Pitted keratolysis (also known as "Keratolysis plantare sulcatum," "Keratoma plantare sulcatum," and "Ringed keratolysis") is a non-contagious skin infection that can be caused by wearing tight or restricting footwear and excessive sweating. The infection is characterized by craterlike pits on the surface of the feet and toes, particularly weight bearing areas. Treatment consists of the application of topical antibiotics. Pitted Keratolysis is caused by bacteria, which thrive in these environments.
The condition is fairly common, especially in military where wet shoes/boots are worn for extended periods of time without removing/cleaning. Skin biopsy specimens are not usually utilized, as the diagnosis of pitted keratolysis is often made by visual examination and recognition of the characteristic odor. Wood lamp examination results are inconsistent.
Video Pitted keratolysis
Symptoms
Pitted keratolysis typically presents with numerous discrete, "punched-out" or pitted lesions, usually located on the sole of the feet. These circular and shallow pits are characteristic of pitted keratolysis, and often overlap to produce larger areas of erosion. The appearance of this condition's characteristic lesions becomes more pronounced when the affected area is wet or sumberged in water. Occasionally these lesions present with a green or brown hue around and within the pits.
These superficial erosions are found under the toes and on the soles of the feet, and especially at the pressure bearing points such as the heel. Typically, both feet are equally effected. Rarely, the condition affects the palms. Pitted keratolysis is associated with excessive sweating of the palms or soles (palmoplantar hyperhidrosis.) The bacterial digestion of the keratin results in a very foul odor. Irritation is generally minimal, though occasionally burning, itching, and soreness are occasionally experienced with pitted keratolysis.
Maps Pitted keratolysis
Microbiology
The most common cause of pitted keratolysis is Corynebacterium species. However, several other bacteria may also cause the condition, particularly Actinomyces keratolytica, Dermatophilus congolensis, Kytococcus sedentarius, and Streptomyces. Less frequently, it is due to Acinetobacter, Clostridium, Klebsiella, and Pseudomonas species.
Risk factors
People of any age, race, or sex can fall victim to this disorder, though it is more commonly found in men. People who sweat or wash excessively tend to be prone to pitted keratolysis. The prolonged wearing of occlusive footwear, such as tight shoes or rubber boots, also makes one more susceptible. Not surprisingly, athletes and soldiers are extremely prone to this problem. Hot and humid weather is another factor for raising the risk. Those on immunosuppressive drug therapy or diabetes sufferers are also more likely to succumb to pitted keratolysis.
Differential diagnosis
- Hyperhidrosis
- Erythrasma
- Tinea pedis
Diagnosis
The diagnosis of pitted keratolysis is based primarily on the physical examination, with recognition of the classic pitted lesions and pungent odor. Dermoscopic examination can facilitate visualization of pits and pit walls. A woods lamp may show coral red fluorescence, as seen in erythrasma. However, this is finding is not uniformly present, as the condition may be caused by bacteria that do not produce fluorescent pigments. Further laboratory testing is not typically required for the diagnosis. However, a potassium chloride preparation can help rule out the presence of a fungal infection. Imaging and biopsy are not necessary.
Treatment
Treatment consists primarily of topical antibioitics. Effective options include clindamycin, erythromycin, mupirocin, and fusidic acid. The topical antibiotic is applied to affected areas twice daily, until resolution. Benzoyl peroxide is an effective alternative, which may be applied alone, or in addition to antibiotic therapy.
Foot hygiene is important. The feet should be washed at least daily with soap and water, and dried thoroughly afterwards. Absorbent socks, such as cotton, should be worn. Open toed shoes may help with ventilation and keep the feet dry. Botulinum toxin which reduces the hyperhidrosis has been helpful. Topical aluminum chloride hexahydrate, applied nightly can decrease excessive sweating and can improve treatment response for pitted keratolysis.
Pitted keratolysis can be reduced and eventually stopped by regularly applying a liberal amount of antiperspirant body powder to the inside of the shoes and socks of the sufferer. Regular powder application will greatly reduce foot perspiration and keep the plantar surface of the foot dry therefore creating an environment hostile to the Corynebacterium.
History
Paulo Labrador Origin Pitted keratolysis was first named "Keratoma plantare sulcatum."
See also
- List of cutaneous conditions
References
Source of the article : Wikipedia
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