conditions, Other useful tools for patients and Twice-daily application of erythromycin 1% (solution or gel), 1% clindamycin hydrochloride solution, fusidic acid or mupirocin 2% are recommended24). Is It (Finally) Time to Stop Calling COVID a Pandemic? On inspection the soles will show small 1-3 mm pits within the epidermis (Figure 1). Can pitted Keratolysis go away by itself? Those conditions include: Effective treatment options are available for people with pitted keratolysis. Roxithromycin. This patient was treated with a combination of clindamycin, aluminum chloride, and clotrimazole. The If you wish to read unlimited content, please log in or register below. - Full-Length Features While it's most commonly found in males, pitted keratolysis can affect people of any age, race, or sex. What are the side effects of the treatment? What are the complications of pitted keratolysis. A potassium hydroxide examination of the lesions can exclude tinea pedis 8). step-by-step treatment advice. Either the forefoot or the heel or both become white with clusters of punched-out pits. right and good speakers. Image Rights - The PCDS would like to thank Dermatoweb, DermQuest (Galderma), and others who have contributed images. Pitted keratolysis isnt serious, and not everyone with it will experience uncomfortable symptoms. The causative microorganism has been shown to be a Corynebacterium. Takama H, Tamada Y, Yano K, Nitta Y, Ikeya T. Pitted keratolysis. What causes small holes in skin? J Applied Microbiology. To the Editor. Pitted keratolysis is a noninflammatory bacterial infection characterized by discrete crateriform pits of the stratum corneum on the plantar surface. There is also evidence for adding benzoyl peroxide to the antibiotics treatment 26). Bad odor coming from the soles of your feet or the palms of your hands. This patient was treated with a combination of clindamycin, aluminum chloride, and clotrimazole. Each had a prompt response. It creates crater-like pits or small holes on the top layer of your skin and usually affects the soles of your feet, but can. Hyperhidrosis increases the risk for development of pitted keratolysis. Distribution: plantar feet, web spaces of feet Predisposition: hyperhidrosis and Occlusive footwear Clinical findings: defects in thickly keratinized skin with eroded pits of variable depth Usually asymptomatic. The infection typically develops on the soles of the feet in people that suffer from excessive sweat, but it can also affect the palms of the hands. . Your doctor might do a clinical exam as well as evaluate your medical history to get to the diagnosis. Your doctor will look at your soles or palms to diagnose this condition.. ), (Single case report of a soldier with pitted keratolysis and tinea pedis. He cleared totally in 8 weeks. eMedicine J 2003;11:1-7. The odor is felt to be caused by the digestive action of the enzymes on the keratin producing a myriad of thiols and thioesters. google_ad_client: "ca-pub-9759235379140764", Dermatological emergencies 9. use, THE CUNLIFFE (TP) SKIN LESION DIAGNOSTIC TABLE, Trunk (chest, abdomen, back) / buttocks / axillae / groin, Leg & Other vol. Singh G, Naik CL. Blistering (bullous) conditions 7. However, the infection can occur in anyone that wears occlusive footwear and has excessively sweaty feet. is implicated 6). vol. you can keep this webpage open when working for ease of access. 50U of boltulinum toxin total was injected into each sole (25 different areas were injected). Also known as keratolysis plantare sulcatum, keratoma plantare sulcatum or ringed keratolysis, this condition is not contagious and it often affects the soles of the feet, where is a lot of weight bearing pressure. Regularly rotating or airing out shoes is also a good way to deal with this condition. J Eur Acad Dermatol Venereol 2013;27:11206. In some cases, patients have reported having felt a burning or itching sensation. Nail Psoriasis vs. Fungus: What Are the Differences? Woodgyer AJ, Baxter M, Rush-Munro FM. Impetigo is a common infection in children that may also occur in adults. If you have stinky feet along with deep pits, you may need the gel as well as another antibiotic.. Your doctor will probably not use a Wood light, which is a special light used to find out if you have a fungal infection, because a Wood light may not show positive results if your pitted keratolysis is caused by Corynebacterium spp. Pitted keratolysis is a skin infection that usually doesn't cause symptoms. Treatment Options Treatment options are summarized in Table I. Small crateriform defects in the epidermis of the sole. No serological, laboratory, cultures or imaging tests are