Foot Problems

Is a bunion, corn, ingrown toenail or a bad case of athlete's foot causing you foot pain or embarrassment? Keep your feet healthy by learning to recognize and treat common foot problems.

Bunion

A bony bump at the base of the big toe, a bunion causes that toe to deviate toward the others. Throwing foot bones out of alignment and producing the characteristic bump at the joint's base, a bunion can be very painful due to pressure or arthritis, and may also lead to corns. Pain relievers, pads to cushion the bunion, custom shoe inserts, or surgery may help, as will wearing roomy shoes and avoiding high heels.

Corns and Calluses

Friction causes the thick, hardened, dead skin of corns and calluses, which form to protect sensitive skin. Appearing cone–shaped, corns point into the skin, and usually occur on areas that bear little weight. Calluses may appear anywhere there's friction, and are more diffuse. Both may be caused by ill–fitting shoes and will fade when friction stops. Moleskin pads can help relieve a corn; calluses can be trimmed or surgically corrected.

Gout

A form of arthritis, gout is characterized by sudden pain, redness, swelling, and stiffness, usually in the large joint of the big toe. Gout can also occur in the foot, ankle, or knees. and is caused by too much uric acid (UA) in the body, which can form hard crystals in joints. Attacks can last days or weeks, and may be treated with anti–inflammatories or UA–lowering medication. Talk to your doctor about diet changes that help break down UA.

Plantar Warts

Plantar warts are tough, horny growths that develop on the soles of the feet. Contagious, they're caused by a virus entering through broken skin, and often spread via public pools and showers. Plantar warts are harmless and can be left untreated, but in many cases they're too painful to ignore. Topical salicylic acid may help, while burning, freezing, laser therapy, and surgical removal are more aggressive options for more severe cases.

Athlete's Foot

A fungal infection that can cause peeling, redness, itching, burning, and sometimes blisters and sores, athlete's foot is mildly contagious, passed by direct contact or by walking barefoot in areas such as locker rooms, or near pools. The fungi then grow in shoes, especially tight ones without air circulation. Athlete's foot is usually treated with topical antifungal lotions or oral medications for more severe cases.

Fungal Nail Infection

Occuring when microscopic fungi enter through a break in the nail, a fungal infection can make your nails thick, discolored and brittle. If left untreated, the nail infection won't go away — and can be hard to treat. Thriving in warm, wet places, the fungi can be spread from person to person. Topical creams may help mild cases but antifungal pills are your best chance of curing a severe infection.

Hammertoe

When toe muscles get out of balance, they can cause painful toe problems. While some people are prone to hammertoe, other risks include tight footwear. Hammertoe generally causes the middle joint of the toe to bend downward, with toes appearing raised near the foot. Well–fitted footwear with the correct amount of space in the toe box, shoe supports, and surgery may offer relief.

Ingrown Toenail

A toenail that has grown into the skin, an ingrown toenail can result in pain, redness, swelling, even infection. Cutting nails too short or not straight across, injury to the toenail, and wearing tight shoes are culprits. For mild cases, soak the foot in warm water, keep it clean, and wedge a small piece of cotton under the corner of the ingrown nail to lift it off the skin. Minor surgery can remove all or part of the nail.

Flatfoot (Pes Planus)

Flatfoot is characterized by the sole of the foot coming into complete or near–complete contact with the ground. It may be inherited, caused by an injury, or by a condition, such as rheumatoid arthritis. Flatfoot symptoms are rare, though weight gain, ill–fitting shoes, or excessive standing may cause pain. Treatment includes foot–strengthening exercises, and shoes with good arch support or orthotics.

Nails and Health…Read the Signs

Did you know your nails can reveal clues to your overall health? A touch of white here, a rosy tinge there, or some rippling or bumps may be a sign of disease in the body. Problems in the liver, lungs, and heart can show up in your nails. Keep reading to learn what secrets your nails might reveal.

Pale Nails

Very pale nails can sometimes be a sign of serious illness, such as:

• Anemia
• Congestive heart failure
• Liver disease
• Malnutrition

White Nails

If the nails are mostly white with darker rims, this can indicate liver problems, such as hepatitis. In this image, you can see the fingers are also jaundiced, another sign of liver trouble.

