Athlete’s foot: recognising and treating it correctly
21/09/2023
Epidermolysis bullosa
18/06/2024
The maceration of the skin of the feet is a fairly common occurrence that can happen due to:
- hypershidrosis
- exposure to a hot and/or humid environment
- wearing non-breathable shoes (e.g. rubber boots, safety shoes, etc.)
- keeping feet immersed in water for long periods of time
- working at high temperatures (around ovens or furnaces, etc.)
Maceration
Maceration occurs when there is excessive water in the stratum corneum, or when the foot is exposed to hot, humid conditions. Both provide the perfect environment in which bacteria can breed and begin proteolysis on the entire epidermis.
Maceration usually occurs between the toes where moisture stagnates the most, but it can also extend to tops of the toes, to the ball of the foot, or to the sides of the foot.
Pseudomonas and other proteolytic bacteria
Tissue breakdown is not caused by moisture or sweating but by the colonization of proteolytic bacteria in the skin. The bacterium most commonly involved is the pseudomonas species, which produces enzymes that digest the proteins of the skin (proteases) resulting in the destruction of the epidermis and formation of extensive erosions. Other proteolytic bacteria that can be associated with maceration such as proteus, escherichia coli and klebsiella. However, when the colonization is caused by pseudomonas, the macerated skin can turn green and can develop a particularly pungent odor.
Trench foot
In some circumstances, trench foot can develop. Trench foot occurs when the foot is kept in water or mud for a long time, as can happen during some agricultural work, fishing or for military personnel in trench warfare. Trench foot causes widespread maceration, deep erosions, and poses a risk of both skin and systemic infection, making early identification and prompt intervention essential.
Maceration caused by hyperhidrosis
Hyperhidrosis is a pathological condition whereby the foot gets wet with sweat regardless of the external temperature. Hyperhidrosis is not an easy condition to treat, with some cases even requiring surgery in order to block the lumbar nerve ganglia. While hyperhidrosis itself can be tricky to cure, preventing foot maceration is much easier.
How to treat foot maceration
What to do
The main goal of treatment is to dry the skin so that the bacteria that cause maceration can no longer proliferate. Astringent Gel with aluminum chloride has antisudoral, moisture-absorbing and antibacterial properties and should be applied wherever maceration is present.
To prevent the toes from touching each other, which leads to moisture retention and bacterial growth, apply cotton gauze (not TNT) between the toes after Astringent Gel has been applied. The dressing should be changed daily.
What not to do
Washing or getting the feet wet should be avoided until re-epithelialization has occurred.
Do not administer antibiotics because the bacteria involved are mostly multiresistant.
Do not apply traditional creams because they will add extra moisture to the skin.
Prevention
Maceration is difficult to prevent completely because it occurs almost unavoidably within certain jobs, such as those that require the use of safety shoes or military boots. Applying Astringent Gel after removing shoes following working in such occupations can, however, be helpful in preventing maceration.
