Pitted keratolysis (PK) presents as defects in the thickly keratinized skin of the plantar foot with sculpted pits of variable depth, depending on the thickness of the stratum corneum, usually associated with pedal hyperhidrosis, caused by Micrococcus sedentarius.
Causes of Pitted Keratolysis
It affects those who sweat profusely (hyperhidrosis) especially if they wear occlusive shoes or boots for long periods. It is caused by corynebacteria, and/or possibly the bacteria Dermatophilus congolensis.
Symptoms of Pitted Keratolysis
The primary lesions of pitted keratolysis are pits in the stratum corneum ranging from 0.5-7 mm, with some development of confluence, irregular erosions, or sulci. A variant of markedly enlarged lesions, called crateriform pitted keratolysis.
The result is very smelly feet, due to infection of the soles. Either the forefoot or the heel or both become white with clusters of punched-out pits.
Diagnosis
Clinical diagnosis ruling out other causes.
Treatment
Topical Therapy Daily applications of agents such as benzoyl peroxide gel or topical antibiotics such as erythromycin are usually effective.
Prevention
Wash affected site with lather from benzoyl peroxide bar or wash. Reduce moisture in shoes with agents such as aluminum chloride or Zeasorb AF powder. Wear less occlusive footwear.
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