Dr Vikas Sharma
The mysterious and annoying crateriform holes or pits on the soles of both the feet can occur in a skin disorder titled pitted keratolysis.
Pitted keratolysis is a bacterial skin infection that affects the soles of the feet and less often the palms of the hands. However, it most often affects the feet because of the sweaty environment created by wearing shoes and socks for an extended period of time.
The skin disorder- pitted keratolysis- is influenced and aggravated via various lifestyle factors.
This condition is characterised by small depressions or pits in the top layer of skin and areas of whitish discoloration. It can be a cause of smelly feet and is much more common in men than women.
The most common symptom of pitted keratolysis is a noticeable odor from the feet, due to the infection of the skin on the bottom of the feet. It is characterised by whitish skin and clusters of punched-out pits.
The pitting is due to destruction of the horny cells (stratum corneum) by protease enzymes produced by the bacteria.
The bad smell is due to sulfur compounds produced by the bacteria: thiols, sulfides and thioesters.
The patients with pitted keratolysis may complain of hyperhidrosis, sliminess, malodor and occasionally, soreness, itching and pain while walking.
The lesions on the soles are conspicuous, discrete, shallow, circular with a punched-out appearance, and can coalesce in places to produce irregular erosions or sulci, ranging from 0.5 to 7.0 mm in diameter and 1 mm to 2 mm in depth.
Spot the culprit
Several different bacterial species can cause pitted keratolysis; the most common culprits are:
- Corynebacteria
- Actinomyces
- Streptomyces
These bacteria often multiply in wet or moist conditions. This is why people who don’t let their feet air out enough often develop it.
The bacteria on the feet or palms will produce protease enzymes, which destroy the outermost layer of the epidermis, causing the characteristic pitting.
Sites of involvement are pressure-bearing areas such as the ventral aspect of the toe, the ball of the foot and the heel.
What causes it?
Factors that lead to the development of pitted keratolysis include:
- Hot, humid weather.
- Occlusive footwear, such as rubber boots or vinyl shoes.
- Excessive sweating of hands and feet (hyperhidrosis).
- Thickened skin of palms and soles (keratoderma).
- Diabetes mellitus.
- Immunodeficiency.
The result is smelly feet, due to infection of the soles. The appearance is more dramatic when the feet are wet.
What to do
Pitted keratolysis will quickly recur unless the feet are kept dry. The following precautions should be taken to prevent recurrences:
- Wear boots for as short a period as possible.
- Wear socks which effectively absorb sweat.
- Wear open-toed sandals whenever possible.
- Apply antiperspirant in form of a roll-on antiperspirant to the feet twice weekly.
(Dr Sharma is a Chandigarh-based dermatologist)
from The Tribune http://bit.ly/2UkYtor
via Today’s News Headlines
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