What medication is effective for treating itching and burning feet?

Treatment for Itching and Burning Feet

For itching and burning feet, start with topical high-potency corticosteroids (mometasone furoate 0.1% or betamethasone valerate 0.1% ointment) applied twice daily, combined with urea 10% cream at least twice daily for skin barrier repair. 1

First-Line Topical Therapy

Topical corticosteroids are the cornerstone of treatment:

• Apply moderate-to-high potency topical corticosteroids (mometasone furoate 0.1% ointment or betamethasone valerate 0.1% ointment) twice daily to affected areas 1
• Hydrocortisone 2.5% has been shown to significantly decrease experimentally-induced pruritus compared to placebo 1
• For mild symptoms, over-the-counter hydrocortisone 1% cream can provide anti-itch relief 2

Add emollients and barrier repair agents:

• Apply urea 10% cream at least twice daily to prevent and treat dry skin, which exacerbates itching 1, 3
• Lotions containing urea or polidocanol may soothe pruritus 1
• Apply after bathing when skin is slightly damp for optimal absorption 3

Consider topical anesthetics for burning pain:

• Lidocaine 5% patches or cream can be applied to painful areas for immediate relief 1
• Topical antipruritic agents containing menthol 0.5% may provide cooling relief 1

Systemic Therapy for Moderate-to-Severe Symptoms

If topical therapy fails after 2 weeks, escalate to oral antihistamines:

• Daytime: Non-sedating second-generation antihistamines (loratadine 10 mg daily) as first-choice systemic therapy 1
• Nighttime: First-generation antihistamines (diphenhydramine 25-50 mg or hydroxyzine 25-50 mg) for their sedative properties to break the itch-scratch cycle 1

For refractory cases, consider GABA agonists as second-line:

• Gabapentin 900-3600 mg daily (starting at 300 mg at bedtime) 1
• Pregabalin 25-150 mg daily (or 75-300 mg every 12 hours) 1
• These work by reducing peripheral release of calcitonin gene-related peptide and modulating central opioid receptors 1

Rule Out Specific Causes

Fungal infection (Tinea pedis/Athlete's foot):

• If fine scaly eruption with fissures between toes is present, this is likely tinea pedis 1
• Treat with terbinafine 1% cream daily for 1 week (mycological cure rate ~94%) 1
• For extensive disease, oral terbinafine 250 mg once daily for 1 week provides faster clinical resolution 1
• Apply foot powder after bathing to reduce recurrence from 8.5% to 2.1% 1, 4

Erythromelalgia (burning feet syndrome):

• If burning pain with redness triggered by warmth, consider erythromelalgia 1
• First-line: Topical amitriptyline-ketamine compound 1
• Systemic: Gabapentin or pregabalin as outlined above 1

Critical Adjunctive Measures

Behavioral modifications:

• Avoid mechanical stress (long walks without cushioned shoes) and chemical irritants (solvents, disinfectants) 1
• Dry thoroughly between toes after showers 1
• Change socks daily and periodically clean athletic footwear 1, 4
• Avoid ice water immersion, which can worsen symptoms; limit cooling to 10 minutes at a time, maximum 4 times daily 1

Common Pitfalls to Avoid

Do not use topical corticosteroids if fungal infection is suspected, as they increase susceptibility to fungal infections and may worsen the condition 5

Do not assume treatment failure without reassessing after 2 weeks - if symptoms worsen or fail to improve with topical therapy, escalate to systemic treatment rather than continuing ineffective topical therapy 1

Do not treat feet in isolation - examine for concomitant nail fungus (onychomycosis), which serves as a reservoir for reinfection in tinea pedis 4

Avoid prolonged use of potent topical steroids without monitoring, especially in children who have proportionately greater percutaneous absorption 5