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Spots of redness on feet are most likely a reaction to something such as allergens and insect bites, a fungal infection, or a preexisting condition that you are already being treated for.
It is important to investigate the cause of the red spots on your feet in order to develop a plan toward healing.
To determine the cause, ask yourself these important questions:
- When did it start?
- Have you been outside when this erupted?
- Did you use new cleaning supplies, soap, or detergent recently?
- Do you have red spots anywhere else on your body?
- Is it itchy?
- What makes it worse?
- What makes it better?
- Is it painful?
- Has this happened before?
- Do your feet sweat excessively?
- Does anyone in your family develop these spots?
- Do you have a fever?
Causes of Red Spots on Feet
Red spots on feet can be due to several factors.
Psoriasis is a chronic inflammatory condition that involves the skin, nails, and joints. Clinical findings will lead to a diagnosis.
There are different clinical types of psoriasis. Chronic plaque psoriasis is the most common, affecting 80%-90% of patients with psoriasis. (1) It may present itself in the feet as red and scaly areas or as large plaques covering the sole of the foot.
Psoriasis can occur in both adults and children. A wide range of treatments are available for this condition, which includes creams, ointments, and medications. Ultraviolet light therapy is another option.
Most of the patients showing up in primary care can be managed with topical therapy by itself. (2)
2. Athlete’s Foot
Athlete’s foot is a fungal infection of the skin of your feet. It usually develops between your toes and the soles of your feet.
Athlete’s foot can manifest as dry, scaling, itchy skin, sometimes including red spots or patches on the feet with tiny sacs of fluid that look like small pimples.
Sometimes, the condition appears as a moist white skin in between your toes, and the skin may peel. This fungal infection can spread to the toenails or other parts of the body.
The athlete’s foot is normally confirmed through visual inspection of the lesions, microscopy, and cell culture. (3)
Athlete’s foot can usually be treated with over-the-counter creams, gels, powders, or sprays. If an athlete’s foot cannot be managed successfully with these products, oral medication may be considered.
3. Insect Bites
An insect bite refers to both bites and stings caused by an arthropod. The outcomes of bites from arthropods are due to traumatic injury or local inflammation and hypersensitivity to arthropod saliva. (4)
Bites commonly manifest as red, inflamed, raised circular skin lesions. They may be solo, grouped in one area, or generalized.
For minor insect bites, laboratory or imaging evaluations are not usually necessary. Additional studies may be indicated in cases of insect bites associated with venom or infections.
Most insect bites can be managed with local wound care. Steroid creams may calm the inflammation and itchiness.
Cold compresses can reduce inflammation. Elevating the foot can relieve the edema if present. Pain can be controlled with nonsteroidal anti-inflammatories. It is important to note that the severity of insect bites can range from minor to life-threatening.
4. Allergic Contact Dermatitis
Allergic contact dermatitis is caused by a hypersensitivity reaction when the skin is exposed to a foreign substance. Red spots, swelling, blisters, burning, itchiness, pain, and cracks in the foot may occur.
A small amount of allergen can trigger an inflammatory reaction. Spreading of the reaction may also occur. The most common allergens are topical antibiotics, fabrics, fragrances, cosmetics, moisturizers, nickel, and poison ivy.
The first step to management is the treatment of irritated skin. Moisturizers and topical steroids are used to manage contact dermatitis.
The next step is determining the cause of the reaction to prevent it from occurring in the future.
5. Irritant Contact Dermatitis
Irritant contact dermatitis is a painful non-allergic skin reaction caused by skin injury, direct toxic effects, or inflammation due to contact with an irritant. Pain, swelling, redness, and itching may occur, and the condition can occur in both adults and children.
The diagnosis of irritant contact dermatitis is clinically based. Duration, intensity, and concentration of the substance are factors that can cause irritant contact dermatitis.
Detergents, soap, cleaners, and acid cause irritant contact dermatitis. Management includes cold compresses, creams, topical steroids, and ointments.
