From the Guidelines
Deep itching in the feet is commonly caused by several conditions including dry skin, athlete's foot (fungal infection), eczema, psoriasis, peripheral neuropathy, and allergic reactions. For immediate relief, try over-the-counter antifungal creams like clotrimazole or terbinafine if fungal infection is suspected, applying twice daily for 1-2 weeks 1. Moisturizing lotions containing urea or lactic acid can help with dry skin, while hydrocortisone 1% cream can reduce inflammation from eczema or allergic reactions, applied sparingly twice daily for up to 7 days. Some key considerations for managing deep itching in the feet include:
- Avoiding greasy creams for basic care, as they might facilitate the development of folliculitis due to their occlusive properties 1
- Not manipulating the skin, as this can increase the risk of infection 1
- Avoiding hot blow-drying of the hair, wearing tight shoes, and using topical acne medications or topical steroids without supervision 1 For neuropathic itching, prescription medications like gabapentin (starting at 300mg daily) may be needed. Soaking feet in cool water with colloidal oatmeal can provide temporary relief. The itching sensation occurs when nerve fibers in the skin are stimulated by inflammatory chemicals, allergens, or nerve damage, sending signals to the brain that trigger the urge to scratch. If itching persists beyond two weeks, worsens, or is accompanied by severe rash, pain, or swelling, medical evaluation is necessary to determine the underlying cause and appropriate treatment. In people with diabetes, it is essential to follow guidelines for preventing foot ulcers, such as screening for signs or symptoms of peripheral neuropathy and peripheral artery disease, and educating patients on proper foot self-care 1.
From the Research
Causes of Deep Itching in Feet
- Deep itching in the feet can be caused by various factors, including:
- Dermatological conditions such as dry skin, fungal infections, and allergic dermatitis 2
- Neuropathic itch, which occurs due to damage to neurons of the peripheral or central nervous system 3, 4
- Tinea pedis, a fungal infection of the skin on the feet 5
- Tinea cruris, a fungal infection of the skin in the groin area 6
Dermatological Conditions
- Dry skin can be associated with autonomic neuropathy and may be fragile, promoting bacterial invasion 2
- Fungal infections, such as tinea pedis, can cause deep itching in the feet 5
- Allergic dermatitis is commonly associated with topical treatments and other sensitizers 2
Neuropathic Itch
- Neuropathic itch can be caused by dysfunctions of itch-sensing neurons that produce sensory hallucinations of pruritogenic stimuli 3
- The same neurological illnesses that cause neuropathic pain can also cause itch, including shingles, small-fiber polyneuropathies, and radiculopathies 3
- Treating neuropathic itch is difficult, and current treatment recommendations include local or systemic administration of inhibitors of neuronal excitability and barriers to reduce scratching 3
Diagnosis and Treatment
- A detailed medical history and comprehensive physical examination are relevant to detect characteristic signs and symptoms of neuropathic itch and to rule out other possible causes for chronic itch 4
- Complementary diagnostic exams, such as laboratory tests and radiological examinations, may be indicated to confirm the diagnosis of neuropathic itch and to identify underlying etiological factors 4
- Treatment of deep itching in the feet depends on the underlying cause, and may include topical antifungal treatments, inhibitors of neuronal excitability, and barriers to reduce scratching 2, 3, 5, 6