Yellow Nails

One of the most common causes of yellow nails is a fungal infection. As the infection worsens, the nail bed may retract, and nails may thicken and crumble. In rare cases, yellow nails can indicate a more serious condition such as severe thyroid disease, lung disease, diabetes or psoriasis.

Bluish Nails

Nails with a bluish tint can mean the body isn't getting enough oxygen. This could indicate an infection in the lungs, such as pneumonia. Some heart problems can be associated with bluish nails.

Rippled Nails

If the nail surface is rippled or pitted, this may be an early sign of psoriasis or inflammatory arthritis. Discoloration of the nail is common; the skin under the nail can seem reddish-brown. 

Cracked or Split Nails

Dry, brittle nails that frequently crack or split have been linked to thyroid disease. Cracking or splitting combined with a yellowish hue is more likely due to a fungal infection.

Puffy Nail Fold

If the skin around the nail appears red and puffy, this is known as inflammation of the nail fold. It may be the result of lupus or another connective tissue disorder. Infection can also cause redness and inflammation of the nail fold.

Dark Lines Beneath the Nail

Dark lines beneath the nail should be investigated as soon as possible. They are sometimes caused by melanoma, the most dangerous type of skin cancer.

Gnawed Nails

Biting your nails may be nothing more than an old habit, but in some cases it's a sign of persistent anxiety that could benefit from treatment. Nail biting or picking has also been linked to obsessive-compulsive disorder. If you can't stop, it's worth discussing with your doctor.

Nails Are Only Part of the Puzzle

Though nail changes accompany many conditions, these changes are rarely the first sign. And many nail abnormalities are harmless -- not everyone with white nails has hepatitis. If you're concerned about the appearance of your nails, see a dermatologist.

Boils (Abscess)

A boil is a common, painful infection of a hair follicle and the surrounding skin. It begins as a red lump, then fills with pus as white blood cells rush in to fight the infection. Good home care can often clear up a single boil, also known as a skin abscess. A doctor's care is needed when a boil resists treatment or develops in certain vulnerable areas of the body.

Boil Symptoms

Boils are usually pea-sized, but can grow as large as a golf ball. Symptoms can include:

• Swelling, redness, and pain
• A white or yellow center or tip
• Weeping, oozing, or crusting

You may also have a general feeling of ill health, fatigue, or a fever, which is reason to call a doctor.

Where Do Boils Form?

Boils can form anywhere on the body, but they're most common on the face, neck, armpits, shoulders, back, and buttocks. Hairy, sweaty areas are typical sites, as well as areas of friction, such as the inner thighs. Boils can also develop around the ear or near the nose. The pain often worsens as pus collects under the skin, then eases as fluids begin to drain.

What Causes Boils?

Most boils are caused by staph bacteria (Staphylococcus aureus), which many healthy people carry on their skin or in their noses without a problem. When a scrape, cut, or splinter breaks the skin, the bacteria can enter a hair follicle and start an infection.  Others boils, such as those associated with acne, develop from clogged pores that become infected.

Ordinary Boil or MRSA Infection?

MRSA can look exactly like an ordinary boil: red, swollen, pus-filled, and tender. But MRSA infections are caused by one particular type of staph that is resistant to many antibiotics. If a skin infection spreads or doesn't improve after 2-3 days of antibiotics, your doctor may suspect MRSA.  The right treatment is important to heal a MRSA infection and prevent a deeper, more dangerous infection.

Are Boils Contagious?

Not exactly, but the germs that cause boils (staph) are easily spread through skin-to-skin contact and contaminated objects.  These bacteria usually do no harm unless they find a break in your skin. To avoid spreading staph, don't share towels, bedding, clothes, or sports gear while you have a boil. Avoid touching the boil, and keep it covered. Frequent hand washing can also help prevent spreading the bacteria.

Early Warning: Folliculitis

Folliculitis is an inflammation or infection of the hair follicles that can develop into a boil. Tiny pimples with whiteheads appear around individual hairs, sometimes surrounded by red skin. It can be itchy, tender, and uncomfortable, but is typically not as painful or deep as a boil. Shaving or friction from tight clothing can let staph bacteria slip under the skin -- the most common cause of both folliculitis and boils.

