Shoe contact dermatitis

What is shoe contact dermatitis?

Shoe contact dermatitis can be defined as skin manifestations on the feet caused by the wearing of shoes, boots and sandals. This often occurs because the skin on the feet reacts to particular substances (allergens) found in footwear.

Uncertain cause

Thiourea allergy

Shoe dermatitis

What causes shoe contact dermatitis?

Contact allergic dermatitis

Many different products and chemicals are used in the manufacture of footwear. Allergy may be due to the chemicals found in the material that the footwear is made from, e.g. leather or rubber, from glues used to hold the shoe together, or from decorations applied to the shoe.

What are the symptoms of shoe contact dermatitis?

Shoe contact dermatitis usually begins on the top surface of the big toe and spreads to the upper surfaces of the foot. Dermatitis may also be found on the sole, the side of the feet and heels and the legs.

Symptoms of contact allergic dermatitis may include swelling, redness, blisters or cracks in the skin, burning, itchiness and pain. The allergy can develop over a long period as the skin on the feet is repeatedly exposed to a certain allergen found in the shoe. However, it is not unusual to suddenly become allergic to a substance after months or years of exposure.

How is shoe contact dermatitis diagnosed?

Often shoe contact dermatitis is difficult to diagnose as there are some other diagnoses that need to be ruled out. These include:

• bacterial infection
• fungal infection (tinea, athlete's foot)
• atopic dermatitis
• irritant contact dermatitis due to occlusion, moisture and friction
• Juvenile plantar dermatosis
• pompholyx
• psoriasis
• lichen planus
• allergic contact dermatitis caused by something other than shoes (e.g. sock fabric, cosmetic product).

Diagnosis by performing special allergy tests (patch tests) may involve testing against some different chemicals due to the many potential allergens that may be present in the shoe. Patch testing with portions of the patient’s shoes, alongside a shoe ‘screening tray’ of common additives and chemicals is essential in making a correct diagnosis.

See individual contact allergens for patch testing recommendations.

What is the treatment for shoe contact dermatitis?

Shoe contact dermatitis should clear rapidly once the offending allergen is removed. This will mean not being able to wear the offending shoes ever again unless the allergen can be removed. For example, allergy to a nickel buckle could be resolved by replacing with a non-nickel buckle. Allergy to chromate in leather can be avoided by choosing vegetable tanned leather items.

Over-the-counter creams and ointments containing mild topical steroids, such as hydrocortisone, may be used to help control itching, swelling, and redness. In more severe cases, a prescription topical steroid may be required, as well as antibiotic medication if the skin becomes blistered, painful and infected.

What should I do to avoid shoe contact dermatitis?

If you suffer from shoe contact dermatitis the best way to prevent any problems is by avoiding all footwear that contains the allergen you are sensitive to.

Some steps you can take to reducing shoe contact dermatitis reactions include:

• Controlling foot perspiration using antiperspirants
• Wear vegetable-tanned shoes
• Replace rubber insoles with a foam sole, e.g. urethane foam
• Air shoes regularly and do not keep them boxed up with DMF sachets.

Your dermatologist may have further specific advice, particularly if you are highly sensitive to particular allergens.