Overview
Pitted keratolysis (PK) is a superficial bacterial infection characterized by crater-like pits on the soles and occasionally the palms, often associated with foot odor due to the proliferation of anaerobic bacteria, primarily Brevibacterium species.Diagnosis
Clinical presentation of characteristic pits on plantar skin or palms 1.
Self-reported foot odor often reported using visual analog scales 1.
Microbiological confirmation via skin scrapings showing anaerobic bacterial colonies, though not routinely necessary for diagnosis 1.Management
First-line treatment: Topical benzoyl peroxide (BP) at 2.5% or 5% concentration applied once daily for 2 weeks 1.
Recommended dose: 2.5% BP may be preferable due to similar efficacy and fewer side effects compared to 5% BP 1.Special Populations
No specific data: Limited information regarding PK management in pregnancy, pediatrics, elderly, or patients with comorbidities based on provided abstracts 12.Key Recommendations
Use either 2.5% or 5% topical benzoyl peroxide for treating pitted keratolysis, with 2.5% potentially preferred due to comparable efficacy and safety profile 1 (Evidence: Strong).
Treatment duration should be approximately 2 weeks for effective management 1 (Evidence: Strong).
Consider self-evaluation of foot odor reduction using visual analog scales to monitor treatment response 1 (Evidence: Moderate).References
1 Leeyaphan C, Limphoka P, Kiratiwongwan R, Ongsri P, Bunyaratavej S. Randomized, controlled trial testing the effectiveness and safety of 2.5% and 5% benzoyl peroxide for the treatment of pitted keratolysis. The Journal of dermatological treatment 2021. link
2 Mehra KS, Elaraoud MS. Total central keratolysis. Annals of ophthalmology 1992. link