Pitted keratolysis pathology

Author: Assoc Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.

As with erythrasma, the causative organism of pitted keratolysis is typically a Corynebacterium. Other organisms have also been implicated, including Dermatophilus congolensis, and Micrococcus sedentarius.

Histology of pitted keratolysis

As with erythrasma, the inflammatory reaction in pitted keratolysis is minimal and thus the process can be easily missed entirely histopathologically. On careful examination, dense groups of the bacteria can be identified in the stratum corneum of acral skin. The organisms are typically both filamentous and coccal. Special stains with either a gram stain or a Steiner stain (figure 1) will intensely stain the causative organism.

Special stains for pitted keratolysis

Similar to erythrasma, gram stain of pitted keratolysis shows gram-positive coccal forms and filaments in the stratum corneum. Steiner stain may also highlight the organisms as seen in figure 1. Sometimes the organisms may be obvious on routine H-E sections. Culture studies may also be helpful in some cases to confirm the causative organism.

Differential diagnosis of pitted keratolysis pathology

Pityriasis versicolor (sometimes called tinea versicolor) – Malassezia (formerly known as Pityrosporum) yeasts colonise the stratum corneum and also fail to elicit much of an epidermal response. The yeast forms are larger than Corynebacteria and fail to stain with gram stain

Normal skin – The causative organisms can be easily overlooked

Erythrasma – This may be indistinguishable without clinical correlation.

Related information

Email Newsletter

Would you like to receive our dermatology updates by email?


Submit your images

We're seeking high-quality photos of skin diseases.  


Machine diagnosis

Watch DermNet's proposal to create a 'Skin Disease Image Recognition Tool' - winner of the 2017 'Clinicians' Challenge Active Award' by the NZ Ministry of Health and HiNZ.

Subscribe to our mailing list

* indicates required
DermNet NZ Newsletter