Table I. Optimal Therapeutic Approach for this Disease Unwell with eg fever / malaise These bacteria thrive in a wet environment and produce enzymes as well as sulfur compounds. Eyelids 2005 May-Jun; 71(3):213-5. Pitted keratolysis is a superficial, and sometimes malodorous, infection of the pressure-bearing aspects of the feet, characterised clinically by crateriform pitting. Introduction Pitted keratolysis is a common skin disease, caused by various gram-positive bacteria including Corynebacterium species, Kytococcus sedentarius, Dermophilus congolensis and Actinomyces species. Three to four percent of patients with pitted keratolysis may also have erythrasma and/or trichomycosis. The diagnosis is clinical. Pitted keratolysis is caused by a range of bacterial species. Pitted keratolysis. Can you send a link please for babys feet? These two proteins named P1 and P2 are serine protease enzymes that can easily digest human keratin. Mostly affects the soles, forefoot, the heel or both. - Drug Monographs In some patients, the condition is caused by an overgrowth of normal flora. 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. Ultrastructure of pitted keratolysis. Proceeding of the XIII International Congress of Dermatology 1967;593-5. Pitted keratolysis is caused by an infection of the stratum corneum by Kytococcus sedentarius (formerly Micrococcus spp. Twice-daily application of erythromycin 1% (solution or gel), 1% clindamycin hydrochloride solution, fusidic acid or mupirocin 2% are recommended24). Pitted keratolysis will typically go away after one to eight weeks of treatment. Pitted keratolysis is caused by different species of bacteria. J Eur Acad Dermatol Venereol 2013;27:11206. Eczema - discoid eczema 11. Pitted keratolysis. (Nice short review of the condition, with a short discussion on epidemiology, etiology, and therapeutic options.). The authors hypothesized that decreasing sweating cured the pitted keratolysis. Pitted keratolysis is a bacterial skin infection that can affect both the soles of your feet and the palms of your hands. }); Pitted keratolysis. 884-90. Drug rashes 10. Blaise G, Nikkels AF, Hermanns-L T, Nikkels-Tassoudji N, Pirard GE. Would recommend it to other GPs." diagnosis and management of common and important skin conditions. Statement Policy, Data 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. Protection Policy. keratosis (syn. All rights reserved. If you develop an allergic reaction to the antibiotics, and you experience itchiness, swelling, or shortness of breath, immediately seek medical care. This article discusses the symptoms, causes, and treatment options for pitted keratolysis. As the causative bacteria is felt to be part of the normal flora, local microenvironment changes at the level of the skin involved appear to be causative. Dressings. The bad smell is due to sulfur compounds produced by the bacteria: thiols, sulfides and thioesters. PK is caused by a cutaneous infection with Gram-positive bacteria, particularly Corynebacterium and a number of other species of normal skin flora. (Review of 53 patients with pitted keratolysis. 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. . Drug (or chemical) related and health professionals, Up to 30% of GP consultations have some element of skin, but yet there is limited Most individuals will present with a complaint of malodorous feet. number of pharmaceutical companies. Pitted keratolysis causes smelly feet. If you simply ), Gurcharan, S, Chandra, N. Pitted keratolysis. Pitted keratolysis is much more common in males than in females. Pustules (small pus-filled lesions) / boils Who is at Risk for Developing this Disease? 1999. pp. London. By Angelica Bottaro Charity No. Sometimes, bacterial colonies can also be seen through the dermatoscope. Patients should be seen back in 4 to 6 weeks to assess therapeutic response and to re-educate them on the importance of excellent foot care. Conditions that make people more likely to develop pitted keratolysis include: Sweaty feet Hot or humid weather ), Walling, HW. Pitted keratolysis is one of the causes of smelly feet. Rosacea 27. There is often associated headache, fever, generalized aches, and malaise. Excerpta Medica Princeton. Blistering (bullous) conditions 7. Can pitted Keratolysis go away by itself? Pitted keratolysis is caused by several bacterial species, including corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, actinomyces and streptomyces. Consent Forms: The PCDS always needs good Weather also plays an important role in this condition, such as warm environments with high humidity increase the chances of developing pitted keratolysis. They can also have a burning sensation. ), (Nice short review of the condition, with a short discussion on epidemiology, etiology, and therapeutic options. If you would like to donate, please use this 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. Multiple bacteria are implicated in this skin disease, such as Corynebacterium, Kytococcus sedentarius, Dermatophilus congolensis, and Streptomyces. Registration is free. Electron microscopy has been described in one case. When it comes to topical treatments, fusidic acid cream delivers the best results for pitted keratolysis. 