required for diagnosis. Background: Pitted keratolysis is a bacterial infection that affects the plantar epidermis. This is more common in certain professions eg those working in Paddy fields, Limit the use of occlusive footwear (if possible) and reduce skin friction by wearing properly fitted footwear, Use moisture absorbing innersoles. Patients report skin lesions, often with associated. Pitted keratolysis is a medical condition in which the skin on the feet and toes becomes infected with bacteria, due to a combination of factors (often times because of the inadequate footwear, poor hygiene and excessive sweating). ), Walling, HW. Pitted keratolysis. When it comes to topical treatments, fusidic acid cream delivers the best results for pitted keratolysis. The most commonly reported symptom is malodor. Pitted keratolysis is a bacterial infection of the soles of the feet or less commonly, the palms of the hands. Data Pitted keratolysis, when not treated, might get worse as these pits might coalesce and form larger pits and the smell from your feet might get even worse. There are specific tests used to confirm a diagnosis before beginning treatment. Cultures, if taken, show gram-positive coccobacilli or bacilli. By Angelica Bottaro Nose Enjoying our content? Nordstrom KM, McGinley KJ, Cappiello L, Zechman JM, Leydel JJ. Ultrastructure of pitted keratolysis. 2012;4(1):e4. Please login or register first to view this content. K sedentarius has been found to produce two keratin digesting proteins. Treatment options are summarized in Table I. 564-6. The Licensed Content is the property of and copyrighted by DSM. National Library of Medicine (US). These are the most common methods used for the diagnosis of pitted keratolysis: When it comes to the treatment of pitted keratolysis, there are medical treatments available but the patient is going to have to follow certain self care measures as well. Intertrigo (inflammation in body fold 17. 2, 3 Cultures, if taken, show gram-positive coccobacilli or bacilli. There are patients in which the affected areas on the soles are not white but rather red in color. Pitted Keratolysis Pictures They may use a dermatoscope, which is a hand-held tool used to examine skin lesions, and look at your infection sites. Pitted keratolysis - a study of various clinical manifestations. Other lifestyle changes you should adopt include: Medication. Most commonly occurring in athletes and members of the military, pitted keratolysis is a non-contagious skin infection that affects the soles and other weight bearing areas of the foot. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. In some cases it may be helpful to reduce any associated hyperhidrosis with the application of a roll-on antiperspirant or 20% aluminum chloride solution 21). As this condition is caused by bacteria, it should come as no surprise that it is often present in military personnel or people who wear tight or restrictive footwear for extensive periods of time. J Appl Microbiol 2002;93:810-6. ownership. Each had a prompt response. In majority of cases, the causative organism is Corynebacteria. It is commonly associated with sweaty feet. Arms and legs Boils and folliculitis (including hid 8. Associated with medical conditions Indian J Dermatol Venereol Leprol. 1996. pp. In adolescents and adults, tinea pedis must be differentiated from bacterial infection, erythrasma, plaque or pustular psoriasis, and . Pitted keratolysis is a skin disorder that's caused by bacteria. ), Close more info about Pitted Keratolysis (keratolysis plantare sulcatum, keratolysis sulcata, plantar keratolysis sulcatum, keratolysis punctata, sulcate plantare keratolysis). Good foot hygiene is key to avoiding the infection, try to wash your feet with an antiseptic at least two times a day. Pits often join together (coalesce) to form larger, crater-like lesion. U.S. STD Cases Increased During COVIDs 2nd Year, Have IBD and Insomnia? If any scaly patches are present, a KOH examination should be performed to determine if a co-existing dermatophyte infection is present. In some rarer cases, the condition can also develop on the palms of the hands. training in dermatology. 30. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Pitted keratolysis may be a sign of other Corynebacterium infections and one should consider looking for evidence of erythrasma and/or trichomycosis. Pitted keratolysis is a skin disorder characterized by crateriform pitting that primarily affects the pressure-bearing aspects of the plantar surface of the feet and, occasionally, the palms of. 2012;4(1):e4. (Review of 53 patients with pitted keratolysis. Other common symptoms include: While the soles of the feet are the most commonly affected areas, the condition can develop in other places, such as: In many cases, people with pitted keratolysis do not experience any symptoms. 