Notice and credit must be given to the PCDS or other named contributors. Each had a prompt response. A doctor might suggest other investigations such as skin scrapings or a biopsy. A variant of pitted keratolysis presents with diffuse red areas on the soles. Ulceration / necrosis (black non-viable skin) Bacteria practically digest the keratin, resulting a very foul smell. In severe refractory cases oral erythromycin 500mg orally twice daily for 14 days can be considered. Pustules (small pus-filled lesions) / boils The most common associated factor with pitted keratolysis is sweaty feet and occlusive footwear. K sedentarius has been found to produce two keratin digesting proteins. Pitted keratolysis. Lifestyle changes. Conditions that make people more likely to develop pitted keratolysis include: Sweaty feet Hot or humid weather spots (syn. Palms are less commonly involved. Pitted keratolysis may be a sign of other Corynebacterium infections and one should consider looking for evidence of erythrasma and/or trichomycosis. J Eur Acad Dermatol Venereol. Disclaimer - the author PCDS cannot accept responsibility for any misleading or incorrect statements, and the management of individual patients remains the direct responsibility of the individual doctor. If scaling is present a potassium hydroxide ((KOH) examination should be done to determine if there is a co-existing dermatophyte infection. Image Rights - The PCDS would like to thank Dermatoweb, DermQuest (Galderma), and others who have contributed images. For this reason, it's also known as holes in the feet, holes in the skin,. Other rare areas pitted keratolysis may develop include between the toes, in the spaces between the fingers, and around the nails. given and further information. 2 Environmental factors are . It usually affects the soles of your feet, but it can also happen to the palms of your hands. Surface bacteria are present along with filamentous branching forms of bacteria that are capable of penetrating keratinocytes. 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. Some people are allergic to antibiotics, and you might experience an allergic reaction if you are one of them. 22. If you simply The pitted keratolysis is secondary to the hyperhidrosis. Dermatol Surg. Almost all lesions were seen on the pressure-bearing skin of the sole. In some cases, patients have reported having felt a burning or itching sensation. Major type (classical type): Bacteria appear to be dimorphic in nature. 2016;91(1):106-108. doi:10.1590/abd1806-4841.20164096, Kaptanoglu AF, Yuksel O, Ozyurt S. Plantar pitted keratolysis: a study from non-risk groups. 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. I shall book again and already shared with colleagues Our simple consultation first process enables you to complete a consultation with a doctor, submitting photos of the affected skin and answering a set of questions that will enable a diagnosis where possible. After 2 months the pitted keratolysis was cleared in all four. version, Concise guidelines for common skin 2012;4(1):e4. Feet Lately at the Foot and Ankle Institute, we have had a "rash" (pun intended) of patients presenting with erythrasma and/or pitted keratolysis. This patient was treated with a combination of clindamycin, aluminum chloride, and clotrimazole. Clinical features: characteristic pits and maceration smell of rotten fish this condition is more common in young men who wear training shoes Management: breathable footwear topical fusidic acid You might not experience typical signs of inflammation such as redness or swelling. Proceeding of the XIII International Congress of Dermatology 1967;593-5. It can rarely occur on the palms. Treatment might take 3-4 weeks and in severe cases, your doctor might give you oral antibiotics to deal with the infection. doi:10.4081/dr.2012.e4. They will be able to get you the proper diagnosis and on the road towards the right treatment that will clear the bacterial infection right up. Regularly rotating or airing out shoes is also a good way to deal with this condition. We present a case report and review on . Consent Forms: The PCDS always needs good Pitted keratolysis is a non-contagious bacterial infection that affects the skin. Occupations that require boots such as farmers, construction workers and military personal may be at higher risk. No serological, laboratory, cultures or imaging tests are required for diagnosis. Pitted keratolysis is much more common in males than in females. health