Foot Itch: Causes, Symptoms, and Relief

Pruritus pedis (foot itch) has diverse causes:

Dermatologic

• Tinea pedis (athlete's foot): Dermatophytes. Interdigital scaling, maceration, vesicles. KOH prep confirms.
• Eczema (dyshidrotic, atopic, contact): Vesicles, fissures, lichenification. Allergens (shoes, socks, topicals).
• Psoriasis: Silvery scale, nail pitting, Auspitz sign. Palmoplantar variant.
• Scabies: Burrows, nocturnal itch, interdigital/web spaces. Mite on scraping.
• Contact dermatitis: Shoe components (leather tanning agents, rubber accelerators, adhesives, dyes).

Systemic

• Diabetes: Peripheral neuropathy, dry skin, fungal predisposition.
• CKD/ESRD: Uremic pruritus.
• Cholestatic liver disease: Bile salt deposition.
• Thyroid disorders, lymphoma, iron deficiency.

Neuropathic

• Small fiber neuropathy (diabetes, idiopathic) — burning, itch.

Management

• Diagnose cause (scraping, biopsy, labs).
• Topical: Antifungals, corticosteroids, calcineurin inhibitors, capsaicin, menthol.
• Systemic: Antihistamines (sedating at night), gabapentin/pregabalin (neuropathic), treat underlying disease.
• Skin care: Hydration, breathable socks/shoes, avoid irritants.