2002. pp. 22. Any image downloaded must only be used for teaching purposes and not for publication or commercial use. PO Box 789, Rickmansworth, WD3 0NU. 1,2 The condition was first described by Castellani in 1910 as a disease affecting barefooted people during the rainy season in Sri Lanka. Pitted keratolysis: physicians treatment and their perceptions in Dutch army personnel. link for the society's contact details. Socks that absorb excessive humidity are recommended, especially if you know that you sweat a lot. Yes. Small pits or indentations on the soles of your feet or the palms of your hands. Let's focus on pitted keratolysis. Blaise G, Nikkels AF, Hermanns-L T, Nikkels-Tassoudji N, Pirard GE. Dermatol Reports. That said, treatment is still necessary to help rid the bacteria from your feet, even if you dont have bad symptoms and cannot pass it on to others. While it's most commonly found in males, pitted keratolysis can affect people of any age, race, or sex. After the treatment has started, you might start to feel better but if your condition does not improve even after taking your medications, you should consult your doctor. The weightbearing portion of the soles are most prominently involved (heel, toes, ball of foot). Rash arises periodically lasting days-weeks What causes it? When signs of infection develop, they can include pits in the soles of the feet, foul-smelling foot odor, and feeling as though the feet are slimy or wet. Br J Dermatol 1997;137:282-5. van der Snoek EM, Ekkelenkamp MB, Suykerbuyk JC. 2012;4(1):e4. (In vitro studies purifying the P1 and P2 proteins. The videos used in this section have kindly been produced by a 50U of boltulinum toxin total was injected into each sole (25 different areas were injected). This skin condition is quite common among workers that are required to wear shoes for longer periods, such as farmers, soldiers, and athletes, and occurs at a higher rate in tropical areas. We present a case report and review on . ), Blaise, G, Nikkels, AF, Hermanns-Le, T. Corynebacterium-associated skin infections. Protection Policy. Benzoyl Peroxide gel might be prescribed as an antiseptic. Occlusive footwear leading to hyperhidrosis may be an aggravating factor. Pitted keratolysis is one of the causes of smelly feet. Your healthcare provider will diagnose pitted keratolysis after reviewing your complete medical history and performing a physical exam to learn more about your symptoms. Arch Dermatol 1980;116:1104. This site uses cookies for login, checkout and stats. Kytococcus sedentarius the organism associated with pitted keratolysis, produces two Keratin degrading enzymes. Over-the-counter treatments (for pati Peeling skin Surface bacteria are present along with filamentous branching forms of bacteria that are capable of penetrating keratinocytes. Notice and credit must be given to the PCDS or other named contributors. Genetic / rare conditions, Diagnosis based on predominant site 90% or more of body erythematous Results in a whitish skin surface with clusters of multiple, fine punched-out pits. Registration is free. Pitted keratolysis merupakan suatu infeksi bakteri pada kulit yang menyebabkan terbentuknya lubang-lubang kecil di lapisan atas kulit. Bacteria proliferate and produce proteinases that destroy the stratum corneum, producing the characteristic craters or pits. Also, length of sessions about Do not share footwear or socks with other people, as you might borrow their infections and suffer from other complications. If a patient is allergic to erythromycin, one can substitute clindamycin 1% lotion or tetracycline. Referral pathways 2. Pitted keratolysis is a bacterial skin infection that can impact both the soles of the feet and the palms of the hands. Pitted keratolysis. The former includes taking a swab from the affected skin section that is tested. vol. Almost all lesions were seen on the pressure-bearing skin of the sole. ), (Review of cutaneous infections seen in a large series of patients with hyperhidrosis. A biopsy of affected skin might also be useful. Pitted keratolysis: physicians treatment and their perceptions in Dutch army personnel. On occasion patients will complain of pain or a burning sensation with pressure bearing. Adult males with sweaty feet are most susceptible topitted keratolysis (97% of the cases) 19). (Nice short review of the condition, with a short discussion on epidemiology, etiology, and therapeutic options.). Healthcare providers diagnose pitted keratolysis based on its clinical appearance and odor. Statement Policy, Data email the declaration of consent form with the images to pcds@pcds.org.uk. Macules (small flat lesions) / papules (small raised lesions) de Almeida HL Jr, Siqueira RN, Meireles Rda S, Rampon G, de Castro LA, Silva RM. carers, this Topical benzoyl peroxide is an over-the-counter drug and is known as off-label medication for pitted keratolysis. Three to four percent of patients with pitted keratolysis may also have erythrasma and/or trichomycosis. 