Pododermatitis (Interdigital Dermatitis) - Page 4

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Pododermatitis (Interdigital Dermatitis)

By: Dr. Rosanna Marsalla

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Diagnosis In-depth

Diagnosis is based on history, clinical signs and histopathology. A thorough physical and dermatological exam is important to evaluate concurrent systemic or skin disease.

  • Distribution of the lesions, nature of lesions and concurrent involvement of the pads and nails, are important to rank differential diagnoses and establish a diagnostic plan.

  • Deep skin scrapings are necessary in all cases of pododermatitis. Fungal cultures of the nails are recommended if nails appear to be deformed or friable.

  • If pads are involved, biopsies are necessary. Changes observed on histopathology are specific for each disease. Old, ulcerated lesions should be avoided. Biopsy should be done on fresh lesions. Several biopsies should be taken to increase the chances of finding characteristic lesions. It is not uncommon to repeat biopsies several times before obtaining a definitive diagnosis. Bacterial infections should be cleared before taking biopsies in order to limit secondary and non-specific changes on histopathology.

  • Fungal cultures of nails may be falsely negative. For this reason, it is important to combine histopathology with the culture. Special stains should be used to identify fungal hyphae in the nails.

  • If a dystrophy of nails is suspected, P3 amputation is necessary to obtain adequate biopsy sample.

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