The Indian J Dermatol Venereol Leprol has a good free full text article on pitted keratolysis:
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I did a Google search for this just the other day.
eMedicine has a good article on it:
http://www.emedicine.com/derm/topic332.htm
A Google image search turned up lots of good pictures:
http://images.google.com/images?svnum=100&hl=en&q=pitted keratolysis&spell=1-
Informative x 1 - List
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There was also this thread:
Pits on sole of foot - whats your diagnosis? -
DaVinci,
Response to an old thread (sorry). I only joined the Arena recently. :)
I felt I had to thank you for the wonderful link you posted: see below.
Well worth a look
Once again, thanks.
Regards :drinks -
To Da Vinci
I wish to say thank you for the picture google link. Brilliant and very good to see such a variety of the same condition. Thank you :)
Mostly they mention antibiotic treatment, I assume that is in the US, what do people do in the UK?
Hana Rudcenko
Cheam Chiropody Clinic
SM3 8BU -
i believe they left out fungal involvement, and in uk i would do a full course of antibiotics as well as antifungals, anxiolytics are also encouraged in generalised hyperhydrosis. formalin soaks. KMNO4, (ASTRINGENTS!!!!)
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Formalin and its formaldehyde cousin is out now....declared carcinogenic here
regards Phill -
I had a rather nasty case myself a few summers ago. I did consider asking my GP for topical Clindamycin but opted for 'neat' tea tree oil (Thursday plantation) instead and it worked a treat.
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Have had amazing results with 3% salicylic acid in spirit used daily for 4 weeks, two times week for 4 weeks, then weekly for 4 weeks, then fortnightly thereafter. Great on really smelly feet too.
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First post to Podiatry arena.... so please be gentle.
I have a patient with nasty pitted keratolysis, will post photos if people want.
He says he has "tried everything" but I am keen to write to GP and ask for a topical antibiotic prescription.
However, re the salicylic acid treatment, is this an OTC product or does it need a prescription too?
Thanks... -
Sorry for late reply, don't get on much. The sal acid is available OTC but the pharmacist likes to receive it on a bit of letter head for some reason. I print up the whole treatment regime onto letterhead for them to take that in. Good luck with it. It works amazingly.
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wow - everyone is really hitting the hard stuff to treat this!
My son had a decent case of this and it responded to a lovely old faishoned cure-
i had him wash his feet straight after school, soak his feet in a weak soultion of Condy's crystals -potassium permanganate- for 5 minutes, then rub in Whitfields ointment.It was very easy and effective. -
TRUST, quite possibly the best product I have come across and a good hard look at personal hygiene and footwer and its fit.
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Hi, my patient was despatched to local pharmacist with clear instructions on letter headed paper. Pharmacist actually dispensed "Whifield's" ointment which seems to be a mix of Benzoic acid & salycylic acid. Am pleased to report all symptoms cleared and a very happy patient! Thanks again for the advice.
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Whitfield's ung? must be some still left over from The Arc. See the old stuff still has benefit
Trust is tricky to get a good link to, we order it in from our supplier, but these links might help.
http://www.trustproducts.co.uk/acatalog/onlineshopping.html
http://www.yourhealthfoodstore.co.uk/personal-health/foot-care/trust-anti-odorant-long-life-foot -
Plantar pitted keratolysis: a study from non-risk groups
Asli Feride Kaptanoglu, Ozlem Yuksel, Selcuk Ozyurt
Dermatology Reports Vol 4, No 1 (2012)
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I've read through the posts on PK but feel I still need some help/advice.
My sons (16 yrs old) feet suffer with hyperhidrosis at the best of times but this wasn't helped after a soggy trekking weekend in October.
He wears the same school shoes each day (I know I should buy a second pair) and then changes into his trainers and/or running spikes (400m sprint runner - plenty of friction going on).
By the end of November it seemed clear he had a widespread case of PK on both feet. Punched out hole/small crater effects and the smell was horrendous! So antibacterial soap and a good scrub. Dedicated foot towel, washed regularly and antibacterial cream (mupirocin) applied twice a day.
The smell seemed to go quite quickly and his feet started to look alot better. However by the end of January it still hadn't cleared up fully and his foot hygiene and application of antibacterial cream was meticulous.
So he took a course of erythromycin oral antibiotics to surely see an end to this.
It's now March and I still can't get rid of it. I'm now just trying out the neat tea tree oil option and now doubt my diagnosis as nothing has worked. Please see the photo attached of what the condition looks like now.
The pits seem to be getting deeper and he only told me today that they feel sore first thing in the morning. What else can I do? Go back to using the antibacterial cream?
Please help!
Thanks, SaraAttached Files:
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Have not read the other posts but BAMBOO SILVER SOCKS?
