How bad can foot eczema be?

shoe-1029734_640I remember hearing a woman interviewed on the radio a few years ago. She was claiming income support (welfare) and lamented that she was unable to attend job interviews because she was allergic to shoes. This was at a time when the press were vilifying any unemployed people who appeared ‘undeserving’ of welfare payments. In the prevailing mood, it was difficult to accept the foot condition as a valid excuse.

At the time, even though I had already succumbed to severe hand eczema, foot eczema was just an abstract idea, something for my imagination. I felt thankful it was only on my hands, bad as that was. But I did develop eczema on my feet, and it was only a matter of months after that radio interview. And it turned out, I had become allergic to my shoes.

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Foot eczema

It was bad. The itching was intense. Tense blisters appeared, making it impossible to put shoes on. I had to sleep with my feet hanging over the edge of the mattress, as I couldn’t stand even the weight of my feet on the bed.  I was thankful that I was able to work at home for several days, as it was impossible for me to leave the house.

Eventually, I had some patch testing. It revealed that I was allergic to two rubber accelerator chemicals (vulcanisers), which commonly occur in the rubber found in the soles of shoes. I still remember studying the vulcanisation (creating a polymer) of rubber in A level chemistry.  These substances can also be found in the adhesives used in joining leather.  As shoes become worn in and are exposed to moisture, the chemicals leach out and come in contact with the skin. Step number one – know your enemy!

Translating chemical names into which shoes you can wear is something else entirely. Shoes don’t come labelled conveniently with things such as ‘contains thiuram chemicals’ or ‘contains carbamates’. The dermatology advice was to ‘wear all-leather shoes with no inner sole (like moccasins), plastic shoes or wooden clogs. If you have difficulty acquiring shoes without rubber insoles, remove the insoles before wearing and replace with those cut from piano felt, cork, or plastic.’ Try going into a shoe shop and asking what their insoles are made of! Try removing the insoles from women’s shoes.  As I suspected that simply sweating was also a likely factor in my eczema, I was keen to avoid plastic shoes too. The advice was also to discard old socks, as they can harbour the harmful chemicals.

I bought some wooden clogs online, and discarded all my socks. Hobbling around with my sore, bare feet (not yet able to go sock shopping) in wooden clogs, I began my campaign to find wearable shoes.

SatraFootwearI contacted Satra Technology, a company based in Kettering, UK, known as a ‘leading technical authority for footwear and leather’. They advised me on alternatives to leather or plastic soles. Interestingly, thermoplastic rubber (TR) and crepe are not vulcanised, so they were safe. Also, I could look out for polyvinyl chloride (PVC), polyurethane (PU) and ethylene vinyl acetate (EVA) soles. Try going into a shoe shop and asking what their soles are made of.

Some shoe retailers were more helpful than others. I was very relieved to find that my recently acquired Trespass walking boots could get the thumbs up – the only rubber component was the outer sole – the midsole and insoles were fine. I discovered that many shoe manufacturers source the leathers and various components from all over the world. It was almost impossible for them to vouch for the exact materials used, especially the glues. Even craft shoemakers relied on glues/cements to keep their leathers in line.

The only assurance I could obtain on leather adhesives was with Gore Tex.  Clarks informed me that glues were not used in joining the uppers and linings of Gore Tex shoes. I was also very thankful when I found Easy Wellies, who made it extremely easy to search their stock for PVC boots and garden shoes.

I eventually had to give up on asking about the cements in leather shoes. My life was slipping away week by week, with one manufacturer after the other unable to give assurances on this. I was becoming tired of existing in PVC wellies and wooden clogs (and my hefty walking boots).  Step number 2 – avoiding the enemy – was proving very hard.

These days, my first stop for shoes is Hotter. Many, but not all, of their styles use polyurethane for soling. Yes! Quite a few of their styles contain elastic (made with rubber?), so I avoid those. Their customer services department is very helpful and will bend over backwards to research the various materials in their shoes. I buy their leather shoes on the understanding that one day I might have a reaction to the leather cement, although apparently they use it sparingly. I just try not to sweat.