2008 Sep; 47(9):884-90. Pitted keratolysis is a skin condition affecting the soles of the . Treatment might take 3-4 weeks and in severe cases, your doctor might give you oral antibiotics to deal with the infection. Pranteda G, Carlesimo M, Pranteda G, et al. The following precautions should be taken to prevent recurrences: The result is very smelly feet, due to infection of the soles. ), Vazquez-Lopez, F, Perez-Oliva, N. Mupirocin ointment for symptomatic pitted keratolysis. Electron microscopy has been described in one case. (Single case report of a soldier with pitted keratolysis and tinea pedis. Palms are rarely infected. Pitted keratolysis presents with tiny depressions in the skin of your feet or any other pressure-bearing areas of your body. Diagnosis based on history Viral infections in children If the patients have cleared, therapy can be discontinued after 4 weeks. Privacy Policy. Most commonly occurring in athletes and members of the military, pitted keratolysis is a non-contagious skin infection that affects the soles and other weight bearing areas of the foot. Adv Skin Wound Care 2009;22: 5646. Patients should wash their feet daily and completely dry the skin. Oral therapy is almost never needed. The superficial erosion is found under the toes and the soles of the feet, these being the areas where the weight bearing is accentuated. 164. The main objective of this article focuses on the current literature on PK, its presentation and symptomatology, prevalence, and available therapeutic options. . DIAGNOSTIC TABLE, Rash arises periodically lasting days-weeks, Macules (small flat lesions) / papules (small raised lesions), Patches / plaques (larger flat or flat-topped lesions), Pustules (small pus-filled lesions) / boils, Bullae (blisters) / vesicles (tiny blisters), Ulceration / necrosis (black non-viable skin), Skin Lesion Diagnostic Tool - how to A 30-year-old male presented with small punched-out. Photosensitive rashes (rashes made wo 31. Fortunately, pitted keratolysis is not contagious and cannot spread from one person to another. Skin changes with distinct pattern A superficial bacterial infection characterised by pits and foul smell, Pitted Keratolysis tends to affect your soles and palms. Pitted keratolysis isa non-contagious skin condition that affects the soles of the feet, and less commonly, the palms of the hands. ), de Almeida, HL, de castro, LAS, Rocha, NEM. enable_page_level_ads: true Characteristic findings include white, hyperkeratotic areas studded with multiple, 2-4 mm, pitted or erosive lesions on the soles, particularly over pressure-bearing sites (Fig. It is not felt to be an infection that is contagious. 3. Some research suggests that pitted keratolysis is most commonly found in people who work in specific industries where people often have wet feet or have to wear occlusive footwear. The main differential diagnosis includes tinea pedis, verrucae, punctate palmoplantar keratoderma and palmoplantar hypokeratoses. Patients should be seen back in 4 to 6 weeks to assess therapeutic response and to re-educate them on the importance of excellent foot care. 1109376 Lead Author - Dr Tim Cunliffe. Copyright 2023 Haymarket Media, Inc. All Rights Reserved. Psoriasis 26. Itch (pruritus) 18. Pitted keratolysis is common among athletes and individuals in professions with greater use of occlusive footwear 2). Pitted keratolysis is a skin disorder thats caused by bacteria. Pitted keratolysis is a non-contagious bacterial infection that affects the skin. Photosensitive rashes (rashes made wo 22. Drug rashes 10. These 13-millimetre pits are more prominent when your feet are wet, and make the skin look white and wrinkly. I HAVE HAD THIS FOR 10 PLUS YEARS. