Thick Calluses and Peeling Skin: Eczema or Athlete's Foot?

Q: Thick Calluses and Peeling Skin: Eczema or Athlete's Foot?

Hello： 1. The photos of the left and right arms appear to be more consistent with chronic psoriasis, which is a type of chronic eczema. Treatment duration may be prolonged, and it is essential to apply the ointment regularly while avoiding scratching. 2. T

Thick calluses and peeling on the hands and feet may indicate chronic eczema or athlete's foot?

Dear Dr.
Lee,
I would like to describe my symptoms as follows:
1.
The dorsal surfaces of my fingers on both hands have developed thick calluses that are neither itchy nor painful.

- Past medical history: I have previously had dyshidrotic eczema.
- Consultation history: A doctor at a clinic previously diagnosed it as "warts" and treated it with cryotherapy.
However, after the wounds healed, thick calluses began to form, accompanied by hyperpigmentation, which is quite unsightly.
I later consulted another doctor who suggested: 1.
Fungal infection 2.
Chronic eczema.
I have been applying ointment regularly, but it seems to have little effect.
I would appreciate your help in diagnosing this condition.
Thank you.
- Photos: http://www.flickr.com/photos/80060460@N05/sets/72157630058917246/
2.
The plantar surfaces of my feet also have thick calluses that peel, occasionally accompanied by dyshidrotic eczema, leading to itching.
Additionally, the dorsal surfaces of my toes exhibit similar symptoms to those on my fingers.
- Past medical history: I have had athlete's foot.
- Consultation history: A doctor diagnosed it as chronic eczema.
I have been applying ointment, but the results remain limited.
I would appreciate your assistance in diagnosing this condition as well.
Thank you.
- Photos: Left foot - http://www.flickr.com/photos/80060460@N05/sets/72157629996811049/ Right foot - http://www.flickr.com/photos/80060460@N05/sets/72157629996813517/
The above photos show my current condition.
Thank you for your help!

Changqi wei pifubing kunrao de ren, 20~29 year old female. Ask Date: 2012/06/06

Dr. Li Yufen reply Dermatology

Hello:
1.
The photos of the left and right arms appear to be more consistent with chronic psoriasis, which is a type of chronic eczema.
Treatment duration may be prolonged, and it is essential to apply the ointment regularly while avoiding scratching.

2.
The condition of the left and right feet mirrors that of the backs of the hands; however, the peeling on the soles may be indicative of dyshidrotic eczema or athlete's foot.
A thorough examination of the entire foot is necessary, or a KOH test may be performed to check for fungal infection.

Wishing you peace and happiness.

Reply Date: 2012/06/06

More Info

Based on the symptoms you've described, it seems you are dealing with a complex interplay of skin conditions that may include calluses, possible fungal infections, and chronic eczema. Let's break down your concerns and provide some insights into each aspect.

Thick Calluses and Skin Peeling
Thick calluses can develop due to repeated friction or pressure on the skin, often from ill-fitting shoes or repetitive activities. They are generally not painful or itchy, which aligns with your description. However, the presence of black pigmentation could indicate post-inflammatory hyperpigmentation, which is common after skin injuries or conditions like warts that have been treated with cryotherapy.

Possible Conditions
1. Eczema (Dermatitis): Chronic eczema can lead to thickened skin (lichenification) and may cause peeling. It often presents with dryness, redness, and sometimes itching. Given your history of sweating and potential moisture exposure, this could be exacerbated by environmental factors or irritants.

2. Fungal Infections: Given your past history of athlete's foot (tinea pedis) and the description of your symptoms, a fungal infection could also be a contributing factor. Fungal infections can cause thickened skin and peeling, particularly in areas that are warm and moist.

3. Warts: If the initial diagnosis was warts, and they were treated with cryotherapy, it’s possible that the treatment led to the formation of calluses as the skin healed. Warts can sometimes recur or lead to surrounding skin changes.

Treatment Considerations
1. Topical Treatments: Since you mentioned using topical medications with limited success, it may be worth revisiting the type of treatment. For eczema, topical corticosteroids or calcineurin inhibitors can help reduce inflammation. For fungal infections, antifungal creams or ointments are necessary.
2. Moisturization: Regularly applying a good moisturizer can help manage dryness and prevent the skin from thickening further. Look for products that contain urea or lactic acid, which can help exfoliate and hydrate the skin.

3. Footwear: Ensure that your shoes fit properly and provide adequate support. Consider using protective pads or orthotics to reduce friction and pressure on the affected areas.

4. Dermatological Evaluation: Since your symptoms have persisted despite treatment, it may be beneficial to consult a dermatologist for a thorough evaluation. They may suggest a skin scraping or biopsy to definitively diagnose any fungal infections or other skin conditions.

5. Lifestyle Modifications: Pay attention to your environment. If you are prone to sweating, consider moisture-wicking socks and breathable footwear. Avoid prolonged exposure to irritants such as harsh soaps or detergents.

Conclusion
In summary, your symptoms could be attributed to a combination of chronic eczema, potential fungal infections, and the aftermath of previous treatments for warts. A tailored approach that includes proper diagnosis, effective topical treatments, and lifestyle adjustments will be crucial in managing your skin condition. If symptoms persist or worsen, seeking a second opinion from a dermatologist may provide additional insights and treatment options.

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