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raw,dry,cracked,leathery skin on bottom side of my foot

by Hanna
(Idaho)

dyshidrosis?

dyshidrosis?

it started about a year and a half ago and i noticed a patch of raw,dry,cracked,leathery skin on bottom side of my right foot, in the big toe area. The patch was about the size of a dime, and everyday the patch would spread more and more then it started moving to my left foot, the same place it had started on my right foot. My feet kept getting cuts because the skin was so thin. So after a couple of months I decided to go to the doctor (it wasn't a dermatologist) and they said it was dyshidrosis and so they gave me this cream. it didn't work so i was wondering if i need to go see a dermatologist? or if you could tell me the answer that would be great.


RESPONSE

Hi Hannah,

Without being able to question you and with inherent limitations of looking at a picture, diagnosing skin conditions is very difficult.

Your primary care doctor made a diagnosis of dyshidrosis, also known as pompholyx. This condition is generally seen in the feet and hands, although does not have to occur in both at the same time. Additionally, the patient usually complains of severe itching and the formation of pustules which are small blisters that are seen in the area. Once these blisters dry out or are broken from scratching the skin will become red and scaly.

It is thought that emotional stress may play a role. Years ago dyshidrosis was associated with feet and hands that perspire quite a bit but that correlation has never been fully proven.

You did not mention your symptoms other than the appearance of your foot, so I do not know if you had any of the symptoms I just described. If not, then I am guessing this is not dyshidrosis.

Obviously you have an eczema or skin rash of some sort and if you have done any research you are probably aware that there are many different types so by just looking at a picture I cannot really tell what is going on, but I would like to give you some insight in to issues that could be causing your problem, because many times simply applying cream without eliminating other issues, will not clear up the skin irritation.

The nature of feet makes them prone to dermatological issues simply because of the fact that they are subject to being in shoes for most of the day. Being in a closed shoe, particularly if your feet tend to perspire, creates a dark moist environment for your feet which can promote all kinds of skin conditions.

The other factor that needs to be addressed is the inner materials of the shoes that you wear. Many people can have reactions to the materials which make up the innersole of their shoes. Along with a reaction to the actual materials, depending on the way you walk, there can be created what are known as shearing forces or essentially grinding of parts of the foot into the innersole which may also cause a skin irritation.

The reason shearing forces is of interest in your case is because it seems the eczema started under the first metatarsal head on one foot and then later on began on the same spot on the other foot. I do not think that is a coincidence. The first metatarsal head, where your skin irritation began, probably exhibits the most amount of shearing force in the whole foot. In addition, depending on your type of foot structure, the first metatarsal head may also create the most direct skin to innersole pressure on the entire foot.

What all this means is that there is a good chance one of your shoes has an innersole that may have chemicals in it that are reacting with the skin on your foot. So even if your doctor had given you the worlds best eczema cream, unless you eliminate the shearing forces, and the innersole, the cream could at best only give you marginal results.

So, that is one area that needs to be addressed.

Secondly, as I previously mentioned, your feet are subject to a dark moist environment which opens up the door for a fungus infection, or athletes foot. That too needs to be ruled out.

Along the lines of dark moist environments, if your foot is constantly going through a cycle of being moist, then drying out, then moist again, and on and on, this too can create a drying out of the skin which can lead to an appearance such as you demonstrate in your foot.

Now, the problem is you have a situation where you skin has become very thin and has cracked in certain places. Aside from the obvious discomfort associated with the cracking, if one of these cracks, known as fissures, become deep enough, they may become infected and then you have a real issue to deal with, so obviously you want to avoid that scenario.

Most eczema is treated with a cortisone cream of some sort, the strength of cream is determined by the severity of the skin condition. Your problem here is that your skin is very thin to begin with and one of the side effects of topical cortisone cream is that it tends to further thin out the skin, so you will have to be very careful if cortisone is prescribed to you.

You should either see a dermatologist or a podiatrist. Where the dermatologist may be better versed in the various topical medications out there for eczema, a podiatrist may the better choice in dealing with the possible shearing forces and shoe environment that your feet find themselves in.

Marc Mitnick DPM
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