How to Manage Severe Atopic Dermatitis of the Feet

Atopic dermatitis typically flares up on the face, on the elbows, and behind the knees. But it’s not unusual for it to appear on the feet also.

The feet provide an ideal environment for an atopic dermatitis flare, which often occurs due to a combination of heat, sweat, and friction, says Sheilagh Maguiness, MD, a dermatologist at University of Minnesota Physicians in Minneapolis. Itchy fabrics or dyes in socks may also play a role in triggering eczema symptoms.

Fortunately, there are ways to reduce the risk of a flare-up on the feet and treat it if one occurs.

There are two main ways to prevent eczema flares, says Dr. Maguiness: avoiding irritants and maintaining a healthy skin barrier (the outermost layer of skin).

Here’s how to do just that.

• Moisturize regularly. Moisturizer can help prevent irritants from seeping under the skin’s surface and triggering the symptoms of atopic dermatitis.

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   “The soak-and-seal technique is part of treatment but also part of prevention,” says Maguiness.
• Avoid certain shoes. Plastic shoes can contain skin-irritating chemicals that may trigger a flare-up for some people, says Maguiness. Likewise, wearing open-toed footwear can be drying, since they expose the skin to too much air and other potential irritants. “If you notice a pattern to the eczema, and it happens to be sharply cut off — like right where the shoe stops touching your skin,” she says, “that may be a clue that you’re developing an allergy or there’s an irritant contact reaction to parts of the shoe.”
• Switch to lighter-colored socks. Try wearing white socks, preferably made of cotton or the newer wicking fabrics, such as bamboo. Some colored socks contain dyes that can irritate the skin and cause an atopic dermatitis flare.

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• Rethink your specialty footwear. Wearing certain athletic gear, such as soccer shoes, hockey skates, and other plastic-based or tight-fitting shoes, may cause a flare-up of atopic dermatitis symptoms. You don’t have to give up sports, but you may want to wear breathable, moisture-wicking socks, apply antiperspirant or antifungal powder to your feet, and, after you’re finished playing, change out of your footwear right away.

Sometimes, even the best-laid prevention plans aren’t enough to keep symptoms at bay. If atopic dermatitis does flare up on your feet, there are some treatment strategies you can try.

• Try a diluted bleach bath. Soak the affected foot/feet in a solution of lukewarm water and fragrance-free household bleach. Ask your doctor about the right ratio of ingredients for the symptoms you’re having.

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• Soak your feet in a baking soda bath. Add about a quarter cup of baking soda to lukewarm water, and soak for 20 minutes. Be sure to rinse with clear water and dry thoroughly. Apply moisturizer afterward.

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• Try an Epsom salt soak. Add a couple of handfuls of Epsom salts to lukewarm water and soak. After the soak, rinse and dry your skin thoroughly, then apply moisturizer.

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• Apply wet wraps. Soak gauze in lukewarm water and wrap the affected foot (or feet). Leave in place for two hours.

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• Use the ‘soak-and-seal’ technique. Soak your feet in lukewarm water and then apply a bland, fragrance-free moisturizer and cover with socks, says Maguiness. If you’ve been prescribed a topical steroid, apply it after the soak and before you put on moisturizer.
• Reevaluate going on prescription treatment. If you aren’t already on a prescription medication, you may want to talk to your dermatologist about starting one. They may recommend a topical steroid to help quell the inflammation right away.

If you see any skin cracks, crusting, or pustules, call your doctor. These can be signs of an infection and may require more involved medical treatment.

• Atopic dermatitis can flare up on the feet, causing difficulty running or walking.
• Certain footwear, such as plastic shoes and colored socks, can be more likely to cause eczema symptoms.
• To combat atopic dermatitis flare-ups on your feet, try using wet wraps, the soak-and-seal technique, or moisturizer and topical steroids (if prescribed by your doctor).