Dermatitis is a general term used to describe inflammation of the skin.
Dermatitis of the foot can be the result a number of different direct and
indirect causes. Direct causes include a contact allergen (e.g. poison
ivy, chemicals) or infectious organism (fungus). Indirect dermatitis is
due to an allergic response without an identifiable cause. And lastly,
dermatitis can be due to insufficient arterial or venous circulation of the leg
and foot.
In adult foot care, the most common source of dermatitis is a chronic fungal
infection of the skin called
dermatophytosis. The
appearance of dermatophytosis resembles dry skin. Dermatophytosis is found
on the sides and soles of the feet. The border of a dermatophytic
infection is often quite distinct showing peeling skin and inflammation.
The fungal organism responsible for dermatophytosis burrows into the skin
causing the red appearance (erythema) we call inflammation. The cause of this
particular form of dermatitis is a fungal organism named tinea rubrum.
Dermatophytosis is often treated unsuccessfully as dry skin. This form of
dermatitis is best treated by changing the environment within the shoe to be
less conducive to the growth of fungus. Fungus thrives in a dark, damp
environment. The creation of a dry, cool environment can make a
significant first step in treatment. This form of dermatitis is also
treated by using a combination of a drying
agent, antifungal shoe spray,
antifungal soap and a
topical antifungal on a daily basis.
Contact dermatitis is another common condition in foot care. Contact
allergens can be any number of chemicals or environmental substances. The
chemicals used in the processing of leather are a common contributing source of
contact dermatitis of the foot. Other direct irritants seen in adult foot
care include cement dust, fertilizers and herbicides. A number of direct
irritants are activated by light exposure and include sun screening agents,
topical antibiotics and aerosol tanning agents. Biological irritants such
as poison ivy and poison oak are also common in foot care. One important
aspect in treating contact dermatitis is a good patient history that recognizes
the patient's occupation and social activities. First and foremost in the
treatment of contact dermatitis though is the identification and removal of the
contributing irritant. This process may not be easy and may include the
discontinuation of any oral medication taken by the patient that may be a source
of systemic skin reaction. Avoid direct sun exposure. Use of an
oral or topical antihistamine may help control any inflammatory reaction. And lastly,
skin softeners need to be used to hydrate
the skin.
Atopic and neurotic dermatitis are two forms of dermatitis also found in
adult foot care. Atopic dermatitis is a category of dermatitis that is
usually associated with allergic disorders such as asthma and hay fever and
immune disorders. Neurotic dermatitis is found in patients who experience
generalized anxiety that results in focal irritation of the skin of the hand or
foot, often both. Atopic dermatitis and neurotic dermatitis are both
treated with topical steroid creams and
skin
softeners. 
Dermatitis secondary to circulatory changes of the feet are common.
Decreased arterial flow to the feet
results in dryness and a brittle appearance of the skin. These findings
are common in older adults. In advanced peripheral arterial disease (PAD),
crusting of the compromised digits occurs. Crusting is also found in acute
cases of circulatory compromise such as frostbite.
Venous stasis dermatitis is common in older adults who have poor venous
return of blood from the feet back up the leg to the heart. This condition
results in pooling of fluids in the lower 1/3 of the leg. This pooling
creates a rough 'orange peel' appearance
of the skin of the leg. The skin
also becomes flakey and dry. Ulcerations of the medial ankle are common.
Treatment for arterial and venous forms of dermatitis focus on the return of
normal blood flow to and from the extremity. For arterial forms of
dermatitis,
skin softeners should be used
on a daily basis. For venous dermatitis, elevation of the legs and
compression hose are used to control swelling of the legs.
Topical skin softeners are also helpful.
Dermatitis of the feet in children should also be noted.
Toe box dermatitis is a
common condition seen in young children, To treat toe box dermatitis, first take a careful look at the materials that
are used to manufacture the shoe. Avoid shoes that contain non-breathable rubber
components. Consider rotating shoes, wearing then only
once every other day. Powders and sprays can help to wick away moisture from the
foot. And lastly, frequent changes of socks will always help.