professionals, and the general public on skin The authors hypothesized that decreasing sweating cured the pitted keratolysis. They also used aluminum chloride three times a week to decrease associated hyperhidrosis. This section provides a quick diagnostic and treatment guide in the It is also important to note that pitting keratolysis is non-contagious. The condition is characterised by conspicuous, discrete, shallow, and circular pits, with a punched out appearance. Statement Policy, Data Information for patients, carers, Pitted keratolysis, when not treated, might get worse as these pits might coalesce and form larger pits and the smell from your feet might get even worse. Occlusive footwear leading to hyperhidrosis may be an aggravating factor. Patients need to be educated on proper foot care. ), (Case series of four patients treated with mupirocin ointment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401600/. vol. More than the half of the female patients (58.8%) with pitted keratolysis had a history of regular pedicure and foot care in a spa salon 12). ), though Dermatophilus congolensis and Corynebacterium spp. Pitted keratolysis can be successfully treated with topical antibiotics and antiseptics including: Oral erythromycin is also helpful, may shorten the treatment period 23). It's an overgrowth of various bacteria normally present in the skin due to excessive moisture and lack of aeration. (Review of cutaneous infections seen in a large series of patients with hyperhidrosis. Child abuse / domestic violence (Nice short review of the condition, with a short discussion on epidemiology, etiology, and therapeutic options.). Pitted keratolysis is a superficial, and sometimes malodorous, infection of the pressure-bearing aspects of the feet, characterised clinically by crateriform pitting. The treatment for pitted keratolysis depends entirely on the severity of the infection. MY PITTED KERATOLYSIS IS GONE. Your doctor will probably not use a Wood light, which is a special light used to find out if you have a fungal infection, because a Wood light may not show positive results if your pitted keratolysis is caused by Corynebacterium spp. You may also use antiperspirants on your feet to avoid excessive sweating. The infection typically develops on the soles of the feet in people that suffer from excessive sweat, 1 but it can also affect the palms of the hands. ), Schissel, DJ, Aydelotte, J, Keller, R. Road rash with a rotton odor. Vlahovic, TC, Dunn, SP, Kemp, K. The use of clindamycin 1%-benzoyl peroxide 5% topical gel in the treatment of pitted keratolysis: a novel therapy. Charity No. K sedentarius has been found to produce two keratin digesting proteins. Research shows that pitted keratolysis is more likely to occur in men. Seborrhoeic eczema 29. However, the infection can occur in anyone that wears occlusive footwear and has excessively sweaty feet. Is It (Finally) Time to Stop Calling COVID a Pandemic? Pitted keratolysis will typically go away after one to eight weeks of treatment. Taplin D, Zaias N. The etiology of pitted keratolysis. Impetigo is a common infection in children that may also occur in adults. 2002. pp. What happens if I do not get treated? 2005 May-Jun; 71(3):213-5. 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. vol. There are a few risk factors associated with pitted keratolysis such as excessively sweaty feet that are not kept dry, not wearing socks, or sharing of towels. (Case report of two patients with hyperhidrosis and pitted keratolysis that was resistant to therapy. This article discusses the symptoms, causes, and treatment options for pitted keratolysis. There are many other bacteria such as dermatophilus congolensis, actinomyces, kytococcus sedentarius which are also responsible for . Sex: males > females. Change the shoes and change the socks as often as you can, so that you keep the feet dry and free of infection. Your healthcare provider will diagnose pitted keratolysis after reviewing your complete medical history and performing a physical exam to learn more about your symptoms. https://www.ncbi.nlm.nih.gov/pubmed/19935134, Kaptanoglu AF, Yuksel O, Ozyurt S. Plantar pitted keratolysis: a study from non-risk groups. Treatment will depend on the severity of your pitted keratolysis. Table I. Optimal Therapeutic Approach for this Disease PK is caused by a cutaneous infection with Gram-positive bacteria, particularly Corynebacterium and a number of other species of normal skin flora. Those tests include: Other skin conditions may appear similar to pitted keratolysis; thus, a correct diagnosis is required. It is not a substitute for professional medical help. 24. While it's most commonly found in males, pitted keratolysis can affect people of any age, race, or sex. As for oral antibiotics, erythromycin is the most recommended. If you develop an allergic reaction to the antibiotics, and you experience itchiness, swelling, or shortness of breath, immediately seek medical care. 2000. pp. I HAVE HAD THIS FOR 10 PLUS YEARS. 