Eczema is the most common form of dermatitis. Causes of eczema include genetics and environmental factors. (7)
Eczema usually develops in children but can also be seen in adults. It appears as red, dry, itchy skin that can lead to infection.
Diagnosis is based on the appearance of the rash and the patient’s history. Treatments include skin hydration, skin moisturizing creams and ointments, and topical steroids for flare-ups. Avoiding environmental allergens would also benefit someone with eczema.
Vasculitis is the inflammation of the blood vessels, causing changes in the blood vessel walls that restrict blood flow and cause tissue damage. The changes include thickening, weakening, narrowing, or scarring of the blood vessels.
The immune system plays a crucial role in the tissue damage seen in vasculitis. It becomes “hyperactive” due to an unknown stimulus, leading to inflammation within the tissues of the body.
Inflammation in blood vessel walls leads to narrowing of the vessels, causing inadequate blood supply to a specific tissue, resulting in damage.
Vasculitis has a variety of forms. The classic rash of vasculitis is called “palpable purpura.” It presents as purple-red spots, typically found on the legs. These spots occur due to the leaking of blood into the skin through damaged blood vessels.
The biopsy of the involved tissue determines the cause and condition. Steroids are the first-line medication. Treatment needs to be individualized based on the severity of vasculitis. (8)
8. Bacterial Infection
Skin breaks, insufficiency of the vein system, and athlete’s foot have been associated with an increased risk of cellulitis in the foot and/or leg.
Patients with soft tissue infections, such as abscesses, may need the area drained. Samples should be sent for bacterial culture. History, local examination of the area, systemic signs, laboratory tests, and biopsies all can be helpful in confirming a diagnosis.
Bacterial infections are treated with antibiotics. Less severe infections can be managed in an outpatient setting with oral antibiotics.
9. Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease is a contagious viral infectious disease, which usually occurs in children. Symptoms include fever, sore throat, loss of appetite, fatigue, and a rash of red spots on the hands, feet, and mouth.
Hand, foot, and mouth disease will resolve within 7-10 days. (10) The infection can spread to others. Vessels that spread this viral infection include the saliva, sputum, nasal mucus, fluid from the blisters or scabs, and feces or poop.
There is no specific medical treatment for this condition. Symptom relief is a priority, which includes taking over-the-counter medications to relieve fever and painful mouth sores.
Prevent dehydration by drinking plenty of fluids. Prevent the spread by washing your hands for 20 seconds.
10. COVID-19 Toes
A skin manifestation involving the toes of patients with COVID-19 called COVID-19 toes is under investigation and involves further study. The condition is described as swollen, discolored toes with red rashes or hives-like eruptions in patients with COVID-19.
These findings have been reported to be seen more in kids and young adults. The lack of coronavirus testing is a big challenge for doctors in confirming a relationship between COVID-19 and these skin findings.
It is important to note that not every patient with the COVID-19 virus will develop skin lesions, especially in the lower extremity. (11)
Statements regarding a relationship between the novel coronavirus and dermatologic manifestations in the lower extremities are not concrete until there is an analysis of more evidence. No conclusive research has been performed on “COVID toes.” (11)
When to See a Doctor
Seek professional medical attention from a doctor if:
- Over-the-counter medications have not helped.
- Your child has red spots and is not drinking enough to stay hydrated.
- Symptoms do not improve after 10 days.
- Symptoms worsen or spread.
- The area is infected and extremely painful.
- Your child develops red spots and has a weakened immune system.
- The symptoms are severe.
- Your child who develops red spots is very young, especially younger than 6 months.
- You develop a high-grade fever, cough, and shortness of breath.
Red spots on feet have several possible causes. Most causes are minor. Allergies, insect bites, irritation, and infections can all cause red spots on the feet. It is important to identify the cause of these spots to develop a proper and effective treatment.
If symptoms worsen or do not improve with home remedies or over-the-counter products, it may be time to seek professional treatment from a doctor.