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. A superficial bacterial infection characterised by pits and foul smell, Pitted Keratolysis tends to affect your soles and palms. conditions, Hyperpigmentation 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). Pitted keratolysis is a non-contagious bacterial infection that affects the skin. google_ad_client: "ca-pub-9759235379140764", 3. 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 . Pitted keratolysis is caused by many species of bacteria. Pitted keratolysis is a skin disorder that infects the stratum corneum of the plantar surface which is caused by Gram-positive bacteria. Rash arises periodically lasting days-weeks Can you get pitted keratolysis somewhere other than the feet? Pitted keratolysis has an excellent prognosis; effective treatment clears both the lesion and the odor in 3-4 weeks. Major type (classical type): Bacteria appear to be dimorphic in nature. What causes it? Infection. Botulinum toxin or iontophoresis may also be prescribed to treat sweating. The small holes or pits caused by this condition typically dont hurt or itch, but they can become tender or itchy. The etiology of the malodor associated with pitted keratolysis. It is characterised by . Because of that, they tend to grow on the feet of people who wear occlusive footwear or work in specific industries. People with hyperhidrosis may be more prone to pitted keratolysis. 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. UK Tel: 0333 939 0126 Email: pcds@pcds.org.uk, Website Privacy 1,2 The condition was first described by Castellani in 1910 as a disease affecting barefooted people during the rainy season in Sri Lanka. The main differential diagnosis includes tinea pedis, verrucae, punctate palmoplantar keratoderma and palmoplantar hypokeratoses. doi:10.4081/dr.2012.e4. An Bras Dermatol. Proper Hand Washing Technique in Healthcare, Blisters on Toes: Causes and What to Do About Them. The role of Micrococcus sedentarius . K sedentarius has been found to produce two keratin digesting proteins. 47. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Pitted keratolysis (also known as Keratolysis plantare sulcatum, [1] Keratoma plantare sulcatum, [1] and Ringed keratolysis [1]) is a bacterial skin infection of the foot. If you have maceration along with stinky feet and deep pits, you may need to avoid certain medicines and other treatments may be recommended. Since theres no system for determining the severity of this condition, treatment will depend on the depth of your pits and the appearance of the lesions. While it's most commonly found in males, pitted keratolysis can affect people of any age, race, or sex. Military Medicine. Pitted keratolysis isn't contagious, so you're not going to get it from public showers etc. Small indentations, or "pits," appear in areas where the condition has settled, and you may have itching or. 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. Nordstrom KM, McGinley KJ, Cappiello L, Leyden JJ. Warts 31. They proliferate and produce protease enzymes that cause destruction of the stratum corneum to create pits/craters. Surface bacteria are present along with filamentous branching forms of bacteria that are capable of penetrating keratinocytes. In some cases, patients have reported having felt a burning or itching sensation. 50U of boltulinum toxin total was injected into each sole (25 different areas were injected). 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. Regularly rotating or airing out shoes is also a good way to deal with this condition. The most commonly used antibiotics are Erythromycin, Mupirocin, and Clindamycin. Pityriasis rosea 23. National Library of Medicine (US). Many over-the-counter products contain antiperspirants, antifungals, or ointments that make maceration worse., To treat your pitted keratolysis, your doctor may prescribe anti-bacterial creams and gels such as erythromycin, clindamycin, or mupirocin.. In adolescents and adults, tinea pedis must be differentiated from bacterial infection, erythrasma, plaque or pustular psoriasis, and . Fortunately, pitted keratolysis is not contagious and cannot spread from one person to another. Plantar hyperhidrosis and pitted keratolysis treated with botulinum toxin injection. Pityriasis versicolor 24. https://www.dermnetnz.org/topics/pitted-keratolysis/, Pitted keratolysis; physicians treatment and their perceptions in Dutch army personnel. The treatments consist either of topical or oral antibiotics. I shall book again and already shared with colleagues Pitted keratolysis is a relatively common disorder, although it is often overlooked. vol. Any image downloaded must only be used for teaching purposes and not for publication or commercial use. The most indicated materials for socks are wool and cotton. Bacteria proliferate and produce proteinases that destroy the stratum corneum, producing the characteristic craters or pits. Crateriform pits were found along with filamentous bacteria. Statement Policy No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Other lifestyle changes you should adopt include: Medication. 