Pitted Keratolysis - Causes, Symptoms and Treatment

Pitted keratolysis also known as Sweaty sock syndrome. It is a skin infection that can be caused by wearing tight or restricting footwear and excessive sweating during exercise. The manifestations are due to a superficial cutaneous bacterial infection. Pitted keratolysis is a descriptive title for a skin condition affecting the soles of the feet. It affects those who sweat profusely ( hyperhidrosis ) especially if they wear occlusive shoes or boots for long periods. There is a variant of pitted keratolysis where there are more diffuse red areas on the soles. It is caused by corynebacteria, and/or possibly the bacteria Dermatophilus congolensis Under appropriate conditions (ie, prolonged occlusion, hyperhidrosis, increased skin surface pH), these bacteria proliferate and produce proteinases that destroy the stratum corneum, creating pits. K sedentarius has been found to produce 2 keratin-degrading enzymes. The malodor associated with pitted keratolysis is presumed to be the production of sulfur-compound by-products, such as thiols, sulfides, and thioesters. Pitted keratolysis can affect patients of any age and both males and females should be affected; however, most written case reports or studies have involved male patients. No mortality is associated with pitted keratolysis. However, the excessive foot odor from this disorder may be socially unacceptable. Pitted keratolysis may be symptomatic; producing secondary painful feet, which can limit function.

Patient with pitted keratolysis may complain of malodor, hyperhidrosis, sliminess, and, occasionally, soreness or itching associated with the pits; however, the pits normally are asymptomatic. Pitted keratolysis is fairly common in bare footed male farmers of rural India. The condition is predominantly seen over the pressure bearing areas of sole and hyperhidrosis is common precipitating factor. The palms of the hand also have been reported to be involved in some patients with pitted keratolysis of the feet. Here, a collarette forms around the keratolysis, rather than pits.A triad of corynebacterial disease also has been reported in 2 male patients. They had erythrasma, trichomycosis axillaris, and pitted keratolysis simultaneously. Clinicians making a diagnosis of pitted keratolysis need to examine the patient for evidence of other corynebacterial infections. The primary lesions of pitted keratolysis are pits in the stratum corneum ranging from 0.5-7 mm, with some development of confluence, irregular erosions, or sulci. A variant of markedly enlarged lesions, called crateriform pitted keratolysis, also has been described. This affects the entire width of the plantar surface of the foot underlying the metatarsophalangeal joints. The pits rarely are seen on non–pressure-bearing areas of the plantar surface. Pitted keratolysis can be successfully treated with topical antibiotics such as fusidic acid cream, or with oral erythromycin.

Causes of Pitted Keratolysis

Common Causes and Risk factors of Pitted Keratolysis

Cutaneous infection with Micrococcus sedentarius.
Dermatophilus congolensis..
Actinomyces.
K sedentarius.
Staphylococcus epidermidis

Sign and Symptoms of Pitted Keratolysis

Common Sign and Symptoms of Pitted Keratolysis

Sole of the forefoot .
Small punched-out circular lesions.
Peeling, cracking, and scaling of the feet.
Redness, blisters, or softening and breaking down (maceration) of the skin.
Itching, burning, or both.

Treatment for Pitted Keratolysis

Common Treatment for Pitted Keratolysis

Pitted keratolysis can be successfully treated with topical antibiotics such as fusidic acid cream, or with oral erythromycin .
Wear boots for as short a period as possible
Wash feet with soap or antiseptic cleanser twice daily
Apply antiperspirant to the feet at least twice weekly
Do not wear the same shoes two days in a row – dry them out
Do not share footwear or towels with others.
Limit the use of occlusive footwear and reduce foot friction with properly fitting footwear.
Absorbent cotton socks must be changed frequently to prevent excessive foot moisture.
Wool socks tend to whisk moisture away from the skin and may be helpful.

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