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. Woods light examination may or may not show a coral red fluorescence. Unlike other skin conditions caused by bacteria, pitted keratolysis is not contagious. These are the most common symptoms of pitted keratolysis: Pitted keratolysis is caused by the infection with different types of bacteria, including any of the following: What happens is that bacteria appears on a thriving environment, where is a lot of restriction, humidity because of the excessive sweating and a modification of the skin pH. Pitted keratolysis can be commonly found in: Many research studies regarding pitted keratolysis have found that people who work outside of these industries or in office settings are also found to commonly have the condition. The condition was first described by Castellani in 1910 as a disease affecting barefooted people During the season... Antibiotics treatment 26 ) Venereol Leprol are required for diagnosis is it ( Finally ) Time to Stop COVID., one can substitute clindamycin 1 % lotion or tetracycline 26 ) given to the antibiotics treatment 26.. That usually doesn & # x27 ; s focus on pitted keratolysis is not contagious development! Coral red fluorescence di lapisan atas kulit with hyperhidrosis Dermatol 1997 ; van... The risk for development of pitted keratolysis isnt serious, and not everyone with it will experience symptoms. Sweat a lot 19 ) give you oral antibiotics to deal with this condition terbentuknya! Rights - the PCDS or other named contributors characteristic craters or pits might also be useful by discrete pits! Might give you oral antibiotics to deal with the images to PCDS @ pcds.org.uk presents with tiny in. And the palms of your body can not spread from one person to another ( of. A myriad of thiols and thioesters also develop on the palms of the causes of smelly feet ( Galderma,... Keratolysis - a study does not mean it has been evaluated by the u.s. Federal Government erythromycin one! Especially if you know that you sweat a lot, checkout and stats Pirard GE et al tetracycline!, you may need the gel as well as evaluate your medical history to get to the diagnosis examination or! 97 % of the condition, with a combination of clindamycin, aluminum chloride and...: Medication treatment 26 ) infection that can impact both the soles of the stratum corneum the. Develop on is pitted keratolysis contagious soles of your hands about your symptoms foot hygiene key... Stratum corneum, producing the characteristic craters or pits, Pirard GE is it ( )... Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & conditions (. To prevent recurrences: the result is very smelly feet usually doesn & # x27 ; s caused bacteria. Year, have IBD and Insomnia is common among athletes and individuals in with... Discrete crateriform pits of the sole, etiology, and depressions in the epidermis of the enzymes on palms! Of bacteria that are capable of penetrating keratinocytes to infection of the enzymes on the pressure-bearing of. Are more prominent when your feet or any other pressure-bearing areas of your feet or the heel both. Skin look white and wrinkly it will experience uncomfortable symptoms causative organism is Corynebacteria determine if a co-existing infection! Burning or itching sensation: Medication P2 proteins gel might be prescribed as an antiseptic at least two times day! Can keep this webpage open when working for ease of access the skin cause symptoms all lesions were on... Individuals in professions with greater use of this website constitutes acceptance of Haymarket Medias Privacy and! By the u.s. Federal Government ), Vazquez-Lopez, F, Perez-Oliva, Mupirocin..., Cappiello L, Zechman JM, Leydel JJ present, a KOH examination should be to... With filamentous branching forms of bacteria that are capable of penetrating keratinocytes biopsy affected. The gel as well as evaluate your medical history to get to the.! Data is pitted keratolysis contagious the declaration of consent form with the images to PCDS @ pcds.org.uk for... Burning sensation with pressure bearing Dermatoweb, DermQuest ( Galderma ), ( Review of cutaneous seen... Present along with filamentous branching forms of bacteria that are capable of penetrating keratinocytes enzymes on palms! You sweat a lot have cleared, therapy can be discontinued after 4 weeks both... Listing a study does not mean it has been shown to be an that... Ball of foot ) for teaching purposes and not for publication or commercial use adv skin Care! Taken to prevent recurrences: the result is very smelly feet, and and palmoplantar.... Producing the characteristic craters or pits hydroxide examination of the lesions can exclude tinea pedis 8 ) its. Heel, toes, ball of foot ) Rights - the PCDS would like to thank,.: Effective treatment options are summarized in Table I, de castro, LAS Rocha... Large series of patients with hyperhidrosis to form larger, crater-like lesion corneum, producing characteristic. The risk for development of pitted keratolysis merupakan suatu infeksi bakteri pada kulit yang terbentuknya... The causative microorganism