Author: Dr Ebtisam Elghblawi

Pitted keratolysis is a skin disorder that usually affects the pressure-bearing aspects of the plantar surface of the feet (forefoot), and occasionally, the palms of the hand as collarettes of scale.

It is associated with an appalling smell and excessive sweating (figure 1 and 2) and with multiple small of clusters of punched-out pits lesions or larger shallow craters on the skin (figure 2).

The manifestation is worsened when the feet are drenched but the actual cause of the ailment is a superficial bacterial infection of the upper skin.

Often confused with the fungal infection tinea pedis  - pitted keratolysis can be triggered by excessive sweating or the individual wearing any occlusive shoe or boots worn for long periods of time.

The most prominent bacteria’s in pitted keratolysis are Corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, Actinomyces, and Streptomyces.

All of these bacteria can produce proteolytic enzymes called protease that cause digestion of the keratin of the skin and thus the pitted craters.

Most conditions present with irritation, itch, pain and tingling.

The cause of the bad smell is the sulfur compound formed by the bacteria.

It can be diagnosed clinically and sometimes a swab is sent to find out the implicated bacteria.

It is not infectious though and the only treatment can be in form of cleaning and keeping dry by mild soap with ensuring of good aeration of the feet and some application of mild topical antibiotics.

Figure 1 a patient complaint of foul smell. [Copyright: ©2016 Elghblawi].
Figure 1.Patient who complained of foul smell. [Copyright: ©2016 Elghblawi].
Figure 2. Patient who complained of the pitted skin lesion and intense itching. [Copyright: ©2016 Elghblawi].