IPJ skin changes in Afro-Caribbean feet

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All,

This summer I have had 3 or 4 patients who whilst in for musculoskeletal complaints mentioned in passing during subjective history taking that they were slightly bothered by the aesthetic appearance of their feet, particularly whilst in flip flops.

Usually evident with this scenario has been some skin change (?depigmentation) over the dorsum of the PIPJs/DIPJs, and often no hyperkeratosis noted. I have always just attributed this to chronic low level toe box trauma whilst shod, and informed that it is unlikely to significantly improve, but appropriate footwear could prevent it from deteriorating (visually) further.

However since the last lady I broke this news to burst into uncontrollable tears, I wondered if maybe I should find out if there is anything anyone else says/recommends in these situations?

 

A big box of tissues?!

I have seen this appearence too - just thought it was normal? The same as caucasian skin develops red patches in the same areas?

 

I come across this problem frequently in my practice which is situated in an area with a high Afro-Caribbean and Asian population. The typical patient is a young female who complains of ‘corns’ which are not always painful and has tried corn plasters to remove them (this increases the size of the pale areas). They often wear heels or ballet type shoes and sometimes present with digital deformities or just have long toes. I believe the pale areas of skin (with or without callus) are caused by dorsal friction and/or pressure resulting in a reduction of melanin in the epidermis. This can also occur in Asian skin however dorsal callus and corns do not always result in depigmentation in black and darker pigmented skin types. Perhaps it is the corn plasters that remove a layer of cells that contain melanin?
It is the aesthetic appearance that concerns the patient the most particularly wearing sandals in the summer. I recommend pressure reduction, moisturising the areas and cushioning with gel covers in the long term. To disguise the pale areas in the short term I have been informed by a patient that Henna can be used. Applying layers of Henna will create an increasingly darker shade. I have also been told that Eyebrow tinting dye works very well and is easier to apply. There are many shades available on the internet and they usually last up to 6 weeks. Removing the entire callus is essential for the dye to be absorbed and care should be taken not to overlap it onto the surrounding skin.
I hope this helps others even if it has taken 5 years to reply to this thread.
I am still puzzled why anyone would want to dye their eyebrows? Personally I am not a fan of the Alistair Darling look!