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Pitted Keratolysis is an infection of the skin of the feet caused by a bacterial infection. Excessive sweating and tight, unventilated shoes can predispose you to this condition. The primary symptoms of this foot infection are bad foot odor and shallow pits on the bottom weight-bearing (plantar) surface of the feet. It is their smelly feet that leads most people to seak treatment since there are rarely any other symptoms. However, reaness, soreness, and itching of the feet are possible. This infection rarely occurs on the palms of the hands.
Causes, Symptoms, and Features of Pitted Keratolysis
Pitted Keratolysis, also known as Keratoma sulcatum is caused by excessive moisture due to sweating (hyperhidrosis) and a bacterial overgrowth of a variety of Corynebacterium species. Kytococcus sendentarius (or "micrococcus"), Dermatophilus congolensis, and some species of Actinomyces have also been identified as causes.
This malodourous foot infection is common among the military, and was first described in British troops in colonial India. It was also a big problem for American troops in Vietnam. However, it affects people worldwide, being more common in the tropics.
The key problem is softening of the soles of the feet caused by the moisture of excessive sweating. Sweaty feet that are not allowed to dry out, because of being enclosed in moist socks and shoes, combined with improper hygiene, allow diptheroid conrynbacterium to multiply and release keratolytic (keratinase) enzymes which eat little holes or pits in the outermost "horned" layer of the skin, called the stratum corneum. This layer consists of dead skin cells which are present as a barrier to protect the underlying skin from dehydration, infection, etc. Most often, it is the thickest parts of the feet that are involved, the heel and the area just under the toes, called the metatarsal region.
Those who must wear tight-fitting shoes and are prone to having their feet sweat or otherwise become wet are prone to pitted keratolysis. It is thus common among athletes, industrial and construction workers, soldiers, and anyone working in water. It is also possible from the frequent use of swimming pools and spas.
Pitted keratolysis, Large Lesions
Typically, the principal clinical finding is multiple small pits in the stratum corneum, about 2 to 5mm in size, which look like they were neatly punched out by a biopsy punch. The bottoms of these pits are lined with bacteria and sometimes they have a discolored or dark border. The skin may also be white and swollen in small areas. There may also be redness around the edges of the infected areas and smaller lesions may sometimes coalesce together to form larger erosions. Usually, besides the annoyance of smelly and unattractive feet, there are no other symptoms, although those that must walk for long periods of time may experience pain and itching.
Home and Medical Treatment and Prevention
Pitted keratolysis can be treated with over-the-counter 5% or 10% benzoyl peroxide. Topical antibiotics such as erythromycin, mupirocin, or clindamycin are also used. These are applied once or twice daily.
To prevent the infection and to help with treatment, the feet should be thoroughly washed and dried often. If desired, use a hair dryer to dry the bottom of the feet after washing. Wear absorbant cotton or synthetic socks and change socks often. Carry extra socks with you to work or play, if necessary, and change them several times throughout the day. Also, foot powder can be used to help absorb moisture. When you get home, take your shoes off and allow them to dry. Do not always where the same pair of shoes, so that each pair can dry as thoroughly as possible before being worn again. Stay barefooted when possible.
Those who are prawn to excessive foot sweating may want to use antiperspirants on the bottom of their feet. You can use standard, over the counter antiperspirants for this but if they fail, even stronger prescription options are available such as Drysol or Xerac Ac. These are topical aluminum chloride hexahydrate solutions that work very successfully to control excessive sweating. Use these according to your doctor's directions. They should be used at night and washed off in the morning and they are NOT to be used with other over-the-counter antiperspirants. Check manufacturer's directions for all such products.
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References
1. Landry, Gregory L., and David T. Bernhardt. "Dermatological Pathologies." Essentials of Primary Care Sports Medicine. Champaign, IL: Human Kinetics, 2003. 103.
2. Braun-Falco, Otto. "Chp. 4: Bacterial Diseases." Dermatology. Berlin: Springer, 2000. 168.
3. Elston, Dirk M. "Bacterial Infections." Infectious Diseases of the Skin. Washington, D.C.: ASM/Manson Pub., 2009. 19.
This page created 03 Oct 2011 15:03
Last updated 16 May 2012 18:02
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