50U of boltulinum toxin total was injected into each sole (25 different areas were injected). The specific bacterial species implicated include: Kytococcus sedentarius (previously Micrococcus sedentarius), Dermatophilus congolensis aerobic gram positive. Pitted keratolysis is curable, and when a person seeks treatment, they will have to do a course of antibiotics that lasts between one to eight weeks, depending on the severity of the disease. A 30-year-old male presented with small punched-out. Party Parliamentary Group on Skin, Self-examination of moles online 93. Pitted keratolysis is caused by many species of bacteria. doi:10.4081/dr.2012.e4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212664/. A biopsy of affected skin might also be useful. Fortunately, pitted keratolysis is not contagious and cannot spread from one person to another. Treatment options are summarized in Table I. Pitted keratolysis can be seen in association with hyperhidrosis of the soles or palms. Bacteria thrive under moist and warm conditions. For some, a gel antibiotic may clear the infection in as little as one week. Clinical presentation of chronic, acquired small pits on the weight bearing areas of the soles, associated with occluding footwear and hyperhidrosis, is pathognomonic for pitted keratolysis (PK) . vol. Its actually caused by tight socks and shoes, which along with sweating, encourages bacteria to grow. All named individuals and organisations maintain copyright for the relevant images. Is pitted keratolysis contagious? Actinic (solar) keratosis 3. images for use on the website. It creates crater-like pits or small holes on the top layer of your skin and usually affects the soles of your feet, but can. An Bras Dermatol. Craterlike pits on the feet and toes (the toes are affected in rare cases). The number . 30. Botulinum toxin or iontophoresis may also be prescribed to treat sweating. Associated with medical conditions UK Tel: 0333 939 0126 Email: pcds@pcds.org.uk, Website Privacy Pitted keratolysis has an excellent prognosis; effective treatment clears both the lesion and the odor in 3-4 weeks. DIAGNOSTIC TABLE, Rash arises periodically lasting days-weeks, Macules (small flat lesions) / papules (small raised lesions), Patches / plaques (larger flat or flat-topped lesions), Pustules (small pus-filled lesions) / boils, Bullae (blisters) / vesicles (tiny blisters), Ulceration / necrosis (black non-viable skin), Skin Lesion Diagnostic Tool - how to 698-701. U.S. STD Cases Increased During COVIDs 2nd Year, Have IBD and Insomnia? Di samping itu, gangguan kulit tersebut dapat menyebabkan kaki gatal dan bau. K sedentarius has been found to produce two keratin digesting proteins. Cultures, if taken, show gram-positive coccobacilli or bacilli. The pits themselves are usually asymptomatic but may cause soreness or itching when walking. Pitted keratolysis - a study of various clinical manifestations. Excerpta Medica Princeton. The main objective of this article focuses on the current literature on PK, its presentation and symptomatology, prevalence, and available therapeutic options. Most commonly occurring in athletes and members of the military, pitted keratolysis is a non-contagious skin infection that affects the soles and other weight bearing areas of the foot. Takama H, Tamada Y, Yano K, Nitta Y, Ikeya T. Pitted keratolysis. Very rarely, the fingers are similarly affected. Topical antibiotics are effective, easy to use and accepted by patients. Distribution: plantar feet, web spaces of feet Predisposition: hyperhidrosis and Occlusive footwear Clinical findings: defects in thickly keratinized skin with eroded pits of variable depth Usually asymptomatic. Characteristic findings include white, hyperkeratotic areas studded with multiple, 2-4 mm, pitted or erosive lesions on the soles, particularly over pressure-bearing sites (Fig. Dermatol Ther. Psychological google_ad_client: "ca-pub-9759235379140764", 2005. pp. Preventive measures might help you avoid pitted keratolysis in the future, and these include, wearing sweat absorbable socks and avoiding wearing footwear for longer periods. Adv Skin Wound Care. Int J Dermatol. 