Woodgyer AJ, Baxter M, Rush-Munro FM, Brown J, Kaplan W. Isolation of Dermatophilus congolensis from two New Zealand cases of pitted keratolysis. 100(1):10-1. ), Tamura, BM, Cuce, LC, Souza, RL. [Medline]. [Medline]. J Cosmet Dermatol. A case of inflammatory pitted keratolysis. Having two pairs of boots or shoes and alternating wearing them from one day to the next will decrease the accumulation of moisture in the boots/shoes (especially if a cedar shoe tree is used). 3. ), (In vitro studies purifying the P1 and P2 proteins. [Medline]. Pitted keratolysis. ), Walling, HW. Gill KA Jr, Buckels LJ. 93(5):810-6. James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, United States and Canadian Academy of PathologyDisclosure: Nothing to disclose. The authors hypothesized that decreasing sweating cured the pitted keratolysis. Infection. ), (Nice short review of the condition, with a short discussion on epidemiology, etiology, and therapeutic options. 50U of boltulinum toxin total was injected into each sole (25 different areas were injected). [Medline]. 2020 May. Instruct patients with pitted keratolysis to return to the clinic if therapy is unsuccessful. Hyperhidrosis seenin 96% of cases, severe odor in 89%, and pain in 11%. [Medline]. 2004 Oct. 43(10):739-44. 47. 2005 Jul-Aug. 71(4):254-8. Reviews risk factors, etiology, pathophysiology, and therapeutic options. (Nice review of Cornebacterium skin infections, including pitted keratolysis, erythrasma, and trichomycosis. 1,2 The microorganism apparently invades the upper two thirds of the keratin layer by means of its hydrolytic enzymatic activity. 19 (5):1039-1043. ), (Transmission and scanning electron microscopy were used to evaluate a biopsy specimen of pitted keratolysis. If any scaly patches are present, a KOH examination should be performed to determine if a co-existing dermatophyte infection is present. [Medline]. A part of the biopsies was inoculated in culture media, and Corynebacteria were selected for further examination. In some cases, reducing any associated hyperhidrosis with the application of a roll-on antiperspirant, 20% aluminum chloride solution, may be helpful. On inspection the soles will show small 1-3 mm pits within the epidermis (Figure 1). Pitted keratolysis is one of the causes of smelly feet. The heel, the forefoot, or both become covered with punched out sores that make them white in color. Br J Dermatol. Pittedkeratolysis(also known as Keratolysisplantare sulcatum, Keratoma plantare sulcatum, and Ringed keratolysis) is a bacterial skin infection of the foot. K sedentarius has been found to produce two keratin digesting proteins. United States and Canadian Academy of Pathology. ), (Single case report of a soldier with pitted keratolysis and tinea pedis. Wilderness Environ Med. 2015 Aug 15. 698-701. It looks like there is a tiny hole, as seen in the picture. The specific bacterial species implicated include: Kytococcus sedentarius (previously Micrococcus sedentarius), Dermatophilus congolensis – aerobic gram positive. Twice-daily applications of erythromycin, clindamycin, or fusidic acid are effective. 1998. Dermatol Surg. Pits – 1 to 3 mm in diameter 2. The longest follow-up was 10 months in one of the patients. 2009. pp. A few cases of concurrent dermatophyte infection with pitted keratolysis have been described. Medscape Education, Methicillin-Resistant Staphylococcus aureus Bloodstream Infections and Injection Drug Use, Tennessee, USA, 2015-2017, 2002 (Nice short review of the condition, with a short discussion on epidemiology, etiology, and therapeutic options.). 1997 Aug. 137(2):282-5. The longest follow-up was 10 months in one of the patients. 32(7):557-64. Please login or register first to view this content. 1985 Apr. ), (Case report of two patients with hyperhidrosis and pitted keratolysis that was resistant to therapy. Presentation of 2 cases with culture of lesions positive for bacteria of the genus Corynebacterium]. This is often accompanied by an offensive odor and is worse when the skin is wet. [Medline]. Thanks for visiting Dermatology Advisor. Blaise G, Nikkels AF, Hermanns-Le T, Nikkels-Tassoudji N, Pierard GE. “Primary hyperhidrosis increases the risk of cutaneous infection: a case control study of 387 patients”. Dermatol Online J. Arch Dermatol. 