GP Quiz 8 - Case 8.
A laboratory technician complained that his feet were very smelly despite washing them twice daily. The image shows the responsible skin condition after the foot had been soaked in tepid tap water for five minutes.
What is this condition?
This is pitted keratolysis. Small craters are seen on the skin of the heel and toes. They are easier to observe when the skin is wet. Pitted keratolysis results in an unpleasant sulphureous smell and is sometimes tender.
What is the cause?
Pitted keratolysis is a skin infection caused by gram-positive bacteria such as corynebacteria or Dermatophilus congolensis.
It arises in those who wear occlusive footwear. In this case, the patient had to wear gumboots for twelve hours a day, four days a week.
How should it be treated?
Pitted keratolysis resolves with oral erythromycin. Topical erythromycin, fusidic acid & clindamycin solution are also effective. They should be applied for several weeks.
The patient should limit his use of occlusive footwear, and wear woollen socks to remove moisture from the skin. Antiperspirant solutions containing aluminium chloride may help.
This quiz was also published by ADIS International in in March 2001.