- Tinea pedis
- Palmoplantar keratoderma
- Pitted keratolysis
This patient was diagnosed with pitted keratolysis, also known as keratoma plantare sulcatum and ringed keratolysis. This is a noninflammatory bacterial infection of the plantar stratum corneum caused by Kytococcus sedentarius (formerly Micrococcus sedentarius), Dermatophilus congolensis, or species of Corynebacterium or Actinomyces.
Learnings/What to Look for
- Predisposing factors are excessive sweating and prolonged occlusion in a warm, humid environment
- Affected areas are generally asymptomatic, but can emit a foul odor due to the production of isovaleric acid by the bacterial metabolism in the leucine in sweat
- Rarely, pruritis, pain, or burning may be present
Pearls Urgent Care Management and Considerations for Transfer
- Topical antibacterial medications, including erythromycin, clindamycin, mupirocin, fusidic acid, or benzoyl peroxide
- Aluminum chloride 20% may be used to treat excessive sweating, which may be a contributing factor in pitted keratolysis
- Patients should be counseled to wash their feet with soap or antiseptic cleanser twice daily; wear absorbent cotton or wool socks; and to avoid wearing the same shoes on consecutive days
Acknowledgment: Images and case presented by Visual Dx (www.VisualDx.com/JUCM).