Dry, cracked and flaky feet are most often seen in tinea pedis and hereditary palmoplantar keratosis. Hereditary palmoplantar keratosis tends to develop in infancy with a family history; it is focal at first, then diffuse after 6 months to 1 year of age, and the lesions are hard, yellowish keratotic plaques with clear borders and a waxy appearance, often with a reddish margin. It is accompanied by pruritus, tenderness or painful cracking, and is more severe in winter.
Tinea pedis occurs on the metatarsals and heels and is diffuse with rough, thickened, flaky, dry skin that is prone to cracking and bleeding in winter and may be painful and itchy. Tests such as fungal microscopy or culture are available if necessary. Clinical differentiation from chronic eczema and psoriasis of the foot is required.