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Living with hand eczema

Have you ever experienced extreme itching and burning on your fingers and hands? If your skin erupts in clusters of tiny blisters filled with clear fluid, it’s possible you have a type of eczema called pompholyx. This is something I have personally been dealing with and trying to make sense of for the last two and a half years, and it seems a fitting subject for my first blog entry on the topic of health and science.

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Finger Pompholyx 1

About 10 percent of people experience hand eczema, and it has a considerable impact on quality of life. It can be caused by contact with irritant chemicals or allergic reactions to non-irritant substances, and it is often claimed that emotional stress or a history of childhood eczema are key factors. Heat, cold, and sweating are also common triggers. Its impact on quality of life can be due to the centrality of our hands for every aspect of daily living and the extreme inconvenience of available measures to minimise exposure to hazards and to protect sore and itchy skin on fingers and hands. Itching is the number one source of distress, and itching on hands can be particularly harrowing.

The physiology of itching is still poorly understood. It is likely that certain chemical (e.g. insect bite) or physical (e.g. wool fibres) stimuli activate itch receptors that cause the brain to interpret the sensation as an itch. One of my personal theories is that the pressure of tense pinpoint pompholyx blisters onto the itch receptors also aggravates the itch. The inevitable scratching makes the skin sore and over-sensitive. Use of steroid creams and ointments leaves skin very dry and even more sensitive. Once the blistering has exhausted itself, the skin often starts to peel off. In my case, this occurred in the areas where the blisters had previously appeared.

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Peeling fingers and palm

At the peeling stage, loss of the tough epidermal layer that normally protects hands from wear and tear leaves the skin particularly fragile and vulnerable. When this first happened to me, I became acutely aware of how I used to take the skin on my palms for granted. Without this layer, I was unable to handle paper without causing my fingertips to bleed from the friction, and all sensations (heat, cold, touch) were magnified and distorted.

The epidermis also forms a barrier against micro-organisms. The bacterium Staphylococcus aureus commonly colonises the skin of people with eczema. This bacterial colonisation aggravates eczema. I have had some protracted episodes of skin flaking and erosion as a result. As you can infer from the close-up of my thumb, this state makes normal life impossible. Even the cotton gloves I have come to rely on would get caught up in the rough (and surprisingly sharp) edges of peeling skin.

Photo of infected and flaky thumb
Infected and flaky thumb

It is important to seek medical advice in case of infection. Extreme cases result in skin breakdown to the extent that the skin becomes ‘raw’ and tissue fluid weeps out. Cotton gloves are frequently recommended for protecting hands when carrying out any tasks that involve coming into contact with irritants. As many of these situations involve getting hands wet, thin vinyl (or PVC) gloves over the top of cotton gloves can provide a waterproof layer. These PVC gloves are not very strong when doing heavy cleaning or gardening jobs, and it is possible to get hold of thick PVC gloves if you have allergies to rubber or latex. I often wear these over the top of cotton + thin PVC gloves, as it makes it easier to slide the thicker gloves on.

Finding a soothing emollient cream or ointment and applying frequently is also important. It can be easy to just soldier on and hope the problem will go away, but if it doesn’t, make sure you get medical help. Probably one of the most useful things to consider with persistent hand eczema is to get some patch testing done. Patch testing involves applying a range of known contact allergens to the skin on the back for 48 hours, and then observing for signs of inflammation. In the UK, you will need a referral to a specialist clinic by your GP.

Here are a few online sources of useful information: http://www.patient.co.uk/doctor/Eczema-on-Hands-and-Feet.htm http://www.patient.co.uk/doctor/pompholyx-pro http://www.eczema.org/

Severe hand eczema: Major new clinical trial compares treatments “head to head”. http://www.bbc.co.uk/programmes/p03tqv2c