Cheers -
First of all your diagnosis is spot on, judging by your description and pics. However, anti-bacterial Mupirocin cream alone may not be man enough to tackle this as it is only bacteriostatic (prevents bacterial reproduction) at low concentrations, which most creams are, and bactericidal (destroys the bacteria) at high concentrations. I would recommend topical anti-biotic, not anti-bacterial, medication. PK is a superficial bacterial infection so a topical application of clindamycin and erythromycin has been evidenced as both safe and effective (as seen in the previous posts on this thread).
Before seeking the advice of a podiatrist, several of my patients reported worsening of the infection after application of over the counter products as these contain anti-bacterials, anti-fungals and anti-perspirants yet utilise an ointment as an application vehicle which often aggravates maceration and hyperhydrosis! I often recommend application of Fusidic acid (see here) lotion, along with the usual advice (see here) of allowing shoes to dry out, avoiding occlusion, etc.
Now, I`m not going to say much about the use of Tea Tree Oil other than....why? ;)
Cheers,
Bel -
5 minute Potassium permanganate foot baths and clotrimazole 1% both applied daily for one month and some debridement when possible and appropriate has never failed for any patient I have seen with this condition.
Dave Smith -
Thanks all for your advice and suggestions. Shortly after my post I took him to see a dermatologist as I'd been unable to track down any erythromycin in a ready made preparation. I was sent away with a prescription for a solution containing the following:
Erythromycin base 5,0 ml
Isopropyl alcohol 65,0 ml
Propylene glycol 15,0 ml
Aqua pur 15,0 ml
To be applied 2 x per day for 3 months
Along with Lomexin spray (fenticonazole nitrate)
So hopefully he'll see some positive results soon.
Thanks again, Sara -
Cheers,
Bel -
I've had a few of these lately. Being as I am a bit of a dermaclot, I've been treating them with twice daily application of surgical spirit to dry the skin followed by a liberal application of Betadine dry powder spray (for the environment and the antimicrobial respectively). I do love Iodine, not least because its brown.
Nobody else has mentioned using dry powder betadine, anyone else tried it? -
Picture
Attached Files:
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:D
Sorry with the late thanks
Hana Rudcenko -
Pitted keratolysis; physicians’ treatment and their perceptions in Dutch army personnel
E.M. van der Snoek1, M.B. Ekkelenkamp, J.C.C.W. Suykerbuyk
Journal of the European Academy of Dermatology and Venereology; Article first published online
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Pitted keratolysis, erythromycin, and hyperhidrosis
Guglielmo Pranteda et al
Dermatologic Therapy; Early View
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Peditech - spray on after washing - clears in about 7 to 10 days.
http://www.boots.com/en/Peditech-Actifresh-Odour-Spray-100ml-up-to-8-months-supply_1049070/
Use as required to keep away - less messy time consuming to use than Trust.
Or Trust; http://www.trustproducts.co.uk/
Justin
Podiatry.ie -
Pitted Keratolysis
A Clinical Review
Ivan R. Bristow , PhD and Yong Leng H. Lee , BSc(Hons)
Journal of the American Podiatric Medical Association: March 2014, Vol. 104, No. 2, pp. 177-182.
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Just wondering what pods in Australia are using for PK? I have a client with the nastiest case of it I have seen. Potassium Permanganate crystals helped initially but haven't cured it. Unfortuantely he works on a farm in boots all day.
What's the best OTC remedy or is there something better on prescription? I need something that will blast it away permanently!
He now also has a lot of pain. Is this common with PK?
It is 6 months since I have seen him (I hoped the absence meant he was cured) and I can get pictures at his appointment next week. -
Emergent pitted keratolysis in the Andes Cusco-Per?
Garc?a CGR, Figueroa NYM, Arrese EJ
source
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Pitted keratolysis
Hiram Larangeira de Almeida Jr et al
An Bras Dermatol. 2016 Jan-Feb; 91(1): 106–108.
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Pitted keratolysis: successful management with mupirocin 2% ointment monotherapy.
Greywal T, Cohen PR.
Dermatol Online J. 2015 Aug 15;21(8). pii: 13030/
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From Podiatry Today:
Current Concepts In Diagnosing And Treating Erythrasma
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Pitted keratolysis – a study of various clinical manifestations
Meena Makhecha et al
Int J Derm; 18 September 2017
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Pitted keratolysis: a case report and review of current literature
Ron Wai Yina Law, Eric So, Anson Ka Cheung Chu, ...
Proceedings of Singapore Healthcare; April 3, 2018
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Pitted keratolysis - a study of various clinical manifestations.
Makhecha M et al
Int J Dermatol. 2017 Nov;56(11):1154-1160. doi: 10.1111/ijd.13744. Epub 2017 Sep 18.
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Clinical manifestations, risk factors, and quality of life in pitted keratolysis: A cross-sectional study in cadets.
Bunyaratavej S et al
Br J Dermatol. 2018 Jun 28.
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