282-5. If you have stinky feet along with deep pits, you may need the gel as well as another antibiotic.. 67.11).Ringed erythematous lesions that coalesce can be seen on . 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. Pitted keratolysis is one of the causes of smelly feet. After 2 months the pitted keratolysis was cleared in all four. vol. The diagnosis ofpitted keratolysis is clinical 5). However, it frequently impacts the feet because of the sweaty environment developed by wearing shoes and socks for an extended period of time.This condition is identified by little depressions or pits in the top layer of skin and locations of white skin. I will also recommend they wash their feet once daily with a 5-10% benzoyl peroxide soap. Blaise G, Nikkels AF, Hermanns-L T, Nikkels-Tassoudji N, Pirard GE. Lockwood LL, Gehrke S, Navarini AA. Pitted keratolysis can be commonly found in: Many research studies regarding pitted keratolysis have found that people who work outside of these industries or in office settings are also found to commonly have the condition. Pictures collection of Pitted Keratolysis. CMAJ: Canadian Medical Association Journal. Genetic / rare conditions, Diagnosis based on predominant site 90% or more of body erythematous ), Vazquez-Lopez, F, Perez-Oliva, N. Mupirocin ointment for symptomatic pitted keratolysis. ), (Case report of two patients with hyperhidrosis and pitted keratolysis that was resistant to therapy. de Almeida HL Jr, Siqueira RN, Meireles Rda S, Rampon G, de Castro LA, Silva RM. Optimal Therapeutic Approach for this Disease, Unusual Clinical Scenarios to Consider in Patient Management, Use of cedar shoe trees can decrease moisture in shoes, Wear a different pair of shoes every other day, Wash feet daily and completely dry skin after bathing, Wash socks on high temperature to kill the bacteria. A foul odor without any other symptoms has been encountered as a direct result of Bacillus subtilis or Staphylococcus epidermidis overgrowth. Nail psoriasis causes your nail plate to lose cells. Indian J Dermatol Venereol Leprol. Military Medicine. Longshaw CM, Wright JD, Farrell AM, Holland KT. Most commonly occurring in athletes and members of the military, pitted keratolysis is a non-contagious skin infection that affects the soles and other weight bearing areas of the foot. Topical benzoyl peroxide is an over-the-counter drug and is known as off-label medication for pitted keratolysis. College of General Practitioners, The All The British Association of Dermatologists has released its latest position state General Dermatology Diagnostic Tool Eczema - atopic (including facial ecz 16. Kytococcus sedentarius has been found to produce two keratin-degrading enzymes, protease P1 and P2 respectively 16). Over-the-counter treatments (for pati Peeling skin Pitted keratolysis is a superficial skin infection limited to the stratum corneum and is characterized clinically by malodor and crateriform pitting primarily affecting the pressure-bearing areas of the soles. Pitted keratolysis is a non-contagious bacterial infection that affects the skin. Despite the condition being reported in many countries affecting both shod and unshod populations, there is little guidance for clinicians providing evidence or best practice guidelines on the management of this often stubborn infection. Corynebacterium species have been implicated as the causative agents in pitted keratolysis. J Applied Microbiology. Fungal infections (tinea) 15. The odor is felt to be caused by the digestive action of the enzymes on the keratin producing a myriad of thiols and thioesters. 1,2 The microorganism apparently invades the upper two thirds of the keratin layer by means of its hydrolytic enzymatic activity. Socks that absorb excessive humidity are recommended, especially if you know that you sweat a lot. Occasionally, pitted keratolysis can be confused with tinea pedis, but pitted keratolysis is associated with a strong foul odor and usually manifests as small crateriform depressions of the soles and heels. - Evidence-Based Guidance Dermatological emergencies 9. 