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The Corynebacteria are a diverse group of gram-positive bacilli which include Corynebacterium diphtheriae as well as a bewildering number of species that are found on the skin as part of the normal flora. These latter organisms are usually referred to as diphtheroids or coryneforms. Three skin conditions appear to be related to an overabundance of these coryneforms: pitted keratolysis, erythrasma, trichomycosis. Interestingly, all three have been reported to coexist in the same person.
Pitted keratolysis is an acquired, chronic, usually asymptomatic, non-inflammatory, superficial bacterial infection of the skin, confined to the stratum corneum of the soles, characterized clinically by multifocal, discrete, superficial crateriform pits and superficial erosions. It can rarely occur on the palms.
Quote:
Prevention and Treatment
Various preventive measures recommended are, avoiding use of occlusive footwear, reduction of foot friction with properly fitting footwear, using absorbent cotton socks, wearing open toed sandals whenever possible, washing feet with soap or antibacterial cleanser twice a day, and avoiding sharing of footwear or towels. In some cases it may be helpful to reduce any associated hyperhidrosis with the application of a roll-on antiperspirant or 20% aluminum chloride solution.[8]
Topical antibiotics are effective, easy to use and accepted by patients. Recommendations include twice daily application of erythromycin[16] solution or gel, 1% clindamycin hydrochloride solution,[19] fusidic acid cream and mupirocin cream.[8]
Various other medications, like 0.1% triamcinolone acetonide, iodochlorhydroxyquin-hydrocortisone cream, flexible collodion, benzoic and salicylic acid ointment, 2% buffered glutaraldehyde,[20] Castellani's paint, gentamicin sulphate cream,[21] 1% clotrimazole cream, 2% miconazole nitrate cream, 1% clindamycin solution, 5% formalin solution and Whitfield's ointment[22] have been used with limited success. Success has also been reported with oral erythromycin therapy.[16] Pitted keratolysis has an excellent prognosis; effective treatment clears both the lesion and the odor in 3-4 weeks.
To Da Vinci
I wish to say thank you for the picture google link. Brilliant and very good to see such a variety of the same condition. Thank you :)
Mostly they mention antibiotic treatment, I assume that is in the US, what do people do in the UK?
Hana Rudcenko
Cheam Chiropody Clinic
SM3 8BU
i believe they left out fungal involvement, and in uk i would do a full course of antibiotics as well as antifungals, anxiolytics are also encouraged in generalised hyperhydrosis. formalin soaks. KMNO4, (ASTRINGENTS!!!!)
The Following User Says Thank You to MR NAKE For This Useful Post:
I had a rather nasty case myself a few summers ago. I did consider asking my GP for topical Clindamycin but opted for 'neat' tea tree oil (Thursday plantation) instead and it worked a treat.
Have had amazing results with 3% salicylic acid in spirit used daily for 4 weeks, two times week for 4 weeks, then weekly for 4 weeks, then fortnightly thereafter. Great on really smelly feet too.
Have had amazing results with 3% salicylic acid in spirit used daily for 4 weeks, two times week for 4 weeks, then weekly for 4 weeks, then fortnightly thereafter. Great on really smelly feet too.
Hi,
First post to Podiatry arena.... so please be gentle.
I have a patient with nasty pitted keratolysis, will post photos if people want.
He says he has "tried everything" but I am keen to write to GP and ask for a topical antibiotic prescription.
However, re the salicylic acid treatment, is this an OTC product or does it need a prescription too?
Sorry for late reply, don't get on much. The sal acid is available OTC but the pharmacist likes to receive it on a bit of letter head for some reason. I print up the whole treatment regime onto letterhead for them to take that in. Good luck with it. It works amazingly.
The Following 2 Users Say Thank You to Nicole Murphy (Avard) For This Useful Post:
wow - everyone is really hitting the hard stuff to treat this!
My son had a decent case of this and it responded to a lovely old faishoned cure-
i had him wash his feet straight after school, soak his feet in a weak soultion of Condy's crystals -potassium permanganate- for 5 minutes, then rub in Whitfields ointment.It was very easy and effective.
The Following 4 Users Say Thank You to kc For This Useful Post:
Hi, my patient was despatched to local pharmacist with clear instructions on letter headed paper. Pharmacist actually dispensed "Whifield's" ointment which seems to be a mix of Benzoic acid & salycylic acid. Am pleased to report all symptoms cleared and a very happy patient! Thanks again for the advice.
