What is the treatment for pruritus on the dorsal surface of the feet?

Treatment for Itching on Tops of Feet

For localized pruritus on the dorsal feet, apply a moderate-potency topical corticosteroid such as mometasone furoate 0.1% or betamethasone valerate 0.1% ointment twice daily as first-line therapy. 1

Initial Treatment Approach

The most effective first-line treatment is a moderate-potency topical corticosteroid applied directly to the itchy areas on the tops of your feet 2, 1:

• Mometasone furoate 0.1% ointment applied twice daily 2, 1
• Betamethasone valerate 0.1% ointment applied twice daily 2, 1
• Clobetasone butyrate (moderate potency) is an alternative option 2, 1

For milder cases or over-the-counter options, hydrocortisone 2.5% can be applied 3-4 times daily for up to 7 days 3, 4. The FDA label specifies application "not more than 3 to 4 times daily" for skin irritation and itching 3.

Essential Supportive Measures

Regardless of the cause, you should implement basic skin care 5:

• Apply emollients at least once daily to prevent dry skin, which commonly triggers itching 5
• Keep feet dry after bathing and use clean towels 5
• Avoid physical triggers including wool socks and harsh soaps 5

If Initial Treatment Fails After 2 Weeks

If moderate-potency steroids don't provide adequate relief after 2 weeks, add 1:

• Menthol 0.5% preparations for counter-irritant effect 2, 1
• Lotions containing urea or polidocanol to soothe itching and maintain hydration 2, 1

For short-term use only (maximum 8 days), topical doxepin may be considered, but must not exceed 10% of body surface area and maximum 12g daily due to contact dermatitis risk 2, 1, 5.

Systemic Therapy for Persistent Symptoms

If topical treatments are insufficient, oral antihistamines serve as adjunctive therapy 1:

Daytime options (non-sedating):

• Loratadine 10mg daily 2, 1
• Fexofenadine 180mg daily 2, 1

Nighttime options (for sleep disruption):

• Diphenhydramine 25-50mg at bedtime 2, 1
• Hydroxyzine 25-50mg at bedtime 2, 1

Treatments to Avoid

Do not use the following, as they lack efficacy 2, 1, 5:

• Crotamiton cream - no significant antipruritic effect versus placebo 2, 1
• Topical capsaicin - not recommended for generalized pruritus 2, 1
• Calamine lotion - no supporting evidence 2, 1

When to Escalate Care

Reevaluate after 2 weeks if symptoms persist or worsen 5. At that point, consider referral to dermatology for evaluation of underlying causes such as neuropathic pruritus (nerve-related), fungal infection (tinea pedis), or systemic disease 4, 6. For neuropathic causes, gabapentin 900-3600mg daily or pregabalin 25-150mg daily may be indicated as second-line therapy 2.

Common Pitfalls

• Avoid prolonged use of topical steroids beyond 7 days on thin skin to prevent skin atrophy 7
• Localized foot itching suggests a neuropathic cause rather than systemic disease, so extensive laboratory workup is typically unnecessary unless symptoms are generalized 6
• Moisture from footwear can trigger or worsen pruritus, so ensure feet remain dry and consider moisture-wicking socks 1