Pitted Keratolysis: Treatment, Symptoms & Causes

Pitted keratolysis (also called caratolysis plantare salcomam, keratoma plantar salcum, and ringed carotalysis) is a bacterial infection of the foot. Transition is characterized by craterlike pit on the sole of the feet and toes, especially weighing areas.

Pitted keratolysis is a descriptive title for a surface bacterial skin infection that affects the soles of the feet, and often affects the palms of the hands. This is one of the causes of smelly feet. It is characterized by white skin and screw-out pit cluster.

Infection Corynebacterium species is caused by bacteria and sometimes Kytococcus sedentarius. The excessive sweating of the feet and the use of projection shoes provides an environment in which these bacteria grow and therefore increase the risk of developing Pitted keratolysis.

This situation is quite common, especially in the army where wet shoes / shoes are worn for extended period without removal / cleaning. Skin biopsy samples are usually not used because the diagnosis of Pitted keratolysis is often done by identifying the visual examination and the specialty odor. Wood lamp examination results are incompatible. Antibiotics such as benzoyl peroxide, clindamycin, erythromycin, fusidic acid, or mupirosine are required for the treatment of Pitted keratolysis. The purpose of prevention efforts is to keep the feet dry using moisturizing shoes and socks as well as antiperspirants.

Signs and Symptoms
Pitted keratolysis usually presents white discoloration of the skin and many different, “screw-out” pit with lesions or caries, usually located on the soles of the feet. Pit usually consists of 1-7 millimeters in diameter. These globular and shallow pit are characteristic of Pitted keratolysis, and often overlap to produce larger areas of erosion. The characteristic of this condition becomes the presence of wounds becomes more pronounced when the affected area is wet or submerged in water. Occasionally these wounds are present in a green or brown color and within the pit.

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These surface erosion are found on the feet of the toes and on the feet of the feet, and especially on the points of pressure such as heel. Generally, both legs are equally affected. Hardly, the condition affects the palms.

Causes
The most common cause of Pitted keratolysis is the Corynebacterium species. However, many other bacteria can also cause this condition, especially in actinomyces keratolytica, dermatophilous conjunctivitis, Kyotococcus sedentarius and streptomyces. Less often, it is caused by acetabacteria, clostridium, clacify, and pseudomonas species.

Pathogenesis
Pitted keratolysis is associated with excessive sweating of palms or soles (pelloplant hyperhidrosis). Pits seen in Pitted keratolysis are due to bacterial secretion of proteins enzymes, which cause rupture of keratin protein in the stratum corneum layer of the affected skin. The result is in the formation of sulfur compounds which leads to a very strong and odor of the neck. The bacteria that Pitted keratolysis increases in warm and humid environments. Irritation is usually minimal, although occasionally burning, itching, and pain are sometimes experienced with Pitted keratolysis.

Diagnosis
The diagnosis of Pitted keratolysis is primarily based on physical examination, in which classic pit lesions and sharp odor are identified. Dermoscopic examination can facilitate the view of pit and pit walls. A wood lamps can show coral red fluorescence, as seen in erythroasma. However, this discovery is not evenly present, because this condition can be caused by bacteria that does not produce fluorescent pigment. Further laboratory testing is not usually necessary for diagnosis. However, a potassium chloride preparation can help in the cancellation of the presence of a fungal infection. Imaging and biopsy are not necessary.

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Differential Diagnosis
•  hyperhidrosis
•  Erythrasma
•  Ringworm

Treatment
There are very few quality evidence to provide guidance and support a treatment method on second. Therefore, the optimal treatment approach for Pitted keratolysis is unclear because this condition has not been studied well. A review suggested a treatment approach in which risk factors are required to be modified (for example, keeping feet clean and dry) and treatment of the underlying bacterial infection is necessary. Effective antibiotic options include clintamycin, erythromycin, mupirosin and fusicic acid. Due to low cost and better availability, topical clindamycin is usually preferred as first line choice. In most cases, fusic acid is given priority over mupirosis due to low resistance to fusic acid between methicillin-sensitive staphylococcus aureus and methicillin-resistant staphylococcus aureus. Benzoyl peroxide is an effective alternative over-the-counter option and is considered as effective in the form of ephemeral clindamycin. Clinical treatment was usually seen after 2.5-3 weeks. Oral antibiotics are usually not recommended.

Foot hygiene is important. Feet can be washed with at least daily soap and water, and dry well

Who is at Risk of Pitted Keratolysis?
pitted keratolysis is more common in males than females. Businesses at risk include:

•  Farmer
•  Athlete
•  Sailor or fisherman
•  Industrial labor
•  Military personnel

Women who offer pedicure and foot care in a spa salon can also be influenced by pitted keratolysis.

Factors that can be caused by the development of pitted keratolysis include:

•  Hot, wet weather
•  Tropical shoes such as rubber shoes or vinyl shoes
•  Excessive sweating of hands and feet (hyperhidrosis)
•  Thin skin of palms and soles (keratoderma)
•  Diabetes
•  Advanced age
•  Immunodeficiency

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How Can Pitted Keratolysis Be Prevented?
Pitted keratolysis will be repeated quickly until the feet are kept dry. The following precautions should be taken to prevent repetition:
•  Wear shoes for as short a time as possible
•  Wear socks that effectively absorb sweat, i.e. cotton and / or wool
•  Wear open-tuned sandals whenever possible
•  Wash feet twice with soap or antiseptic cleaner
•  Apply antiperspirant for weekly feet at least twice
•  Wear the same shoes in two consecutive days – dry them
•  Do not share shoes or towels with others.
•  Wear shoes for as short a time as possible

Wear socks that effectively tighten the cotton and / or wool to sweat
•  Wear open-tuned sandals whenever possible
•  Wash feet twice with soap or antiseptic cleaner
•  Apply antiperspirant for weekly feet at least twice
•  Wear the same shoes in two consecutive days – dry them
•  Do not share shoes or towels with others.

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