Pitted keratolysis is an acquired, superficial bacterial infection of the skin which is characterized by typical malodor and pits in the hyperkeratotic areas of the soles. It is more common in barefooted people in tropical areas, or those who have to wear occlusive shoes, such as soldiers, sailors and athletes. In this study, we evaluated 41 patients who had been diagnosed with plantar pitted keratolysis. The patients were of high socioeconomic status, were office-workers, and most had a university degree. Malodor and plantar hyperhydrosis were the most frequently reported symptoms. The weight-bearing metatarsal parts of the feet were those most affected. Almost half the women in the study gave a history of regular pedicure and foot care in a spa salon. Mean treatment duration was 19 days. All patients were informed about the etiology of the disease, predisposing factors and preventive methods. Recurrences were observed in only 17% of patients during the one year follow-up period. This study emphasizes that even malodorous feet among non-risk city dwellers may be a sign of plantar pitted keratolysis. A study of the real incidence of the disease in a large population-based series is needed.
I've read through the posts on PK but feel I still need some help/advice.
My sons (16 yrs old) feet suffer with hyperhidrosis at the best of times but this wasn't helped after a soggy trekking weekend in October.
He wears the same school shoes each day (I know I should buy a second pair) and then changes into his trainers and/or running spikes (400m sprint runner - plenty of friction going on).
By the end of November it seemed clear he had a widespread case of PK on both feet. Punched out hole/small crater effects and the smell was horrendous! So antibacterial soap and a good scrub. Dedicated foot towel, washed regularly and antibacterial cream (mupirocin) applied twice a day.
The smell seemed to go quite quickly and his feet started to look alot better. However by the end of January it still hadn't cleared up fully and his foot hygiene and application of antibacterial cream was meticulous.
So he took a course of erythromycin oral antibiotics to surely see an end to this.
It's now March and I still can't get rid of it. I'm now just trying out the neat tea tree oil option and now doubt my diagnosis as nothing has worked. Please see the photo attached of what the condition looks like now.
The pits seem to be getting deeper and he only told me today that they feel sore first thing in the morning. What else can I do? Go back to using the antibacterial cream?
I've read through the posts on PK but feel I still need some help/advice.
My sons (16 yrs old) feet suffer with hyperhidrosis at the best of times but this wasn't helped after a soggy trekking weekend in October.
He wears the same school shoes each day (I know I should buy a second pair) and then changes into his trainers and/or running spikes (400m sprint runner - plenty of friction going on).
By the end of November it seemed clear he had a widespread case of PK on both feet. Punched out hole/small crater effects and the smell was horrendous! So antibacterial soap and a good scrub. Dedicated foot towel, washed regularly and antibacterial cream (mupirocin) applied twice a day.
The smell seemed to go quite quickly and his feet started to look alot better. However by the end of January it still hadn't cleared up fully and his foot hygiene and application of antibacterial cream was meticulous.
So he took a course of erythromycin oral antibiotics to surely see an end to this.
It's now March and I still can't get rid of it. I'm now just trying out the neat tea tree oil option and now doubt my diagnosis as nothing has worked. Please see the photo attached of what the condition looks like now.
The pits seem to be getting deeper and he only told me today that they feel sore first thing in the morning. What else can I do? Go back to using the antibacterial cream?
Please help!
Thanks, Sara
Hi Sara,
First of all your diagnosis is spot on, judging by your description and pics. However, anti-bacterial Mupirocin cream alone may not be man enough to tackle this as it is only bacteriostatic (prevents bacterial reproduction) at low concentrations, which most creams are, and bactericidal (destroys the bacteria) at high concentrations. I would recommend topical anti-biotic, not anti-bacterial, medication. PK is a superficial bacterial infection so a topical application of clindamycin and erythromycin has been evidenced as both safe and effective (as seen in the previous posts on this thread).
Before seeking the advice of a podiatrist, several of my patients reported worsening of the infection after application of over the counter products as these contain anti-bacterials, anti-fungals and anti-perspirants yet utilise an ointment as an application vehicle which often aggravates maceration and hyperhydrosis! I often recommend application of Fusidic acid (see here) lotion, along with the usual advice (see here) of allowing shoes to dry out, avoiding occlusion, etc.
Now, I`m not going to say much about the use of Tea Tree Oil other than....why?
