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Pitted keratolysis in Adult
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Pitted keratolysis in Adult

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Contributors: Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH
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Synopsis

Pitted keratolysis is a bacterial infection of the plantar stratum corneum caused by any of the following bacteria: Micrococcus sedentarius (Kytococcus sedentarius), Dermatophilus congolensis, or species of Corynebacterium or Actinomyces. The hands may rarely be affected. Lesions 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.

Codes

ICD10CM:
L08.89 – Other specified local infections of the skin and subcutaneous tissue

SNOMEDCT:
51212009 – Pitted keratolysis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Tinea pedis – Usually scaly and erythematous.
  • Tinea nigra – Presents with a black pigmented patch.
  • Dyshidrotic eczema – Presents with pruritus, scale, and pinpoint vesicles on the palms, soles, and lateral digits.
  • Chronic hand and foot eczema tends to be more pruritic.
  • Punctate keratoderma – Has firm keratotic papules.
  • Web space erythrasma is typically hyperkeratotic but can be erosive. This shows corral red fluorescence on Wood's lamp examination and may be seen in the same patients. 
  • Mosaic warts show more vascularity and sometimes the black dots of thrombosed capillaries. 
  • Pitting due to arsenic toxicity is associated with the other features of arsenism such as teardrop pigmentation. 
  • Basal cell nevus pitting is seen with the jaw cysts and nevoid basal cells.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 04/29/2019
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Pitted keratolysis in Adult
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Pitted keratolysis : Pits, Plantar foot
Clinical image of Pitted keratolysis
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