Pitted keratolysis. Multiple, round, shallow pits on undersurface of child’s toes.
Multiple shallow pits on forefoot of child.
CLINICAL FEATURES
Multiple shallow pits on the soles or the undersurface of the toes characterize pitted keratolysis. Excessive sweating of the feet is invariably associated. Sometimes painful in the child, it can also be malodorous. The wearing of occlusive footwear or wet footwear is an aggravating factor. The condition is due to infection with Corynebacterium species. They can be seen on Gram-stained scrapings as Gram-positive rods or on silver stains of tissue sections as black rods. Culture is not necessary.
TREATMENT
Topical antibiotics such as erythromycin or clindamycin applied daily to twice daily usually resolve the problem. Washing with antibacterial soaps may help clear the infection. Rarely are oral antibiotics required. Adjunct therapy such as changing footwear, keeping the feet dry, and use of antiperspirants to reduce sweating may help.