Boil Type: Carbuncle

When several boils form close together and join beneath the skin, it's called a carbuncle. They are most commonly found on the back and the neck but can develop anywhere. Men are more likely to develop carbuncles than women. A carbuncle tends to lie deeper beneath the skin than a boil and can take longer to heal.

Boil Type: Cystic Acne

Cystic acne is a type of skin abscess that forms when oil and dead skin cells clog a hair follicle, creating a place where bacteria grow and thrive. It affects deeper skin tissue than regular acne, leading to firm, painful cysts.  It's most common on the face and shoulders and typically occurs in the teenage years

Boil Type: Armpit and Groin

When lumps and pus-filled abscesses repeatedly develop in these areas of the body, it may be a chronic condition called hidradenitis suppurativa. Infection starts in sweat glands and hair follicles that become blocked. Mild cases heal with home care. Several drugs and treatments are available for more serious and recurring cases.

Boil Type: Pilonidal Abscess

When a boil forms in the skin just above the buttocks crease, it may be a pilonidal abscess.  Hair is believed to play a role, and irritation, pressure, and prolonged sitting may also contribute to the development of a cyst here. If a cyst becomes inflamed and infected, it becomes an abscess. Some children are born with a "pilonidal dimple" where infections can crop up. Signs of infection require a doctor's attention.

Boil Type: Stye

The familiar "stye on the eye" is a boil, usually caused by staph bacteria. It starts in the follicle of an eyelash and may be red, warm, swollen, and uncomfortable. A stye is sometimes confused with a chalazion, which is also a lump on the eyelid, but a chalazion is usually painless and is caused by a blocked oil gland, not an infection.

Who Gets Boils?

Anyone can develop a boil. Your risk increases with:

• Close contact with an infected person
• Acne, eczema, or other causes of breaks in the skin
• Diabetes
• A weakened immune system

Treatment: Home Care

You can take care of most boils at home. Apply warm, moist compresses several times a day to help a boil open and drain. After it starts draining, keep it clean, and continue using warm compresses - a clean one every time. Change the bandage often and wash your hands well. Resist the urge to squeeze or pop the boil. This can make the infection worse.

When to Call the Doctor

If a boil doesn't heal after a week of home care, call your doctor. Other reasons to call include:

• A boil on the face or spine
• A fever or red streaks coming from the sore
• A very large or painful boil
• A boil that keeps coming back

  Treatment: Procedures

If the fluid inside a boil doesn't drain by itself, your doctor may prick the top of the sore with a sterile instrument to be sure it drains completely. A deep infection may be packed with sterile gauze so it continues to drain. Antibiotics are sometimes given to help with healing.

Treatment: Recurrent Boils

For some people, boils are a recurring problem. In addition to standard treatment, your doctor may try to eliminate or reduce staph bacteria throughout the body. This can include washing up with a special antiseptic soap, using an antibiotic ointment inside the nose, or 1-2 months of antibiotics by mouth, or all three.

Boil Complications

Most boils heal with home treatment or a doctor's visit. Sores on the face may require antibiotics because they're so close to the eyes and brain. Rarely, the staph bacteria from a boil or carbuncle can get into the bloodstream, which can then affect the heart and other internal organs.

How to Prevent Boils

Since bacteria are everywhere in our environments and on many people's skin, the best defense against boils includes:

• Hand washing or use of alcohol-based hand sanitizer
• Careful cleaning of cuts, scrapes, and other wounds
• Keeping wounds covered
• Not sharing towels, sheets, razors, etc.

Launder towels, sheets, and anything else in contact with an infected area in very hot water. Throw away any wound dressings in a tightly sealed bag.

Eczema

Eczema has been called "the itch that rashes" because the itching usually occurs first. This group of skin rashes may first appear in babies and toddlers, becoming a drier, flaky rash in older children. Adults may see scaly, leathery patches or a stubborn hand eczema. Atopic dermatitis is a common, often inherited form, but there are other types, as well as many treatment options.

