Podiatric Dermatology

Getting Under Your Skin

Previously we have talked about verrucae.  This month we are taking a look at other problems affecting the skin.  May is also Melanoma and Skin Cancer Awareness Month and provides a good reminder about how to check your feet for suspicious lesions.

The skin is the largest organ of the body and in adults covers an area of approximately 2m2.  Its primary functions include:

  • Protection – the skin acts as a barrier, protecting us from infection and the elements, temperature change
  • Temperature regulation – through thermoregulation and sweat production
  • Sensation – touch, temperature and pressure
  • Metabolism – production of vitamin D

We are going to look at a range of skin problems this month, from eczema and psoriasis, to chilblains and the new phenomenon of Covid toe and finally a look at melanoma.

With all skin conditions, correct diagnosis is key to successful treatment.

Eczema

Eczema is a generalised term that includes many conditions causing inflammation of the skin.  Eczema on the feet most often presents with small, intensely itchy blisters on the soles of feet and edges of the toes.  The actual cause of eczema is unknown, but it is more common in people who have another form of eczema and tends to run in families.

How to treat eczema:

  • Wash the affected skin with a mild cleanser and gently pat dry.  Do not rub vigorously with a towel. 
  • Remove rings and other jewellery when you wash your hands, so that water does not linger on your skin.
  • Wash then moisturise hands or feet immediately after coming into contact with a potential trigger.
  • Keep fingernails short to help prevent scratching from breaking the skin.
  • A mild corticosteroid cream will often reduce inflammation and help with itchy symptoms.

Psoriasis

Psoriasis is a long-term condition autoimmune condition that causes inflammation in the body.  It most commonly affects the skin, causing red, scaly, thick plaques which can be painful and bleed if cracks appear. 

Psoriasis can also affect the nails and the joints, psoriatic nails often being mistaken for fungal infections.

Treatment of psoriasis:

Mild psoriasis can usually be treated with topical steroids.  If the condition is extensive, medical treatment may include phototherapy and oral medication.

Your podiatrist can help keep down the painful plaques and reduce the thickness in psoriatic nails.

Chilblains

May is not the usual time of year to be talking about chilblains, but as their symptoms are similar to covid-toe (see below), we thought it would be useful to include them here. 

Chilblains are patches of skin that appear swollen and red or occasionally blue in colour.  Due to the swelling of the surrounding tissue, they may look shiny.  Other symptoms may include burning sensation, blisters and itchiness.

Cause:

Cold weather can cause small blood vessels near the surface of your skin to tighten. As you warm up, these vessels try to expand too quickly and causing blood to leak into the nearby tissue making it swell, resulting in inflammation, pain and itching.

Things you can do:

As soon as you notice symptoms, try to warm up the affected area slowly by putting it under a blanket and avoid applying direct heat.  Warming up the area too rapidly can make your symptoms worse.

Prevention is better than cure and if you are prone to chilblain.  Avoid extreme cold and ensure socks are not too tight, restricting the blood flow further.  A good chilblain cream will help to increase the circulation in the area and reduce the discomfort.

If your chilblains bleed or ulcerate, see your podiatrist urgently.

COVID-toe

COVID-toe are most commonly seen in children and young adults but can appear at any age.  It is more often seen in people who have had a previous asymptomatic COVID-19 infection.

Typical symptoms include discolouration and swelling and the appearance of chilblain-like lesions, along with blistering itching and pain.  The symptoms of COVID toe typically last 2-6 weeks however the discolouration of the skin can last longer.

Melanoma

Melanoma is a cancer that starts in the cells which produce pigmentation in our skin or nails and is most commonly caused by prolonged exposure to ultra violet rays from the sun, sunbeds or even radiation.

Signs to look out for:

Asymmetry – part of the lesion is a different shape to the other

Border – the borders are irregular

Colour – the lesion is not uniform in colour

Diameter –  if the area is larger than a pencil rubber it is a cause for concern

Evolving – moles stay the same size but melanomas grow

Family history – there is some evidence that this may be a factor in the risk of melanoma.

Melanoma can also affect the nails.  Any new pigmented band along the length of the nail to the nail base, which does not grow out or becomes wider or causes the nail to split should be checked out.

What to do next:

If you are concerned about any skin or nail lesion, go to your podiatrist for examination and advice.  If there is any cause for concern, you will be referred for further investigation.   

Most lesions turn out to be benign and may be caused by trauma, infection or a side effect from medication.  However, the motto is that it is better to be safe than sorry.  Check out changes in moles or marks regularly, use sun cream – especially on the soles of the feet, and have anything suspicious checked out early. 

This month we have highlighted just a few of the conditions that can affect the skin.  Podiatrists are experts in skin conditions on the feet and can give advice about any worrying rashes or lesions.  If the skin problem on your foot is not responding to treatment at home, or is getting worse, give us a call.

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