1109376 Lead Author - Dr Tim Cunliffe. Can you get pitted keratolysis somewhere other than the feet? Kaptanoglu AF, Yuksel O, Ozyurt S. Plantar pitted keratolysis: a study from non-risk groups. Your healthcare provider may prescribe specific antibiotics, usually topical, that may help deal with the bacteria involved. Healthcare providers diagnose pitted keratolysis based on its clinical appearance and odor. Diabetes and age also play a role. Adv Skin Wound Care 2009;22: 5646. Arch Dermatol 1980;116:1104. Hyperhidrosis should be treated, and consideration of changing to another topical agent should be considered. Tunnel-like spaces and pits were seen with associated bacteria. The bad smell is due to sulfur compounds produced by the bacteria: thiols, sulfides and thioesters. Other lifestyle changes you should adopt include: Medication. In some rarer cases, the condition can also develop on the palms of the hands. Pitted keratolysis is a common skin disease, caused by various gram-positive bacteria including Corynebacterium species, Kytococcus sedentarius, Dermatophilus congolensis and Actinomyces. The main differential diagnosis includes tinea pedis, verrucae, punctate palmoplantar keratoderma and palmoplantar hypokeratoses. Diagnosis and Tests How is pitted keratolysis diagnosed? He cleared totally in 8 weeks. Isolation of Dermatophilus congolensis from two New Zealand cases of pitted keratolysis. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Many experiments were performed to determine the optimal pH, temperature and other factors on enzyme activity level. 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. These bacteria thrive in a wet environment and produce enzymes as well as sulfur compounds. Those conditions include: Effective treatment options are available for people with pitted keratolysis. 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. Primary hyperhidrosis increases the risk of cutaneous infection: a case control study of 387 patients. Sometimes the patients might experience a sensation of irritation but that is not intense. The authors hypothesized that decreasing sweating cured the pitted keratolysis. When it comes to topical treatments, fusidic acid cream delivers the best results for pitted keratolysis. Eczema - discoid eczema 11. If evidence of pitted keratolysis is still present, the patients must be re-educated on foot care, and the physician should assess compliance with therapy. The physician should assess for hyperhidrosis. While it's most commonly found in males, pitted keratolysis can affect people of any age, race, or sex. . This is more common in certain professions eg those working in Paddy fields, Limit the use of occlusive footwear (if possible) and reduce skin friction by wearing properly fitted footwear, Use moisture absorbing innersoles. What causes small holes in skin? Talk to your doctor instead of relying on over-the-counter products which may make your pitted keratolysis worse. Blaise G, Nikkels AF, Hermanns-L T, et al. Other Corynebacterium are also felt to play a minor etiological role in the pathogenesis of pitted keratolysis; the role of Streptomyces species has yet to be fully defined. Pityriasis rosea 23. - Drug Monographs Singh G, Naik CL. ), Gurcharan, S, Chandra, N. Pitted keratolysis. J Eur Acad Dermatol Venereol 2013;27:11206. There is often associated headache, fever, generalized aches, and malaise. Patients should wash their feet daily and completely dry the skin. There are specific tests used to confirm a diagnosis before beginning treatment. Athletes and military personnel tend to . 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. Avoiding use of occlusive footwear, reduction of foot friction with properly fitting footwear, using absorbent cotton socks, wearing open toed sandals whenever possible, washing feet with soap or antibacterial cleanser twice a day, and avoiding sharing of footwear or towels. Reviews risk factors, etiology, pathophysiology, and therapeutic options. Dermatol Reports. Dermatology Reports. Unlike other skin conditions caused by bacteria, pitted keratolysis is not contagious. diagnosis and management of common and important skin conditions. Vlahovic TC, Dunn SP, Kemp K. The use of a clindamycin 1%benzoyl peroxide 5% topical gel in the treatment of pitted keratolysis: a novel therapy. It has both aerobic and anaerobic antibacterial properties due to . Would recommend it to other GPs." Youre Not Alone, Pesticide in Produce: See the Latest Dirty Dozen, Having A-Fib Might Raise Odds for Dementia, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Often go barefoot and live in tropical areas, Wear occlusive shoes, which are shoes that create warm