Eczema Symptoms

Itching is the defining symptom. Once you start scratching, the skin becomes inflamed -- and even itchier. The appearance can vary greatly and may include:

• Red, scaly areas
• Small, rough bumps
• Thick, leathery patches
• Bumps that leak fluid and crust over

In darker-skinned people, the affected area might be lighter or darker.

Eczema in Babies

Infants who are just 6 to12 weeks old can develop atopic dermatitis as a patchy facial rash. It can progress, becoming red and scaly, and may appear on the forehead or scalp. Moisture from drooling worsens the rash. In some cases, the condition goes away by age 2. But about half of people who had atopic dermatitis as a child will have the condition as an adult.

Atopic Dermatitis or Cradle Cap?

"Cradle cap" in babies is actually a condition known as seborrheic eczema or seborrheic dermatitis. It appears as yellow, oily, scaly patches on the scalp and will usually clear up without treatment at 8 to 12 months of age. In contrast, atopic dermatitis (AD) in infants usually appears as a red rash. It's more often found on the cheeks, but AD can also affect the scalp.

Eczema in Children

Children may develop the rash on the inside of their elbows or behind the knees, around their mouths, on the sides of their necks, or on wrists, arms, and hands. Those with atopic dermatitis are more likely to have food allergies, including allergies to peanuts, milk, or other nuts. However, experts say you shouldn't restrict foods unless there is a confirmed food sensitivity. Reassure children that it isn't contagious.

Eczema in Adults

Adults typically notice itchy patches on the hands, elbows, and in the "bending" areas of the body, such as the inside of the elbows and back of the knees. But eczema can appear anywhere, including the neck, chest, even the eye lids. Those who had atopic dermatitis as a child may see drier, scaly rashes as adults. The skin may be discolored or thickened.

Diagnosing Eczema

If a rash persists, causes significant discomfort, or develops a crust or pus-filled blister, you may want to see your health care provider. A diagnosis of eczema  is usually based on a detailed medical history, symptoms, measurable physical signs, and a family history of allergic conditions. Your doctor may also order allergy tests or a microscopic exam of a skin scraping (seen here) to rule out infections.

Who Gets Eczema?

There's a link between atopic dermatitis and hay fever or asthma. If a parent has hay fever or asthma, their children are more likely to have the skin condition. And about half of children with atopic dermatitis will go on to develop hay fever or asthma.

Eczema and Allergies

The substances that bring on an allergy attack -- dust mites, pollen, animal dander, mold -- can cause some people with atopic dermatitis to break out in a rash. Food allergies also can trigger a flare-up. These allergens cause the immune system to overreact, activating cells that produce inflammation in the skin.

Other Eczema Triggers

Irritants can cause inflammation and itching, bringing on a bout of eczema. Touching harsh chemicals can cause a nasty rash in anyone, but people with eczema may be sensitive to mild irritants, such as wool, detergents, astringents, or fragrances. Emotional stress can trigger a flare-up, as can sweating and frequent wetting and drying of the skin -- even everyday hand-washing.

Eczema and Dry Skin

The outer layer of our skin normally acts as a barrier, protecting inner layers from irritants and infection. People with atopic dermatitis have very dry skin that isn't as protective. If you have eczema, use mild cleansers and apply a moisturizing cream or ointment after washing.  A dry climate or the low humidity of winter can cause the condition to flare up. People with atopic dermatitis are also more likely to get skin infections.

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What Causes Eczema?

We don't know exactly what causes atopic dermatitis, the most common form of eczema. Experts believe genetic, environmental, and skin factors all play a role. A malfunction of the immune system may be involved, creating inflammation in the skin, even when there is no infection to fight. Emotional disorders do not cause eczema, as doctors thought many years ago, but stress can make symptoms worse.

Stop the Scratching

People with atopic dermatitis may scratch as many as 500 to 1,000 times a day. That scratching worsens the rash and can increase the risk of infection due to breaks in the skin. Use a cold compress to lessen the itchy feeling. Distract children with activities. Moisturizers are soothing, and some medicated creams or ointments may help, too.

