table of contents
◼︎ Pathophysiology Overview
Toe numbness with pruritus represents a neurocutaneous manifestation of riboflavin (Vitamin B2) deficiency. This essential coenzyme deficiency disrupts:
- Myelin sheath maintenance
- Cellular energy production (FAD/FMN-dependent processes)
- Epidermal barrier function
◼︎ Clinical Presentation
Manifestations typically include:
✓ Sensory abnormalities
- Parasthesia (60-75% cases)
- Thermal dysregulation
✓ Dermatologic involvement - Hyperkeratotic plaques (interdigital regions)
- Erythematous fissures
✓ Pruritus severity - VAS 6-8/10 in 82% of untreated cases
- Nocturnal exacerbation pattern
◼︎ Therapeutic Protocol
1. Systemic Therapy
| Agent | Dosage | Duration | Mechanism |
|---|---|---|---|
| Tabetil (Cetirizine) | 10 mg OD | 14-21d | H1-receptor antagonism |
| Riboflavin | 50 mg BID | 8 weeks | Corrects FAD/FMN coenzymes |
2. Topical Management
Domeboro (Astringent Solution)
- Apply BID using soaked gauze compresses
- Contains:
• Aluminum acetate (2%) – astringent
• Calcium acetate – pH modulator
◼︎ Preventative Measures
- Footwear requirements:
✓ Moisture-wicking insoles
✓ Breathable uppers (mesh/leather)
✓ Toe box clearance ≥1.2cm - Environmental control:
⇒ Maintain foot pH 5.4-5.9 using acidic emollients
⇒ Immediate sock change post-perspiration
Clinical Note: Monitor serum riboflavin levels at 4-week intervals. Persistent symptoms beyond 3 weeks warrant neurology consult to exclude peripheral neuropathy etiologies.