Cath Lab Digest

Eczema can arise in various permutations ranging from nummular eczema and atopic dermatitis to xerotic eczema and hyperkeratotic plantar eczema. Accordingly, these authors review key clinical signs, possible etiologies and exacerbating factors, and appropriate treatment considerations.

   Eczema, a form of dermatitis or inflammation of the superficial layers of the skin, is the most common skin reaction that podiatrists encounter.¹ It is an acute inflammatory cutaneous eruption characterized by itching, redness, papules, vesicles, edema, serous discharge, dryness, flaking, blistering, cracking, oozing, bleeding and crusting.

   There is a tendency to use the terms eczema and dermatitis interchangeably. When it comes to pedal skin, physicians frequently use dermatitis to describe any itchy, red skin problem. However, dermatitis merely refers to an inflammation of the skin that may result in a spectrum of lesions varying from acute necrosis and ulceration to simple erythema. In an effort to identify the specific eruption, we have terms such as contact dermatitis, seborrheic dermatitis, nummular dermatitis and atopic dermatitis.²

   Simply diagnosing patients with “dermatitis/eczema” is inadequate as one should more clearly define the condition with further diagnostic effort.

   Classification of the underlying diseases has been haphazard and unsystematic as physicians often use many synonyms to describe the same condition. One may describe a type of eczema by specific appearance (eczema craquele, which has the appearance of cracked porcelain or discoid eczema, which is in the shape of a “disc”) or by the possible cause (varicose eczema).³

   However, the morphological and pathologic changes in all forms of eczema are similar. The skin disease will usually pass through the following three stages: acute eczema, subacute eczema and chronic eczema.

   Acute eczema is marked by pruritus, erythema, edema (with or without vesicles) and oozing. With subacute eczema, one may see pruritus, erythema, scaling and crusting. Patients with chronic eczema will have pruritus and lichenification.

   Therefore, when you see a patient for an initial evaluation, it is important to note whether he or she is in an acute or chronic phase or somewhere in the middle. The patient may also have rubbed or scratched the affected area, and that will change the appearance of the dermatoses. While we only deal with the pedal skin, it is important to observe the other skin areas (legs, arms, hands, trunk) to gain more insight into the diagnosis.

A Guide To Different Types Of Pedal Eczema

   Atopic eczema/dermatitis. There may be a hereditary component with this condition. One will often see this condition in families whose members also have hay fever, allergic rhinitis and asthma. Itching is the outstanding feature of this disease. Many of the clinical signs are secondary to the scratching and rubbing of the skin. Family members may also have a history of atopic dermatitis.

   An itchy rash is particularly noticeable on the face and scalp, neck, inside the elbows, behind the knees and buttocks. Isolated involvement of the feet without lesions elsewhere is rare. Due to the rubbing of the skin and the breakdown of the barrier function of the stratum corneum, one can get secondary bacterial, fungal and viral infections.

   Causes include extreme heat/cold, sweating, occlusive clothing, fragrances, oils, soaps and environmental allergens. Exacerbating factors include over-washing, contact irritants, allergens, illness, perspiration, excessive heat, rough fibers (wool sweaters), dry air, tight clothing, and dust mite allergies.