Tyrone asked
I believe I have pitted keratolysis. What are the best options?
Answer
Pitted keratolysis fortunately is not a serious condition but can cause small spots or craters where the skin is infected and also cause a foul smell. Pitted keratolysis is caused by various different types of bacteria and tend to grow and proliferate in the favorable conditions of warm, moist areas. These areas most commonly occur on the foot due to footwear retaining moisture but infections can really occur anywhere if the conditions are right.
Since you stated you have a current infection, treatment usually is done with a topical antibiotic. For more severe infections where topical antibiotics aren't working, you may need to take a systemic antibiotic (by mouth). Usually topical antibiotics will take care of the problem though.
The most common topical antibiotics used are erythromycin and clindamycin. Both are available by prescription only (at least in the United States). Over the counter antibiotics such as Neosporin products MAY work, but typically the prescription antibiotics are necessary. Neomycin type products probably would work best at the first sign of symptoms or more as a preventative.
I usually do recommend going to the doctor though because pitted keratolysis can sometimes be hard to diagnose without a skin culture. Many times what looks like keratolysis is actually a fungal infection as fungus also thrives in warm moist areas. Yeast infection are also a possibility. Antibiotics do not treat fungi or yeast infections.
After treatment, it's imperative to take precautionary measure in hopes of preventing a recurrent infection. Most commonly, pitting keratolysis occurs on the feet if you wear boots for extended periods of time or if you have excess sweating (known as hyperhidrosis). Here are some measures to take to prevent infection:
- Change footwear when possible and try to change socks to a clean pair once to twice a day.
- You can apply an antiperspirant that can reduce sweating. Antiperspirants are readily available over the counter. You want to make sure to differentiate them from deodorants. Make sure to read the label of products. Most commonly, antiperspirants contain some sort of aluminum base. It would be listed as an "active ingredient". You want to test an aluminum product on a small area of skin first since some people do have allergic reactions to them. There are some prescription products as well that reduce sweating.
- Once footwear is removed, immediately wash the area with soap and warm water.
Try and clean out your shoes and remove moisture from them daily as well. Typically stuffing some newspaper in them overnight and tossing a small amount of baking soda in will get rid of any moisture retained in the footwear. The best option would be to have a few different pairs of shoes you can cycle in and out.
Once treatment is started, the infection typically clears up relatively quickly. A few weeks of treatment and you should be good to go!