I've read through the posts on PK but feel I still need some help/advice.
My sons (16 yrs old) feet suffer with hyperhidrosis at the best of times but this wasn't helped after a soggy trekking weekend in October.
He wears the same school shoes each day (I know I should buy a second pair) and then changes into his trainers and/or running spikes (400m sprint runner - plenty of friction going on).
By the end of November it seemed clear he had a widespread case of PK on both feet. Punched out hole/small crater effects and the smell was horrendous! So antibacterial soap and a good scrub. Dedicated foot towel, washed regularly and antibacterial cream (mupirocin) applied twice a day.
The smell seemed to go quite quickly and his feet started to look alot better. However by the end of January it still hadn't cleared up fully and his foot hygiene and application of antibacterial cream was meticulous.
So he took a course of erythromycin oral antibiotics to surely see an end to this.
It's now March and I still can't get rid of it. I'm now just trying out the neat tea tree oil option and now doubt my diagnosis as nothing has worked. Please see the photo attached of what the condition looks like now.
The pits seem to be getting deeper and he only told me today that they feel sore first thing in the morning. What else can I do? Go back to using the antibacterial cream?
Please help!
Thanks, Sara
Sara
5 minute Potassium permanganate foot baths and clotrimazole 1% both applied daily for one month and some debridement when possible and appropriate has never failed for any patient I have seen with this condition.
Dave Smith
__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.
Thanks all for your advice and suggestions. Shortly after my post I took him to see a dermatologist as I'd been unable to track down any erythromycin in a ready made preparation. I was sent away with a prescription for a solution containing the following:
Erythromycin base 5,0 ml
Isopropyl alcohol 65,0 ml
Propylene glycol 15,0 ml
Aqua pur 15,0 ml
To be applied 2 x per day for 3 months
Along with Lomexin spray (fenticonazole nitrate)
So hopefully he'll see some positive results soon.
Thanks again, Sara
The Following User Says Thank You to SDBizz For This Useful Post:
Thanks all for your advice and suggestions. Shortly after my post I took him to see a dermatologist as I'd been unable to track down any erythromycin in a ready made preparation. I was sent away with a prescription for a solution containing the following:
Erythromycin base 5,0 ml
Isopropyl alcohol 65,0 ml
Propylene glycol 15,0 ml
Aqua pur 15,0 ml
To be applied 2 x per day for 3 months
Along with Lomexin spray (fenticonazole nitrate)
So hopefully he'll see some positive results soon.
Thanks again, Sara
Thanks for the update, Sara. Please do inform us of his progress...with pics
I've had a few of these lately. Being as I am a bit of a dermaclot, I've been treating them with twice daily application of surgical spirit to dry the skin followed by a liberal application of Betadine dry powder spray (for the environment and the antimicrobial respectively). I do love Iodine, not least because its brown.
Nobody else has mentioned using dry powder betadine, anyone else tried it?
Background Pitted keratolysis (PK) is a common plantar skin manifestation in army personnel, farmers and athletes. Due to pain while walking and marching, the condition can cause reduced operational deployability (in case of army personnel).
Objective We used a questionnaire to investigate currently used treatment options of PK and perceptions on perceived efficacy of these treatments among Royal Netherlands Armed Forces primary health care physicians.
Methods A cross-sectional anonymous postal questionnaire survey was conducted among all Royal Netherlands Armed Forces primary health care physicians. In addition to question about prescription behaviour on the treatment of PK by topical and oral therapies and given non-pharmacological treatment, several questions assessed perceived efficacy of these therapies.
Results Of the 164 eligible primary health care physicians, 51 (31.1%) completed the questionnaire. Half of physicians had seen less than five patients with PK in the preceding year. Two-thirds of physicians reported problems with operational deployability in less than 10% of army personnel with PK. PK was treated mostly with topical and non-pharmacological treatments. Oral therapy was seldom prescribed. For hyperhidrosis, aluminium chloride hexahydrate was used in most cases.
Conclusion PK and related reduced operational deployability were less often reported than expected in this study. Dutch physicians prefer combined topical antibiotic therapy with non-pharmacological treatments and perceive the efficacy of topical antibiotic therapy superior to non-pharmacological treatments. Preventive measures, topical antibiotic therapy and adequate treatment of hyperhidrosis are the mainstay methods in the management of patients with PK.
Pitted keratolysis
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