30. Effective treatment of pitted keratolysis clears both the lesions and odor in 3-4 weeks. Holland KT, Marshall J, Taylor D. The effect of dilution rate and pH on biomass and proteinase production by Micrococcus sedentarius grown in continuous culture. vol. J Appl Microbiol. July/1986. Sign in Major type (classical type): Bacteria appear to be dimorphic in nature. Who's at risk? Link to toe picture If evidence of pitted keratolysis is still present, the patients must be re-educated on foot care, and the physician should assess compliance with therapy. Hanel H, Kalisch J, Keil M, Marsch WC, Buslau M. Quantification of keratinolytic activity from Dermatophilus congolensis. 2005 May-Jun. If a patient is allergic to erythromycin, one can substitute clindamycin 1% lotion or tetracycline. Pitted keratolysis: successful management with mupirocin 2% ointment monotherapy. Who is at Risk for Developing this Disease? Can J Microbiol. 'Breakthrough Finding' Reveals Why Certain COVID Patients Die, Understanding Messenger RNA and Other SARS-CoV-2 Vaccines, COVID-19 Vaccine Has Potential Side Effects, Nurse Volunteer Says, 'Will the Vaccine Alter My Genes?' (Four males with pitted keratolysis were treated with a combination of clindamycin and benzoyl peroxide gel once a day. Zaias N, Taplin D, Rebell G. Pitted keratolysis. Treatment options are summarized in Table I. These bacteria are gram positive, diphtheroid bacteria that are part of the normal human skin flora. Another angle Please confirm that you would like to log out of Medscape. 72(3):331-5. (Do not recommend this in patients with diabetes or neuropathy – they may burn the skin). Shah AS, Kamino H, Prose NS. This is because these areas are subjected to the weight of the body . [Medline]. 282-5. The etiology of malador associated with pitted keratolysis. Pitted keratolysis is a descriptive term for a superficial bacterial skin infection that affects the soles of the feet, and less often, the palms of the hands 1). 2014 Jul-Aug. 24(4):499-500. Very few studies have focused on variations in clinical manifestations of PK. Wool socks tend to whisk moisture away from the skin and may be helpful. Singh G, Naik CL. Pitted keratolysis: successful management with mupirocin 2% ointment monotherapy. Register for free and gain unlimited access to: - Clinical Updates, with personalized daily picks for you - Evidence-Based Guidance If hyperhidrosis is present, the patient will need to be treated with nightly aluminum chloride 20% application to the soles. [Medline]. Journal Article, You are being redirected to Primary hyperhidrosis increases the risk of cutaneous infection: a case-control study of 387 patients. 137. De Luca JF, Adams BB, Yosipovitch G. Skin manifestations of athletes competing in the summer olympics: what a sports medicine physician should know. [Medline]. 1992 Sep. 9(3):251-4. vol. Occupational pitted keratolysis. Make sure to provide below the email address that is associated with your PC Optimum account. Otherwise, care for pitted keratolysis proceeds on an as-needed basis. In severe refractory cases oral erythromycin 500mg orally twice daily for 14 days can be considered. [48]. Rho NK, Kim BJ. If the feet have been recently washed fluorescence is unlikely to be seen. ), Blaise, G, Nikkels, AF, Hermanns-Le, T. “Corynebacterium-associated skin infections”. Image . 1-4. Nordstrom KM, McGinley KJ, Cappiello L, Zechman JM, Leyden JJ. Sehgal VN, Ramesh V. Crateriform depression--an unusual clinical expression of pitted keratolysis. [44, 45] A study of physicians treating Dutch army personnel concluded that preventive measures, topical antibiotic therapy, and adequate treatment of hyperhidrosis are the mainstay methods in the management of patients with pitted keratolysis. Googling ‘tiny hole in toe’ comes up with pitted keratolysis which it doesn’t appear to be. 1992 May. They also used aluminum chloride three times a week to decrease associated hyperhidrosis. 1996 Jan-Feb. 24(1):55. 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