Feet contact dermatitis
Contact dermatitis of the feet is often due to excessive sweating—use antiperspirants as for primary focal hyperhidrosis to reduce sweating. Sweat can irritate the skin and leach allergens from footwear or socks. Avoid wearing heavy work boots or shoes in hot environments—if this is not possible, use spray-on antiperspirants before putting on socks and footwear, wear thick cotton socks as a barrier, and change socks regularly.
To reduce inflammation, apply a potent topical corticosteroid. Use:
betamethasone dipropionate 0.05% cream or ointment topically, once daily until skin is clear (for up to 4 weeks). betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
If the contact dermatitis is chronic or does not respond to initial therapy with a potent topical corticosteroid, or the skin is lichenified, apply a more potent topical corticosteroid. Use:
betamethasone dipropionate 0.05% ointment in optimised vehicle topically, once daily until skin is clear (for up to 4 weeks). betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
If contact dermatitis is severe and acute, a course of oral corticosteroids may be required—refer these patients to a specialist for diagnosis and patch testing. While waiting for specialist advice, use:
prednisolone (or prednisone) 25 to 50 mg orally, once daily for 5 to 7 days, then taper over 2 weeks to minimise rebound flare. prednisolone prednisolone prednisolone
If dryness or cracking is prominent, use emollients (eg glycerine 10 to 20% in sorbolene cream, urea 10% cream [with or without lactic acid 5%]) in addition to the topical or oral corticosteroid.
If a patient has chronic contact dermatitis that does not respond to topical and oral therapy, refer for specialist advice. Also see Deterioration or relapse of contact dermatitis.