Pitted keratolysis usually presents no diagnostic difficulties because of its distinctive clinical appearance and odor. Participating in a sport that makes the feet hot and sweaty often contributes to this dermatologic condition. Sometimes simple measures such as proper foot drying and ventilating procedures are enough to clear the infection. The next line of treatment involves the use of tropical agents such as erythromycin 2% solution.

 

Pitted keonratolysis. A skin infection of the feet is common in active people because it thrives in their worm. Sweaty sneakers. Its distinct clinical appearance and odor make it easy to diagnose. Treatment generally consists of hygienic measures. Sometimes supplemented by topical medications and perhaps an oral medication

 

Corynebacterium as the culprit

Through pitted keratolysis was first described by Castellani in 1910 the source of infection was not identified until 1967 when Taplin and Zaias determined that a member of the Corynebacterium genus caused the disorder. (Two years earlier their group had originated the term “pit

 

Bacteria are not generally considered pathogenic, though they do threaten immunocompromised individuals. A study has shown that these bacteria can hydrolyze keratin, the main protein component of the upper skin layers. Hyperhydration greatly enhances growth of corynebacteria on the feet. In one study, “pitted keralytosis developed in 53% of 387 military volunteers whose feet remained wet for 3 or more days. It is not surprising then, that athletes easily acquire this disorder. Sports that make the feet hot not only produce sweating and hydration. But also contribute to the formation of caluses, which provide abundant keratin for corynebacterial growth.

Identifying the infection

Physical findings. Pitted keratolysis minifests as discrete pits or craterlike lesions on the plantar surfaces. These “punched out” lesions congrete on the thicker. Pressure-bearing areas of the heels. Balls of the feet and toe pads (figure1). The craters range from 1 to 7 mm in diameter and are similar in depth. Their dimensions are proportional to the size of the bacterial colony on the skin surface. Some pits have a brownish color that may give the feet a dirt appearance (figure 2). Adjacent pits may coalesce (figure 3). Affected areas have little or no inflammation. And most cases are asympotomatic. Hyperhidrosis is often noted on the feet. And the pits are more prominent when water-soaked. The feet of a patient who has pitted keratolysis are typically malodorous. Providing a distinctive, pungent cue to the correct diagnoses. The differential diagnosis of pitted keratolysis includes plantar warts typically have localized areas of hyperkeratolysis and are often painful. Athlets’s foot. Involves pruritus between the toes and its not limited to pressure-bearing areas. Less common consideration in the differential diagnosis include punctate hyperkeratolysis. Porokyratolysis, basal cell nevus syndrome. Essenic kerarosis tungulasis, and yaws. Woods ultraviolet light examination is not constently helpful, but the affected area disted keratolysis. Although various investigations have proposed that species of Actinomyces. Are causes of pitted keratolysis? The condition is usually at tribute to a member of the Corynebacterium genus. Electron microscopy and studies of guanine-cytosine rations of bacteria DNA have been consistent with the hypothesis that Corynebacteria cause this disorder. More than half of the microorganisms that normally inhabit the skin are gram-positive, pleomorphic. Aecrobic rods that belong to the genus Corynebacterium. Expect for Corynebacterium disphhtheriae, none of the organisms exhibit strictly species-definable biochemical, morphologic, or cultural characteristics. Coryneform

 

The stratum comeum. Examinations of deeper layers shows longer filaments that tend to branch. The underlying dermis may contain a spotty infiltrate of rounds cells. Superficial biospsy of affected tissue shows a crater defect in the upper two-thirds of the stratum comeum. Organisms may be obtained from the pitted lesions and cultured on brain-heart infusion agar under nitrogen and carbon dioxide at 98.6f (37C).

Treatment options

Pitted keratolysis may undergo spontaneous remissions or exacerbations . and it may .