Managing Persistent Skin Issues: A Guide for Workers with Foot and Skin Conditions

Skin issues

Hello Doctor: I work in cleaning and wear rubber boots every day, regardless of the season.
I had athlete's foot before I became a cleaner, which has led to onychomycosis (fungal nail infection) in both feet, and it keeps recurring.
Sometimes when I have to work overtime, I come home extremely tired and forget to apply the medication! This has prolonged my treatment significantly! It's not that I want to waste healthcare resources; my liver function tests were normal last year, and I was taking medication for the fungal nail infection.
However, nearly a year later, as my onychomycosis was improving, the health insurance stopped covering the medication, and when I needed to apply it again, I found myself back at square one! I hate that I can't find a permanent solution! It's a never-ending cycle! Additionally, I enjoy drinking bubble tea, which has led to fatty liver disease, and there was a period when I couldn't take medication! At first, I would shower very quickly, almost like a combat shower.
Later, I developed a large patch of small bumps on my body, including my back, which was diagnosed by a doctor as folliculitis, and it was fungal! The doctor asked me why I wasn't applying the medication he prescribed.
I replied that I didn't know I could apply it! Especially on my back, which itches terribly.
I can't reach it, and no one is available to help me! I'm also the type of person who sweats a lot; when I work, I get completely soaked.
I know some ways to manage it, like changing into a dry uniform when I'm soaked, but on those days, I have to change 3-4 times! What should I do? Thank you.

Jason, 30~39 year old female. Ask Date: 2020/07/24

Dr. Wu Yuxin reply Dermatology

It seems that you should start by improving your lifestyle.
Changing clothes 3-4 times is not difficult; why not do it? If you enjoy drinking bubble tea and have fatty liver, and there is a period when you cannot take medication, then why not quit? If you can't accomplish these things, it's no wonder that your skin condition cannot be controlled.

Reply Date: 2020/07/24

More Info

Managing persistent skin issues, especially for individuals in demanding jobs like cleaning, requires a multifaceted approach that addresses both the symptoms and the underlying causes. Your situation highlights several common skin conditions, including athlete's foot (tinea pedis), onychomycosis (fungal nail infection), and folliculitis, which can be exacerbated by environmental factors and lifestyle choices. Here’s a comprehensive guide to managing these conditions effectively.

Understanding Your Conditions
1. Athlete's Foot (Tinea Pedis): This fungal infection thrives in warm, moist environments, making it common among individuals who wear closed shoes for extended periods. Symptoms include itching, burning, and peeling skin, often between the toes.

2. Onychomycosis (Fungal Nail Infection): This condition often follows athlete's foot and can lead to discolored, thickened, or brittle nails. It can be persistent and may require long-term treatment.

3. Folliculitis: This is an inflammation of hair follicles, often caused by bacteria or fungi. It can present as red, itchy bumps and may be aggravated by sweating and friction from clothing.

Lifestyle Modifications
1. Foot Hygiene:
- Daily Washing: Wash your feet daily with soap and water, ensuring to dry them thoroughly, especially between the toes.

- Moisture Control: Use antifungal powders or sprays to keep your feet dry. Consider moisture-wicking socks that help reduce sweat accumulation.

- Footwear Choices: Opt for breathable shoes when possible. If you must wear rain boots, consider using moisture-absorbing insoles.

2. Skin Care:
- Moisturizing: Apply a good moisturizer to your feet and body after bathing to prevent dryness, which can exacerbate skin conditions.

- Avoid Irritants: If you have sensitive skin, avoid harsh soaps and detergents that can strip your skin of natural oils.

3. Diet and Health:
- Hydration and Nutrition: Stay hydrated and consider reducing sugar and processed foods, especially if you have fatty liver disease. A balanced diet can improve your overall skin health.

- Limit Alcohol and Sugary Drinks: These can contribute to liver issues and may affect your skin condition.

Treatment Options
1. Topical Treatments:
- For athlete's foot and onychomycosis, antifungal creams or ointments (like clotrimazole or terbinafine) should be applied as directed. Consistency is key; even if symptoms improve, continue treatment for the full duration to prevent recurrence.

- For folliculitis, topical antibiotics or antifungal creams may be prescribed by your healthcare provider.

2. Oral Medications:
- If topical treatments are ineffective, consult your doctor about oral antifungal medications for persistent fungal infections.

3. Steroid Creams:
- For inflammatory skin conditions, such as folliculitis, a mild topical steroid may help reduce inflammation and itching. However, these should be used under medical supervision to avoid side effects.

Preventive Measures
1. Clothing Changes:
- Change out of wet clothes promptly and consider carrying extra uniforms to change into during your shifts.

- Use breathable fabrics that wick moisture away from the skin.

2. Regular Check-ups:
- Regular visits to a dermatologist can help monitor your skin conditions and adjust treatments as necessary.

3. Education:
- Learn about your conditions and treatment options. Understanding your skin health can empower you to take proactive steps in managing it.

Conclusion
Managing persistent skin issues, particularly in a physically demanding job, requires diligence and a proactive approach. By implementing good hygiene practices, making lifestyle changes, and adhering to treatment plans, you can significantly improve your skin health and reduce the recurrence of these conditions. If symptoms persist or worsen, do not hesitate to seek professional medical advice for tailored treatment options. Remember, consistency in treatment and preventive measures is crucial in breaking the cycle of recurring skin issues.

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