From the Guidelines
Treatment for atrophic dermatitis of the feet should prioritize a combination of moisturizing, topical corticosteroids, and proper foot care, with the most recent guidelines suggesting the use of emollients and topical anti-inflammatory medications as first-line treatment 1. The goal of treatment is to reduce inflammation, repair the skin barrier, and prevent further irritation.
- Start with a medium-potency topical corticosteroid such as triamcinolone 0.1% cream applied twice daily for 1-2 weeks to reduce inflammation, followed by a maintenance regimen of once daily or every other day for another 2-3 weeks.
- Apply a thick emollient like petroleum jelly or ceramide-containing moisturizers immediately after bathing to lock in moisture.
- For severe cases, consider short-term use of a higher-potency steroid like clobetasol 0.05% ointment, but limit this to 2 weeks to prevent skin thinning.
- Wet wraps can enhance medication absorption - apply medication, cover with damp cotton socks, then dry socks overtop for 15-20 minutes daily.
- Keep feet clean and dry, wear cotton socks, and avoid irritating footwear.
- Topical calcineurin inhibitors like tacrolimus 0.1% ointment are steroid-free alternatives particularly useful for long-term management, as supported by recent guidelines 1. It's essential to note that the decision to initiate these treatments should be made using shared decision-making between patients and clinicians, taking into account the severity of atrophic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
From the Research
Treatment Options for Atrophic Dermatitis of the Feet
- Topical corticosteroids have been the mainstay of treatment for atopic dermatitis, but their use is associated with side effects such as skin atrophy, telangiectasia, and striae 2
- Non-steroidal ant-inflammatory agents, such as topical calcineurin inhibitors (TCIs), are a viable alternative to topical corticosteroids in treating dermatitis of sensitive areas, including the feet 2, 3
- Pimecrolimus cream 1% is an effective and well-tolerated treatment for atopic dermatitis, and does not cause skin atrophy or other side effects associated with topical corticosteroids 3, 4
- Medical device emollients, such as ceramide-hyaluronic acid emollient foam, have also shown efficacy in treating atopic dermatitis, and may be used in conjunction with other treatments 2
- Maintenance therapy for atopic dermatitis includes the use of emollients and daily bathing with soap-free cleansers, and topical corticosteroids or TCIs may be used as needed to control flare-ups 5
Specific Treatments for Atrophic Dermatitis
- Pimecrolimus 1% cream is recommended as a first-line therapy for patients with mild-to-moderate atopic dermatitis, including those with sensitive skin areas such as the feet 4
- Tacrolimus ointment 0.1% is also effective in treating atopic dermatitis, and may be used in conjunction with other treatments 6
- Ultraviolet phototherapy may be used to treat moderate to severe atopic dermatitis that is not responsive to first-line treatments 5