What is chronic foot eczema?
Chronic foot eczema is a common inflammatory skin condition that can significantly impair patients' quality of life, affecting their daily activities, work capacity, and overall well-being [1, 2]. Although many people associate foot problems with fungal infections (mycoses), eczema is a distinct condition that requires a specific approach to diagnosis and treatment. It is important to understand that eczema is not a fungal infection, although their symptoms can sometimes be similar.
Diagnosis and causes of foot eczema
Thorough diagnosis is crucial for the effective treatment of chronic foot eczema. The physician needs to take a detailed medical history, paying special attention to potential contact with irritants and allergens [2]. Patch testing is a standard diagnostic method to identify contact allergy, which may cause or exacerbate eczema [2].
Foot eczema can be caused by various factors, including:
- Atopic dermatitis (genetic predisposition)
- Contact dermatitis (reaction to irritants or allergens, such as metals, chemicals, or shoe components)
- Irritant dermatitis (skin damage due to frequent contact with water or detergents)
Accurate identification of the type of eczema and its triggers allows for the development of the most effective treatment strategy.
Symptoms and impact on quality of life
The primary symptom of eczema is itching (pruritus), which can be very intense and debilitating [5]. In addition to itching, foot eczema manifests as redness, dryness, scaling, fissures, skin thickening, and blister formation. These symptoms can cause significant discomfort and pain, making it difficult to walk, wear regular shoes, and perform daily tasks. Chronic foot eczema can lead to missed work or school, reduced productivity, and a diminished overall quality of life [1].
Modern approaches to the treatment of foot eczema
Managing chronic foot eczema is often challenging, and many patients experience dissatisfaction with available options [2]. However, recent advancements in dermatology offer new opportunities to control this condition.
Topical therapy:
- Moisturizers and emollients: The foundation of skin care in eczema, helping to repair the skin barrier [1].
- Topical steroids: Potent anti-inflammatory agents used to manage flare-ups. For moderately severe symptoms (e.g., DLQI ≥ 10), potent or super-potent topical corticosteroids are frequently prescribed [2].
- Non-steroidal anti-inflammatory agents: Can be used in combination with corticosteroids or as maintenance therapy. For example, in one study, the combination of Dexyane Med and topical mometasone showed significant improvement in patients with chronic hand eczema and contact eczema [6].
Systemic therapy:
In cases where topical treatment is ineffective or the eczema is severe, systemic medications may be prescribed. Discussion of individual treatment goals, including systemic therapy, should begin early in the patient interaction, with the primary goal being functional restoration, while skin clearance is secondary [2].
New therapeutic targets and drugs are emerging among systemic agents. For example, apremilast, a phosphodiesterase-4 inhibitor that modulates the immune system, is approved for the treatment of psoriasis and psoriatic arthritis, and is also used "off-label" for other dermatological conditions when standard treatments fail [7]. Although apremilast is not directly mentioned for foot eczema in these sources, its use in dermatology demonstrates the evolution of systemic approaches [7].
Difference between eczema, nail fungus, and other conditions
It is critical to distinguish foot eczema from other conditions such as fungal infections (mycoses) or psoriasis. Nail fungus (onychomycosis) affects the nail plate, causing it to thicken, change color, and crumble. Foot skin fungus (tinea pedis) can present with scaling, itching, and redness, but its nature is infectious rather than inflammatory like eczema.
Itching, although the primary symptom of eczema, also accompanies many other dermatological and systemic diseases, including atopic dermatitis, psoriasis, contact dermatitis, urticaria, and even certain internal illnesses [5]. Therefore, if itching and rashes appear on the feet, a consultation with a dermatologist is necessary for accurate diagnosis and prescription of appropriate treatment. Antihistamines, often used for itching, have a limited role in eczema and are more effective in urticaria or drug reactions [5].
Comprehensive approach and support
Managing chronic foot eczema goes beyond simple pharmacological treatment. It requires a comprehensive approach that includes eliminating or avoiding causative factors, behavioral changes, and social support [2]. Discussion of each new treatment method, when necessary, should be considered as an addition or overlay to any previous therapy [2].
Remember that self-medication can be ineffective and even dangerous. Only a qualified specialist can make the correct diagnosis and select an individual treatment plan.
Sources
- [1] A Review of Existing and New Treatments for the Management of Hand Eczema. https://pubmed.ncbi.nlm.nih.gov/37496489/
- [2] Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. https://pubmed.ncbi.nlm.nih.gov/32776537/
- [5] [Translated article] Pruritus in Dermatology: Part 2-Diseases and Their Treatment. https://pubmed.ncbi.nlm.nih.gov/37302478/
- [6] What's new in the treatment of eczemas. https://pubmed.ncbi.nlm.nih.gov/29050445/
- [7] Apremilast in dermatology: A review of literature. https://pubmed.ncbi.nlm.nih.gov/32876993/
The information provided in the article is for reference purposes only and cannot replace professional medical advice. Always consult a specialist for diagnosis and treatment.