[Your Practice Letterhead/Address]
[Your Phone Number]
[Your Fax Number]
April 3, 2025
To: Dr. [DOCTOR_NAME]
[Family Doctor's Practice Address]
[Family Doctor's Fax Number]
Regarding: [PATIENT_NAME]
Date of Birth: [PATIENT_DOB]
Date of Service: [VISIT_DATE]
Subject: Podiatric Evaluation and Management Plan for Plantar Verruca and Juvenile Plantar Dermatitis
Dear Dr. [DOCTOR_NAME],
Thank you for allowing me to participate in the care of your patient, [PATIENT_NAME], whom I evaluated in my clinic on [VISIT_DATE]. He presented with concerns described as "corns and some sort of dermatitis."
History
[PATIENT_NAME] is a 12-year-old male with a history of juvenile plantar dermatitis since approximately age 6 (2018). He reported previous treatment with steroid creams in Bahrain, which provided temporary improvement. More recently, a plantar lesion developed approximately 3 months ago, which has shown minimal response to over-the-counter wart/corn remedies. The patient is active, participating in swimming and taekwondo. His mother noted previous episodes where the dermatitis involved deep, bleeding cracks, although this has improved.
Clinical Findings
On examination, a primary plantar lesion was identified on a weight-bearing surface. The lesion exhibited characteristic black speckles (thrombosed capillaries), confirming it as a plantar verruca (wart). A smaller satellite verruca was noted nearby. Examination also revealed bilateral ankle dermatitis consistent with juvenile plantar dermatitis, which appeared less severe than historically described, with no active fissures or bleeding observed during this visit.
Assessment
Plantar Verruca: Diagnosis confirmed based on clinical appearance (thrombosed capillaries). Differential diagnosis of corn (heloma dura) was ruled out.
Juvenile Plantar Dermatitis: Chronic condition, currently showing signs of improvement compared to previous descriptions.
Treatment Plan
Given the patient's anxiety regarding excision and the mother's preference for a conservative approach, the plantar verruca was treated as follows:
Superficial debridement of the verrucous tissue.
Application of Cantharidin cream directly to the verrucae.
Occlusive dressing applied.
The patient and his mother were instructed to remove the dressing after 24 hours and gently cleanse the area with soap and water. They were advised that blistering is an expected outcome of Cantharidin treatment.
For the juvenile plantar dermatitis, continued diligent moisturization was recommended.
The patient was advised he could continue his normal activities, including swimming and taekwondo, but should try to maintain the integrity of the dressing during the initial 24-hour period. He was cautioned against picking or manipulating the treated area.
Follow-Up
[PATIENT_NAME] is scheduled to return to my clinic in 3 weeks for reassessment of the verruca and potential further treatment if required. We will monitor for reduction in size, decreased vascularity, and any signs of excessive blistering or secondary infection.
Thank you for entrusting [PATIENT_NAME] to my care. I will keep you updated on his progress. Please do not hesitate to contact me should you have any questions.
Sincerely,
[PROVIDER_NAME], [PROVIDER_CREDENTIALS]