Treatment: Corticosteroids

Over-the-counter hydrocortisone creams or ointments may help mild cases of eczema but should not be used on children under 2 or for more than seven days without consulting a doctor. Stronger corticosteroid products may be necessary to control the inflammation. Side effects from extended use include skin thinning, infection, and stretch marks.  In rare cases that haven’t responded to other treatment, a doctor may prescribe oral or injectable corticosteroids.

Treatment: Antihistamines

Antihistamines may provide relief from the vicious cycle of itching and scratching for some, but not all, people with the atopic dermatitis type of eczema. Many OTC and prescription-only options are available, each with slightly different dosing and side effects.  Check with your health professional for a recommendation.

Treatment: Immune Modulators

Prescription topical medicines that calm an overactive immune system, such as Elidel and Protopic, may help treat eczema from atopic dermatitis. Doctors generally prescribe them only when other treatments have failed, for short-term use, in certain patients. They're required by the FDA to carry a "black box" warning due to concerns about an increased risk of cancer. However, the American Academy of Dermatology disagrees with the FDA's safety warning. It's best to discuss the risks and benefits with your health care provider.

Treatment: Hand Eczema

People with severe hand eczema may get relief from a promising new drug. Studies have shown that alitretinoin, a relative of vitamin A, can greatly improve or even clear up hand eczema that didn't respond to other treatments. It hasn't yet been approved by the FDA for this use. It can cause headaches or dry, flushing, or sun-sensitive skin. You should not become pregnant while taking alitretinoin because it can cause severe birth defects.

Treatment: Phototherapy

UV light affects the immune system and can improve moderate to severe cases of eczema from atopic dermatitis or contact dermatitis. PUVA is a UV treatment combined with psoralen, a medication. Because UV light can cause skin damage or premature aging of the skin and increases the risk of skin cancer, you should discuss the risks and benefits with your health care provider. It may not help or worsen eczema in some people.

Treatments for Children

Corticosteroids of various strengths may be used in children with atopic dermatitis, depending on the severity of the condition. Potent corticosteroids can suppress growth in children.  Prescription topicals Elidel and Protopic  have been approved by the FDA for children 2 years of age or older. Lifestyle changes are also important. Keep your child's fingernails short and their skin moisturized. Dress them in loose-fitting clothes and make sure they do not become overheated.

Treatment: Bleach Baths

A small amount of household bleach in the bath may help control atopic dermatitis when there is a staph infection present, too.  In one study, children with moderate to severe atopic dermatitis and staph soaked in diluted bleach baths and used an antibiotic ointment in their noses.  These treatments significantly improved  their skin symptoms. Parents should consult a dermatologist or other health care provider first to see if bleach baths are appropriate.

Treatment: Herbs and More

Some promising studies showed that probiotics, oolong tea, or Chinese herbal medicine may ease symptoms. However, other studies have not been supportive. Herbs and supplements are not regulated as closely as medicines and can sometimes have harmful effects. Be sure to talk to your doctor or other health care provider before taking herbs or supplements. Stress-reducing therapies such as massage and relaxation may also be helpful.

Eczema and Infection

Almost all people with atopic dermatitis have Staphyloccocus aureus bacteria on their skin, compared with just about 5% of people without the skin condition. Be alert to the signs of infection, including honey-colored crusts, pus- or fluid-filled blisters, scaly red patches, swelling, or fever, and contact your doctor or health care provider.

Caring for Dry Skin

Even when the eczema subsides, the dry skin remains. Hydrate the skin with short daily baths in warm water. Pat the skin partially dry and apply a thick moisturizer -- emollients and creams are usually more effective than lotions -- on top of any medication and elsewhere on the body within three minutes of taking the bath. Apply moisturizers throughout the day and use only mild soaps or cleansers. Look for fragrance-free products to help prevent a reaction. Remember, "unscented" may just mean the product contains another ingredient to mask the scent.

Coping With Eczema

Your child may feel self-conscious about the appearance of the rashes. Help him or her avoid triggers and cope with stress. The American Academy of Dermatology hosts Camp Discovery at several locations around the country for kids with skin conditions. Adults may need to adjust their activities. Jobs that require a lot of hand-washing or exposure to chemicals or other irritants, such as health care, housecleaning, or hairdressing, may not be a good choice for someone with eczema.