Pitted Keratolysis

What is Pitted Keratolysis?

Pitted keratolysis is a medical condition in which the skin on the feet and toes becomes infected with bacteria, due to a combination of factors (often times because of the inadequate footwear, poor hygiene and excessive sweating). Also known as keratolysis plantare sulcatum, keratoma plantare sulcatum or ringed keratolysis, this condition is not contagious and it often affects the soles of the feet, where is a lot of weight bearing pressure.

As this condition is caused by bacteria, it should come as no surprise that it is often present in military personnel or people who wear tight or restrictive footwear for extensive periods of time. Different types of bacteria love humid and warm environments, so they will thrive in footwear that is not removed or cleaned regularly.

Symptoms of Pitted Keratolysis

These are the most common symptoms of pitted keratolysis:

• Craterlike pits on the feet and toes (the toes are affected in rare cases). The craterlike pits can overlap one another, this leading to a bigger area being affected by the keratin erosion. The pits can also be surrounded by a hue that is green or brown in color. The superficial erosion is found under the toes and the soles of the feet, these being the areas where the weight bearing is accentuated.
• Bacteria practically digest the keratin, resulting a very foul smell. A lot of patients diagnosed with pitted keratolysis have social anxiety because of their smelly feet.
• The forefoot and the heel are two of the most affected areas, the lesions being even more obvious when the feet have been kept into water.
• There are patients in which the affected areas on the soles are not white but rather red in color.
• Both sides of the feet are affected.
• Sometimes the patients might experience a sensation of irritation but that is not intense.
• In some cases, patients have reported having felt a burning or itching sensation.

What are the Causes of Pitted Keratolysis?

Pitted keratolysis is caused by the infection with different types of bacteria, including any of the following:

• Corynebacteria
• Dermatophilus congolensis
• Kytococcus sedentarius actinomyces
• Streptomyces

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. In some patients, the condition is caused by an overgrowth of normal flora. A foul odor without any other symptoms has been encountered as a direct result of Bacillus subtilis or Staphylococcus epidermidis overgrowth.

Diagnosis

These are the most common methods used for the diagnosis of pitted keratolysis:

• Clinical assessment of patient symptoms
• Probe taking with a swab and lab analysis for the identification of the causing bacteria
• Skin scraping in case there is a suspicion of infection caused by different types of fungi
• Skin biopsy – this is often performed for the confirmation of a clinically suspected diagnostic, this being based on the characteristic histopathological features

Treatment

When it comes to the treatment of pitted keratolysis, there are medical treatments available but the patient is going to have to follow certain self care measures as well. The treatments consist either of topical or oral antibiotics. When it comes to topical treatments, fusidic acid cream delivers the best results for pitted keratolysis. As for oral antibiotics, erythromycin is the most recommended. As for the self care measures that the patient has to follow, below you will find a few recommendations:

• Keeping feet dry at all times
• Wearing boots for as little time as possible. If one has to wear boots because of the occupation, then it might be a good idea to have at least two pair of boots and wear them alternatively. Plus, a frequent change of socks would be a good idea.
• Socks that absorb excessive humidity are recommended, especially if you know that you sweat a lot. The most indicated materials for socks are wool and cotton.
• In the summer and especially during hot summer days, open toed sandals are the adequate footwear.
• The feet need to be cleaned with antibacterial soap or a cleaner with antiseptic properties.
• Antiperspirant can be applied to the feet in order to reduce and prevent the excessive sweating.
• It is not recommended that the same pair of shoes is worn every day. Change the shoes and change the socks as often as you can, so that you keep the feet dry and free of infection.
• Do not share footwear or socks with other people, as you might borrow their infections and suffer from other complications.

Is Pitted Keratolysis contagious?

Even though pitted keratolysis is caused by a bacterial infection, this medical condition is not contagious. 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.

Pitted Keratolysis Pictures

Pictures collection of Pitted Keratolysis…