Bilateral Painful Erythematous Nodules on the Sole

An otherwise healthy 8-year-old boy presented with erythematous and tender nodules on the soles of the feet, leading to difficulty walking (Figure, A). There was no palmar involvement. He had a past medical history of diarrhea without fever during the preceding week. Moreover, he reported repetitive thermal and mechanical trauma playing football and cycling the days before nodules were noted. Blood count, erythrocyte sedimentation rate, and C-reactive protein were normal. Serologic tests were performed to exclude Toxoplasma gondii, Francisella tularensis, Epstein-Barr virus, cytomegalovirus, and enterovirus infections. On the basis of the generally good health of the patient, the medical history and the results of blood tests, a diagnosis of palmoplantar eccrine hidradenitis was made. Because these skin nodules usually resolve spontaneously in a few weeks, the child was treated with analgesics for pain and bed rest. We decided not to perform a skin biopsy and, after 2 weeks, we noted complete resolution of the erythematous nodules (Figure, B). No relapses were reported by his parents during subsequent physical activities.