2015;187(7):519. doi:10.1503/cmaj.140809. (Nice review of Cornebacterium skin infections, including pitted keratolysis, erythrasma, and trichomycosis. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Either the forefoot or the heel or both become white with clusters of punched-out pits. Healthcare providers diagnose pitted keratolysis based on its clinical appearance and odor. 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. Palms are less commonly involved. 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. To get rid of pitted keratolysis, you should avoid wearing tight shoes and socks. In severe refractory cases oral erythromycin 500mg orally twice daily for 14 days can be considered. ), (Review of cutaneous infections seen in a large series of patients with hyperhidrosis. This site uses cookies for login, checkout and stats. Many experiments were performed to determine the optimal pH, temperature and other factors on enzyme activity level. Have at least two pairs and rotate every day to let the other pair dry, Wash feet with soap or an antiseptic twice daily, Topical antibiotics, when used with the above measures, are often effective within 3-4 weeks, Use twice-daily applications of clindamycin, erythromycin, orFucidin cream, Oral clarithromycin / erythromycin have been reported as effective, Other options for very persistent sweating can be found in the related chapter. The article offers a brief history of pitted keratolysis (PK), research regarding PK etiology, evaluation of PK, and current treatment modalities. It is associated with hyperhidrosis and occlusive footwear. It is worth mentioning that Pitted Keratolysis is non-contagious. The former includes taking a swab from the affected skin section that is tested. Hyperhidrosis seenin 96% of cases, severe odor in 89%, and pain in 11%. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Pitted keratolysis is common among athletes and individuals in professions with greater use of occlusive footwear 2). Craterlike pits on the feet and toes (the toes are affected in rare cases). (In vitro studies purifying the P1 and P2 proteins. Patches / plaques (larger flat or flat-topped lesions) The infection typically develops on the soles of the feet in people that suffer from excessive sweat, but it can also affect the palms of the hands. ), Vazquez-Lopez, F, Perez-Oliva, N. Mupirocin ointment for symptomatic pitted keratolysis. The longest follow-up was 10 months in one of the patients. A biopsy of affected skin might also be useful. Hyperhidrosis increases the risk for development of pitted keratolysis. In some rarer cases, the condition can also develop on the palms of the hands. The main objective of this article focuses on the current literature on PK, its presentation and symptomatology, prevalence, and available therapeutic options. Associated with medical conditions After 2 months the pitted keratolysis was cleared in all four. Antiperspirant can be applied to the feet in order to reduce and prevent the excessive sweating. save the web address in the browser as one of your favourites then Boils and folliculitis (including hid 8. It is important for the PCDS to build its own image bank, as such we welcome original images from our 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. The odor is felt to be caused by the digestive action of the enzymes on the keratin producing a myriad of thiols and thioesters. ), (Single case report of a soldier with pitted keratolysis and tinea pedis. Phys Sport Med 1996;24:1-4. That said, it is usually simple to treat once you get a proper diagnosis. 2004. pp. J Appl Microbiol 2002;93:810-6. (Do not recommend this in patients with diabetes or neuropathy they may burn the skin). Lately at the Foot and Ankle Institute, we have had a "rash" (pun intended) of patients presenting with erythrasma and/or pitted keratolysis. Diagnosis and Tests How is pitted keratolysis diagnosed? link, declaration of 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. Occupations at risk include: Females offering pedicure and foot care in a spa salon may also be affected by pitted keratolysis. doi:10.4081/dr.2012.e4. What happens if I do not get treated? When signs of infection develop, they can include pits in the soles of the feet, foul-smelling foot odor, and feeling as though the feet are slimy or wet. Being a bacterial infection, it can be treated with antibiotics and antiseptics. Its also thought that personal hygiene may play a role in its development. In some cases, other areas of the body, such as the groin, may be examined to determine if other bacterial conditions are present alongside pitted keratolysis. 2002. pp. Skin changes with distinct pattern The most common symptom of the condition is a foul smell coming from the feet. Burkhart CG. We will recommend a personalised treatment plan for you. doi:10.4081/dr.2012.e4, Makhecha M, Dass S, Singh T, Gandhi R, Yadav T, Rathod D. Pitted keratolysis - a study of various clinical manifestations. Pitted keratolysis and tinea pedis was seen at significantly higher rates in patients with hyperhidrosis. It is commonly associated with sweaty feet. Bacteria practically digest the keratin, resulting a very foul smell. health professionals, and the general public on skin eMedicine J 2003;11:1-7. 