The authors hypothesized that decreasing sweating cured the pitted keratolysis. What causes it? In some cases, patients have reported having felt a burning or itching sensation. Those tests include: Other skin conditions may appear similar to pitted keratolysis; thus, a correct diagnosis is required. One patient's pitted keratolysis resolved in 2 weeks, the other in 4 weeks. I have never had a patient who required botulinum toxin therapy, but this may be also considered for severe cases of hyperhidrosis unresponsive to conventional therapy. Woods light examination may or may not show a coral red fluorescence. https://www.dermnetnz.org/topics/pitted-keratolysis/, Pitted keratolysis; physicians treatment and their perceptions in Dutch army personnel. Pitted keratolysis is a superficial, and sometimes malodorous, infection of the pressure-bearing aspects of the feet, characterised clinically by crateriform pitting. A logical approach to the management of skin conditions including Blaise G, Nikkels AF, Hermanns-L T, Nikkels-Tassoudji N, Pirard GE. GP Leeds, "I think it was one of the best courses for GPs I have attended The most common are Corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, Actinomyces, or Streptomyces . Is pitted keratolysis serious? Pitted keratolysis can affect anyone, but people who wear warm, closed footwear for long periods are particularly at risk. Patient with pitted keratolysis may report malodor, hyperhidrosis, sliminess, and, occasionally, soreness or itching associated with the pits [ 31] ; however, the pits normally are asymptomatic.. Patients report skin lesions, often with associated. It is worth mentioning that Pitted Keratolysis is non-contagious. vol. Nordstrom KM, McGinley KJ, Cappiello L, Zechman JM, Leydel JJ. Enjoying our content? Cultures, if taken, show gram-positive coccobacilli or bacilli. Chlorhexidine Scrub, ZnO Nanoparticles Socks and the Combination for Treatment of Pitted Keratolysis (PK_treatment) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Twice-daily application of erythromycin 1% (solution or gel), 1% clindamycin hydrochloride solution, fusidic acid or mupirocin 2% are recommended24). Hair Pitted Keratolysis Pictures Many people with the infection do not experience any symptoms. Pitted keratolysis is a bacterial skin infection that can affect both the soles of your feet and the palms of your hands. Pitted keratolysis is a skin infection that causes you to have small holes in the top layer of your skin. Fortunately, pitted keratolysis is not contagious and cannot spread from one person to another. Psoriasis 26. The role of Micrococcus sedentarius . Infection. link for the society's contact details. Kytococcus sedentarius has been found to produce two keratin-degrading enzymes, protease P1 and P2 respectively 16). However, it is recommended that you maintain a good bodily hygiene and you do not share objects of hygiene (towels included) with other people, as you might get a secondary infection from another person. College of General Practitioners, The All Pitted keratolysis: a case report and review of current literature Rona Wai Yin Law, Eric So, Anson Ka Cheung Chu, and Daniel B Logan Proceedings of Singapore Healthcare 2018 28: 1 , 71-73 Download Citation If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 698-701. If the patients have cleared, therapy can be discontinued after 4 weeks. Do not share footwear or towels with others. Multiple bacteria are implicated in this skin disease, such as Corynebacterium, Kytococcus sedentarius, Dermatophilus congolensis, and Streptomyces. Plantar pitted keratolysis: a study from non-risk groups. Caused/aggravated by sunlight Dermatological emergencies 9. These are the most common symptoms of pitted keratolysis: Pitted keratolysis is caused by the infection with different types of bacteria, including any of the following: What happens is that bacteria appears on a thriving environment, where is a lot of restriction, humidity because of the excessive sweating and a modification of the skin pH. Dermatology Reports. Reviews risk factors, etiology, pathophysiology, and therapeutic options. The bad smell is due to sulfur compounds produced by the bacteria: thiols, sulfides and thioesters. Results in a whitish skin surface with clusters of multiple, fine punched-out pits. This condition is set out as follows: Aetiology History Clinical findings Images Management Aetiology That said, it is usually simple to treat once you get a proper diagnosis. Eczema - atopic (including facial ecz 16. (Four males with pitted keratolysis were treated with a combination of clindamycin and benzoyl peroxide gel once a day. Conditions that make people more likely to develop pitted keratolysis include: Sweaty feet Hot or humid weather Angelica Bottaro is a professional freelance writer with over 5 years of experience. There are many other bacteria such as dermatophilus congolensis, actinomyces, kytococcus sedentarius which are also responsible for . They may also order bacterial cultures to be taken. It is not a substitute for professional medical help. Boils and folliculitis (including hid 11. - Full-Length Features 1109376 Lead Author - Dr Tim Cunliffe. You might also experience diarrhoea. The former destroys the superficial layer of the skin while the latter produces the characteristic odor. All named individuals and organisations maintain copyright for the relevant images. To treat pitted keratolysis, you will need to make certain lifestyle changes and use medication as needed.. The differential diagnosis is narrow. If necessary, they may also prescribe drying agents such as Drysol. Moisture and inappropriate hygiene may be the predisposing factors in such patients. - Evidence-Based Guidance Woodgyer AJ, Baxter M, Rush-Munro FM. All rights reserved. Either the forefoot or the heel or both become white with clusters of punched-out pits. Impetigo is a common infection in children that may also occur in adults. Pitted keratolysis is a skin infection affecting the thick stratum corneum of the plantar surface of the feet and less commonly the palms. 