Pitted keratolysis in Adult
Alerts and Notices
Synopsis
Affected areas are generally asymptomatic but can emit a foul odor due to the production of isovaleric acid by the bacterial metabolism of the leucine in sweat. Rarely, pruritus, pain, or burning may be present. Predisposing factors are excessive sweating and prolonged occlusion in a warm, humid environment. Although rare, the hands may be affected.
Codes
ICD10CM:L08.89 – Other specified local infections of the skin and subcutaneous tissue
SNOMEDCT:
51212009 – Pitted keratolysis
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Differential Diagnosis & Pitfalls
- Tinea pedis – Usually scaly and erythematous. Hyphal elements can be demonstrated using a potassium hydroxide (KOH) preparation.
- Tinea nigra – Presents with a black pigmented patch.
- Dyshidrotic eczema – Presents with pruritus, scale, and pinpoint vesicles on the palms, soles, and lateral digits.
- Subacute and chronic hand and foot eczema, including nummular and contact dermatitis.
- Punctate keratoderma – Has firm keratotic papules.
- Webspace erythrasma – Typically hyperkeratotic but can be erosive. This shows coral-red fluorescence on Wood's lamp examination. Concomitant erythrasma and pitted keratolysis may be seen.
- Mosaic warts – Show more vascularity and sometimes the black dots of thrombosed capillaries.
- Arsenic toxicity – Pitting is associated with the other features of arsenism such as teardrop pigmentation.
- Nevoid basal cell carcinoma syndrome (Gorlin syndrome) – Palmoplantar pits can be seen but usually in the presence of other stigmata of the condition, including odontogenic keratocysts and numerous basal cell carcinomas, among other findings.
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Therapy
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References
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Last Reviewed:10/28/2019
Last Updated:12/05/2019
Last Updated:12/05/2019
Patient Information for Pitted keratolysis in Adult
Overview
Pitted keratolysis is a skin condition affecting the soles of the feet and, less commonly, the palms of the hands. It is caused by a bacterial infection of the skin and may give off an unpleasant odor.Who’s At Risk
Pitted keratolysis can occur in people of any race, any age, and either sex, though it is more common in males. Athletes and military personnel tend to develop this condition most commonly. Conditions that make people more likely to develop pitted keratolysis include:- Sweaty feet
- Hot or humid weather
- Unventilated (occlusive) footwear, such as rubber boots or vinyl shoes
Signs & Symptoms
The most common locations for pitted keratolysis include:- Pressure-bearing sites on the soles of the feet, especially the heels
- Non-pressure-bearing sites on the soles of the feet
- Palms of the hands
Pitted keratolysis may occasionally be itchy or painful. The foot odor often associated with pitted keratolysis may be socially embarrassing.
Self-Care Guidelines
Keeping the feet as dry as possible is important. Try the following:- Wear absorbent cotton socks and change them frequently.
- Wear wool socks, which may wick moisture away from the foot.
- Wash your feet with antibacterial soap or antiseptic cleanser daily.
- Consider using a hairdryer to dry feet thoroughly after washing them.
- Apply antiperspirant to the soles of your feet daily.
- Minimize the use of tight-fitting, occlusive footwear. (Try sandals if possible.)
- Avoid wearing the same pair of shoes 2 days in a row.
When to Seek Medical Care
If attempts to minimize moisture do not improve the condition, make an appointment with a dermatologist or another physician.Treatments
In addition to recommending the above steps to minimize moisture, a physician may try the following:- Prescription-strength antiperspirant containing aluminum chloride
- Prescription antibiotic lotions such as clindamycin, erythromycin, or mupirocin
- Antifungal cream such as miconazole or clotrimazole
- Prescription oral antibiotics such as erythromycin
- Injections of botulinum toxin (in severe cases)
References
Bolognia, Jean L., ed. Dermatology, pp.1129. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1875-1876. New York: McGraw-Hill, 2003.
Pitted keratolysis in Adult