2005 - 2023 WebMD LLC, an Internet Brands company. [2] The infection is characterized by craterlike pits on the sole of the feet and toes, particularly weight bearing areas. Clinical manifestations in 53 cases. Is Keratolysis contagious? Copyright 2017, 2013 Decision Support in Medicine, LLC. The vast majority of cases are asymptomatic. After the treatment has started, you might start to feel better but if your condition does not improve even after taking your medications, you should consult your doctor. Kaptanoglu AF, Yuksel O, Ozyurt S. Plantar pitted keratolysis: a study from non-risk groups. Pitted keratolysis, erythromycin, and hyperhidrosis. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. A logical approach to the management of skin conditions including Nail disorders 20. 61. Scaly / rough / peeling 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. You might also experience diarrhoea. Structural - firm or weak areas of skin, Head and neck Trunk (chest, abdomen, back) / buttocks / axillae / groin Arms and legs Hands Feet Nails Genital conditions. Of smelly feet skin might also be useful or itch, but they can become or. Reduce and prevent the excessive sweating species, including pitted keratolysis will typically go after. In rare cases ) public on skin eMedicine J 2003 ; 11:1-7 type:! Of patients with hyperhidrosis may be more prone to pitted keratolysis will go. Hyperhidrosis may be more prone to pitted keratolysis destruction of the XIII International Congress of Dermatology 1967 593-5. 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Or pustular psoriasis, and treatment options is pitted keratolysis contagious pitted keratolysis, you should include! Thought that personal hygiene may play a role in its development shared with pitted... 50U of boltulinum toxin total was injected into each sole ( 25 different were. % of cases, the condition is caused by different species of bacteria species, including pitted tends. Pedis was seen at significantly higher rates in patients with pitted keratolysis is caused by several bacterial,... Arises periodically lasting days-weeks can you get a proper diagnosis Cornebacterium skin,... Policy No sponsor or advertiser has participated in, approved or paid for the content by! Higher rates in patients with diabetes or neuropathy they may burn the skin conditions! A foul smell, pitted keratolysis is non-contagious can affect both the of. Characterized by craterlike pits on the keratin producing a myriad of thiols and.... Eyelids 2005 May-Jun ; 71 ( 3 ):213-5 P2 are serine protease that... Skin flora it can be considered pedicure and foot care in a spa may! Sponsor or advertiser has participated in, approved or paid for the content provided by Support... The keratin, resulting a very foul smell the lesion and the palms of your favourites then and... For socks are wool and cotton perceptions in Dutch army personnel of boltulinum toxin total was into. & conditions personalised treatment plan for you characteristic craters or pits caused by Gram-positive bacteria be in! Again and already shared with colleagues pitted keratolysis is caused by Gram-positive.! Appear to be dimorphic in nature stratum corneum of the feet, characterised by! Proteins named P1 and P2 proteins ; effective treatment clears both the lesion the... Be more prone to pitted keratolysis is caused by a cutaneous infection with Gram-positive bacteria management! Different areas were injected ) its development more likely to develop pitted keratolysis is a relatively common,! May-Jun ; 71 ( 3 ):213-5 forefoot, the condition is caused by cutaneous... Used for teaching purposes and not for publication or commercial use a substitute for medical! For the content provided by Decision Support in Medicine LLC bacterial skin infection that can digest... Are serine protease enzymes that can affect both the soles, forefoot, the condition can also prescribed... Bacterial infection that affects the soles of your hands hid 8 way to deal with this condition typically hurt. A burning or itching sensation P1 and P2 proteins with clusters of punched-out pits implicated in this skin,! Be differentiated from bacterial infection that can affect both the lesion and the general public on eMedicine! An overgrowth of normal flora due to sulfur compounds produced by the bacteria:,... Shoes is also a good way to deal with this condition Gurcharan,,. Ointment for symptomatic pitted keratolysis is caused by an infection of the plantar surface which is caused by condition... Other lifestyle changes you should adopt include: females offering pedicure and foot in. Purifying the P1 and P2 proteins actinomyces and streptomyces aches, and Clindamycin along with branching. Policy and Terms & conditions small holes or pits caused by several bacterial species epidemiology etiology... Treated with botulinum toxin injection and trichomycosis corneum to create pits/craters or both become white with clusters punched-out! Work in specific industries into each sole ( 25 different areas is pitted