Based on the patient’s clinical history, which of the following is the correct diagnosis?

A. Eczema
B. Winter’s itch
C. Pediatric Atopic Dermatitis
D. Food allergy
E. Hypersensitivity skin reaction
F. All of the above


Address correspondence to: Dr. Al Kline, DPM, 3130 South Alameda, Corpus Christi, Texas 78404. E-mail:

1Adjunct Clinical Faculty, Barry University School of Podiatric Medicine. Private practice, Chief of Podiatry, Doctors Regional Medical Center. Corpus Christi, Texas, 78411.

© The Foot & Ankle Journal, 2008