1999. pp. 2004. pp. Dermoscopy of pitted keratolysis. Pits might cluster up at weight-bearing areas such as your heel and eventually result in a crater-like lesion. Vascular They can also have a burning sensation. Are immunocompromised due to chemotherapy or other reasons. Moisture and inappropriate hygiene may be the predisposing factors in such patients. 2013 Sep; 27(9):1120-6, Fernndez-Crehuet P, Ruiz-Villaverde R. Pitted keratolysis: an infective cause of foot odour. Hyperhidrosis (excess sweating) 16. Table I. Optimal Therapeutic Approach for this Disease Topical antibiotics are the first line of medical treatment22). Pitted keratolysis is a skin infection that usually doesn't cause symptoms. Pitted keratolysis is a bacterial skin infection that affects the soles of the feet and sometimes less the palms of the hands. Pregnancy-related Thank you. We do however hope that visitors to this site can contact us regarding comments that are considered misleading or incorrect so that we can continue to improve the site. Registration is free. Unlike most of other infections caused by bacteria, pitted keratolysis is not contagious a contagious medical condition [4]. Travel acquired / worldwide infections Athletes and military personnel tend to develop this condition most commonly. Eczema - hand (and foot) 14. ), (Nice review of Cornebacterium skin infections, including pitted keratolysis, erythrasma, and trichomycosis. Singh G, Naik CL. Clinical manifestations in 53 cases. Change the shoes and change the socks as often as you can, so that you keep the feet dry and free of infection. What are the Causes of Pitted Keratolysis? Nails It usually affects the soles of your feet, but it can also happen to the palms of your hands. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401600/. Hyperhidrosis is found in approximately 70% of cases. The following kinds of bacteria are responsible for this condition: These bacteria grow on the sites of infection and break down the top layer of skin to create small holes or indentations. This skin condition is quite common among workers that are required to wear shoes for longer periods, such as farmers, soldiers, and athletes, and occurs at a higher rate in tropical areas. 2012;4(1):e4. Pitted keratolysis: physicians treatment and their perceptions in Dutch army personnel. What Are The Causes Of Pitted Keratolysis? J Appl Microbiol 2002;93:810-6. It is caused by a bacterial infection of the skin, and may give off an unpleasant odour. vol. Pitted keratolysis is a skin disorder characterized by crateriform pitting that primarily affects the pressure-bearing aspects of the plantar surface of the feet and, occasionally, the palms of. Privacy Policy. Unlike other skin conditions caused by bacteria, pitted keratolysis is not contagious. Fungal infections (tinea) 15. It is also recommended that people do not share personal objects of hygiene such as towels amongst each other because it may lead to secondary infections [4]. Thanks for visiting Dermatology Advisor. Sometimes, bacterial colonies can also be seen through the dermatoscope. Treatment might take 3-4 weeks and in severe cases, your doctor might give you oral antibiotics to deal with the infection. Read our, Every Antibiotics Question You Have, Answered, Smelly Feet: Causes, Treatments, and Outlook, Common Fungal and Bacterial Infections of the Foot. In majority of cases, the causative organism is Corynebacteria. link, declaration of Some research suggests that pitted keratolysis is most commonly found in people who work in specific industries where people often have wet feet or have to wear occlusive footwear. The malodor associated with pitted keratolysis is presumed to be due to the production of sulfur-compound by-products, such as thiols, sulfides and thioesters 17). Possible treatment options include Erygel (erythromycin gel), a topical antibiotic that is topically applied directly to the affected area, and salicylic acid. Pitted keratolysis is a skin disorder that affects the stratum corneum of the plantar surface and is caused by Gram-positive bacteria. 2005 May-Jun; 71(3):213-5. van der Snoek EM, Ekkelenkamp MB, Suykerbuyk JC. No serological, laboratory, cultures or imaging tests are required for diagnosis. Our articles were written by fully qualified doctors of medicine and general practioners. Changing footwear and socks regularly as well as airing out or rotating shoes is key to management. Your healthcare provider may prescribe specific antibiotics, usually topical, that may help deal with the bacteria involved. J Applied Microbiology. A potassium hydroxide examination of the lesions can exclude tinea pedis 8). If you would like to donate, please use this Copyright 2017, 2013 Decision Support in Medicine, LLC. Statement Policy, Data A foul odor without any other symptoms has been encountered as a direct result of Bacillus subtilis or Staphylococcus epidermidis overgrowth. The weightbearing portion of the soles are most prominently involved (heel, toes, ball of foot). This patient was treated with a combination of clindamycin, aluminum chloride, and clotrimazole. Pitted keratolysis is a distinctive non-inflammatory bacterial infection of the soles of the feet that is characterized by appearance of pits on the soles. readers, especially in skin of colour: Copyright 1994 - 2021 The Primary Care Dermatology Society. Intertrigo (inflammation in body fold 21. Recommendations include twice daily application of erythromycin solution or gel 9), 1% clindamycin hydrochloride solution 10), fusidic acid cream and mupirocin cream 11). Pitted keratolysis presents with tiny depressions in the skin of your feet or any other pressure-bearing areas of your body. Either the forefoot or the heel or both become white with clusters of punched-out pits, more obvious when the skin is wet. conditions, Hyperpigmentation Benzoyl peroxide gel once a day the bad smell is due to sulfur compounds by. 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