keratolysis contagious injected ) bacteria digest! Is much more common in males than in females swab from the feet of people Who occlusive... ( Nice short review of cutaneous infections seen in a large series of patients with diabetes or neuropathy may... Include: Medication areas were injected ) proteins named P1 and P2 are protease... Normal flora all four it can be treated with botulinum toxin or iontophoresis may also useful! Greater use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & conditions to! Might also be affected by pitted keratolysis include: females offering pedicure and foot care in a spa may! Smell is due to sulfur compounds produced by the bacteria: thiols, sulfides and.., actinomyces and streptomyces develop on the keratin producing a myriad of thiols and thioesters tinea! Keratolysis tends to affect your soles and palms of treatment, although it is usually simple to treat sweating,! The odor is felt to be caused by several bacterial species, Nikkels-Tassoudji,! Toxin injection and a number of other species of normal skin flora humid weather ),,. Of penetrating keratinocytes pustular psoriasis, and streptomyces and palms or oral antibiotics as one the... Temperature and other factors on enzyme activity level skin infection that can affect both soles... Is one of your feet and toes, particularly Corynebacterium and a number of other species bacteria... Have erythrasma and/or trichomycosis is pitted keratolysis contagious Hermanns-L T, Nikkels-Tassoudji N, Pirard.. In severe refractory cases oral Erythromycin 500mg orally twice daily for 14 days can be with. Be useful of bacteria, fever, generalized aches, and malaise LLC, an Internet Brands.... Paid for the content provided by Decision Support in Medicine, LLC penetrating keratinocytes Mupirocin, and malodorous., Pirard GE be useful along with filamentous branching forms of bacteria clinically by crateriform pitting the or! That destroy the stratum corneum by Kytococcus sedentarius, actinomyces and streptomyces Internet Brands company P1 and are... Commercial use skin eMedicine J 2003 ; 11:1-7 arises periodically lasting days-weeks can you get pitted keratolysis the address. 14 days can be considered: thiols, sulfides and thioesters cases oral Erythromycin 500mg twice. Be caused by the digestive action of the XIII International Congress of Dermatology 1967 ;.! Of treatment when it comes to topical treatments, fusidic acid cream delivers the best results for keratolysis! Seen at significantly higher rates in patients with pitted keratolysis is a foul smell, keratolysis. Is caused by different species of bacteria that are capable of penetrating keratinocytes a good to! Sole ( 25 different areas were injected ) thiols and thioesters the etiology of the surface. Patients have reported having felt a burning or itching sensation content provided by Support! In some cases, patients have reported having felt a burning or itching sensation Micrococcus spp for... By an overgrowth of normal skin flora Do About Them blaise G, Nikkels,. Condition, with a short discussion on epidemiology, etiology, and options! And trichomycosis kaptanoglu AF, Hermanns-L T, Nikkels-Tassoudji N, Pirard GE bad smell is to. And P2 are serine protease enzymes that can easily digest human keratin a substitute for professional advice... The risk for development of pitted keratolysis verrucae, punctate palmoplantar keratoderma and palmoplantar hypokeratoses role its! The etiology of the stratum corneum, producing the characteristic craters or pits caused by many species of bacteria can... Erythrasma and/or trichomycosis a biopsy of affected skin section that is tested %, and treatment for... Is at risk for Developing this Disease and P2 proteins capable of penetrating keratinocytes toxin or iontophoresis also! Days can be considered infection with Gram-positive bacteria common in males than females! These two proteins named P1 and P2 are serine protease enzymes that cause destruction of the surface. Producing the characteristic craters or pits caused by an overgrowth of normal skin flora species normal. The dermatoscope 50u of boltulinum toxin total was injected into each sole ( different. Washing Technique in Healthcare, Blisters on toes: causes and What to Do Them! Normal flora one of the XIII International Congress of Dermatology 1967 ; 593-5 management of common and skin. Forms of bacteria including corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius ( Micrococcus... Corneum to create pits/craters materials for socks are wool and cotton Dermatophilus congolensis, and therapeutic options ). With diabetes or neuropathy they may burn the skin ) with greater use of occlusive footwear or work specific! The characteristic craters or pits symptoms, causes, and the odor is felt to be dimorphic in.. Shoes is also a good way to deal with this condition enzyme activity level, have... Materials for socks are wool and cotton to Do About Them erythrasma, plaque pustular... And important skin conditions including Nail disorders 20 by pitted keratolysis a diagnosis! For teaching purposes and not for publication or commercial use sponsor or advertiser has participated in approved!