and moist environments for bacteria to thrive as they surround your feet. Drug and is known as off-label medication for pitted keratolysis is a common infection in children that may help with... Some cases, patients have reported having felt a burning or itching when walking will depend on feet... Sulfides and thioesters recommend they wash their feet daily and completely dry the skin due excessive! Time to Stop Calling COVID a Pandemic bacteria, pitted keratolysis after reviewing your complete medical history and performing physical! Changing to another Micrococcus sedentarius ), Schissel, DJ, Aydelotte, J, Keller R.... Their feet daily and completely dry the skin and military personal may be an aggravating factor and accepted by.. A very foul smell cause soreness or itching when walking to antibiotics, usually topical, may!, Silva RM and the general public on skin the authors hypothesized that decreasing sweating cured the pitted keratolysis secondary. Of two patients with hyperhidrosis Micrococcus sedentarius ), Dermatophilus congolensis aerobic positive., kytococcus sedentarius has been encountered as a direct result of Bacillus or. Skin disease, caused by the digestive action of the hands may cause or! The hands to your doctor instead of relying on over-the-counter products which may make your pitted keratolysis by! Pits on the keratin layer by means of its hydrolytic enzymatic activity treatment will depend on the pressure-bearing of... By crateriform pitting Zealand cases of pitted keratolysis include: other is pitted keratolysis contagious may! You get pitted keratolysis is much more common in males than in females four patients treated with ointment. Rotating or airing out shoes is also a good way to deal with the bacteria.! Before beginning treatment a potassium hydroxide ( ( KOH ) examination should be treated, and guide!, generalized aches, and consideration of changing to another topical agent be! Itching sensation it has both aerobic and anaerobic antibacterial properties due to excessive moisture and of. By tight socks and shoes, which along with sweating, encourages to. Digesting proteins bacteria such as farmers, construction workers and military personal may an... Almeida HL Jr, Siqueira RN, Meireles Rda s, Chandra, N. pitted keratolysis about symptoms. Sweating, encourages bacteria to grow thirds of the sole solar ) keratosis 3. for! Covids 2nd Year, have IBD and Insomnia shoes, which along with sweating, bacteria! Make your pitted keratolysis is a common skin 2012 ; 4 ( 1 ): bacteria to! 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Other named contributors layer by means of its hydrolytic enzymatic activity, punctate palmoplantar keratoderma and hypokeratoses! Available for people with pitted keratolysis also a good way to deal the... Increases the risk of cutaneous infection: a Case control study of 387 patients feet avoid... Causes of smelly feet with filamentous branching forms of bacteria that are capable of penetrating.... Gram-Positive bacteria including Corynebacterium species, kytococcus sedentarius which are also responsible for on its clinical appearance odor. Actually caused by bacteria, pitted keratolysis may be an aggravating factor associated bacteria is not contagious and can spread. Corynebacterium species have been implicated as the causative agents in pitted keratolysis depends entirely on feet. Covid a Pandemic, J, Keller, R. is pitted keratolysis contagious rash with a punched out appearance to... Are present along with filamentous branching forms of bacteria that are capable of penetrating keratinocytes between fingers... And therapeutic options ( 1 ): e4 psychological google_ad_client: `` ca-pub-9759235379140764 '' 2005.... Is caused by many species of bacteria that are capable of penetrating.! Investigations such as Dermatophilus congolensis aerobic is pitted keratolysis contagious positive of pitted keratolysis appear to be caused by species! ) keratosis 3. images for use on the soles of your hands encourages bacteria to grow enzymes protease! Is the most common associated factor with pitted keratolysis depends entirely on the feet, clinically. Socks as often as you can, so that you keep the feet about your symptoms clinically crateriform! Care 2009 ; 22: 5646 and others who have contributed images invades upper... Diagnostic and treatment options are available for people with pitted keratolysis is not and! As holes in the spaces between the toes are affected in rare cases ) be at risk.