Medical Care

Although no studies are published on hygiene, several protective measures for preventing pitted keratolysis have been recommended over time. Limit the use of occlusive footwear and reduce foot friction by wearing properly fitted 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. In 2008, Blaise et al recommended that affected patients should wash their socks at a temperature of 60ºC to kill the Corynebacterium that may be transferred to the socks from skin scaling. In some cases, reducing any associated hyperhidrosis with the application of a roll-on antiperspirant, 20% aluminum chloride solution, may be helpful.^[41]

The treatment of pitted keratolysis also lacks evidence-based studies; however, historically, dermatologists find that topical antibiotics are effective, even if the recommendations presented above are not followed. Topical antibiotics are certainly easy to use and are well accepted by patients. Twice-daily applications of erythromycin, clindamycin, or fusidic acid are effective.^{[29, 34, 42, 43]}The combination topical gel of clindamycin 1%–benzoyl peroxide 5% has been found effective in 4 patients, but efficacy required the concurrent use of aluminum chloride hexahydrate solution.^[38]Either solutions or gel formulations may be used. Topical mupirocin (Bactroban) also has been effective.^{[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.^{[46, 47]} Other data suggest benzoyl peroxide alone can be effective.^[48]

For cases resistant to topical antibiotic treatments and/or associated with hyperhidrosis, the use of botulinum toxin injections has been effective.^[49]The use of oral erythromycin was reported by Zaias in 1982 based on personal observation. Effective treatment of pitted keratolysis clears both the lesions and odor in 3-4 weeks.

Long-Term Monitoring

Instruct patients with pitted keratolysis to return to the clinic if therapy is unsuccessful. Otherwise, care for pitted keratolysis proceeds on an as-needed basis.

Medication

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Media Gallery

A large plaque-like lesion of Pitted keratolysis on the large toe.
A case of inflammatory pitted keratolysis
Pitted keratolysis with hyperkeratosis on the heel.
Classic pits of pitted keratolysis on the plantar aspect of the phalanges.
Pitted keratolysis forming sulci on the heel.
Histopathology reveals a crater limited to the thick stratum corneum of the epidermis.

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Author

Linda J Fromm, MD, MA, FAAD Private Practice, Fromm Dermatology at Health Concepts; Dermatologist, Rapid City Medical Center

Linda J Fromm, MD, MA, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

James W Patterson, MD Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

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 Pathology

Disclosure: Nothing to disclose.

Acknowledgements

Joseph C English III, MD Clinical Vice-Chairman for Quality and Innovation, Professor of Dermatology, Department of Dermatology, University of Pittsburgh School of Medicine

Joseph C English III, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association

Disclosure: Nothing to disclose.

Pitted Keratolysis Treatment & Management

Medical Care

Long-Term Monitoring

References

Tables

Contributor Information and Disclosures

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