Which clinical history findings are characteristic of pitted keratolysis?

Updated: Jul 30, 2018
  • Author: Linda J Fromm, MD, MA, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Patient with pitted keratolysis may report malodor, hyperhidrosis, sliminess, and, occasionally, soreness or itching associated with the pits [28] ; however, the pits normally are asymptomatic. Patients with primary hyperhidrosis have been shown to have a significant increase in pitted keratolysis compared with controls. [29]

The etiology of the tenderness in symptomatic cases of pitted keratolysis is unknown. In addition to pits, erythematous-to-violaceous macules to plaquelike lesions may be present. [26] In military personnel, whose long-term occlusive boot wearing exacerbates disease, lesions often become denuded, leading to foot pain and disability. [30] The palms of the hand also have been reported to be involved in some patients with pitted keratolysis of the feet. [31] Of the paddy field workers, 1.5% were diagnosed with palmar lesions in addition to foot lesions. [21] With hand involvement, a collarette forms around the keratolysis, rather than pits.

A triad of concurrent corynebacterial diseases (ie, erythrasma, trichomycosis axillaris, and pitted keratolysis) has been reported. [32] In a 2008 study, 108 of 842 South Korean male soldiers were diagnosed with pitted keratolysis, of which 13 (13%) of 108 had the triad. [23] Clinicians making a diagnosis of pitted keratolysis need to examine the patient for evidence of other corynebacterial infections.


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