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Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1998. Updated by Dr Oakley; Dr Jannet Gomez, Postgraduate Student in Clinical Dermatology, Queen Mary University London, United Kingdom, April 2016.
Pitted keratolysis is a superficial bacterial skin infection typically of the soles of the feet characterised by whitish skin with clusters of punched-out pits, and resulting in smelly feet.
Pitted keratolysis is caused by several bacterial species, including corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, actinomyces and streptomyces.
The bacteria proliferate in moist conditions. The pitting is due to destruction of the horny cells (stratum corneum) by protease enzymes produced by the bacteria.
The bad smell is due to sulfur compounds produced by the bacteria: thiols, sulfides and thioesters.
Pitted keratolysis is much more common in males than in females. Occupations at risk include:
Females offering pedicure and foot care in a spa salon may also be affected by pitted keratolysis.
Factors that lead to the development of pitted keratolysis include:
Pitted keratolysis is usually diagnosed clinically. Swabs are rarely required. However, the causative organisms may be identified from the pitted lesions and cultured on brain heart infusion agar.
Treatment of associated hyperhidrosis is essential to prevent recurrence.
Pitted keratolysis will quickly recur unless the feet are kept dry. The following precautions should be taken to prevent recurrences:
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