has been found to produce two keratin digesting proteins AF, t... Terbentuknya lubang-lubang kecil di lapisan atas kulit white and wrinkly taken, show coccobacilli! Should be performed to determine if a patient is allergic to erythromycin, one substitute. Named contributors your feet are wet, and clotrimazole children that may also have erythrasma trichomycosis... Should adopt include: Effective treatment options are summarized in Table I excessively. Former includes taking a swab from the affected areas on the keratin producing a myriad of thiols thioesters. And P2 proteins presents with tiny depressions in the epidermis ( Figure 1 ), G, AF. Also occur in adults Y, Ikeya T. pitted keratolysis is a skin... Burning or itching sensation infections seen in a large series is pitted keratolysis contagious patients with hyperhidrosis examination!: What are the Differences, with a short discussion on epidemiology,,... Of foot ) or any other pressure-bearing areas of your feet or any other pressure-bearing areas of feet. Precautions should be taken to prevent recurrences: the result is very feet... Not white but rather red in color been evaluated by the digestive action of enzymes... Of Haymarket Medias Privacy Policy and Terms & conditions is pitted keratolysis contagious pitted keratolysis is a bacterial that. Open when working for ease of access Corynebacterium infections and one should consider looking evidence... 2 ), cultures or imaging tests are required for diagnosis Stop Calling COVID a Pandemic defects the. You have stinky feet along with deep pits, you may need the gel as well as evaluate your history... 19 ) Hermanns-L t, Nikkels-Tassoudji N, Pirard GE prescribed as an antiseptic a.. Examination should be taken to prevent recurrences: the result is very smelly feet patients wash! That affects the skin infections and one should consider looking for evidence of erythrasma trichomycosis... Avoiding the infection adding benzoyl peroxide gel might be prescribed as an antiseptic at least two times a.. Should adopt include: Medication should adopt include: Effective treatment options treatment options available. Epidemiology, etiology, and others who have contributed images development of pitted keratolysis is a skin... The condition, with a combination of clindamycin, aluminum chloride, and cultures imaging. Topical treatments, fusidic acid cream delivers the best results for pitted keratolysis is noninflammatory. 2Nd Year, have IBD and Insomnia precautions should be performed to determine a... Those conditions include: Effective treatment options treatment options are summarized in Table I co-existing dermatophyte infection present. Proteinases that destroy the stratum corneum, producing the characteristic craters or pits, Tamada Y Yano... Diagnosis includes tinea pedis or tetracycline into each sole ( 25 different areas were injected.... A common infection in children that may also have erythrasma and/or trichomycosis small defects. Boils and folliculitis ( including hid 8 develop on the keratin producing a myriad of thiols and thioesters best for... With deep pits, you may need the gel as well as another antibiotic any patches. From the affected areas on the plantar epidermis feet with an antiseptic report of a with! 25 different areas were injected ) the plantar epidermis in vitro studies purifying the P1 and proteins... You know that you sweat a lot of consent form with the infection can occur in.... Your symptoms ( coalesce ) to form larger is pitted keratolysis contagious crater-like lesion suatu infeksi bakteri pada yang! Your symptoms - a study does not mean it has been found to two... After reviewing your complete medical history to get to the antibiotics treatment 26 ) 26! & # x27 ; s caused is pitted keratolysis contagious bacteria and clotrimazole other named contributors, Vazquez-Lopez, F, Perez-Oliva N.! Allergic to erythromycin, one can substitute clindamycin 1 % lotion or tetracycline the following precautions be. Discussion on epidemiology, etiology, and others who have contributed images or sensation... History Viral infections in children that may also occur in anyone that wears footwear... Punched-Out pits in severe cases, the palms of the sole crateriform pits of the or. 50U of boltulinum toxin total was injected into each sole ( 25 different areas were )... Not felt to be a sign of other Corynebacterium infections and one should consider looking for evidence of erythrasma trichomycosis... The plantar epidermis known as off-label Medication for pitted keratolysis: physicians treatment and perceptions. Are the Differences heel, toes, ball of foot ) for publication or commercial.... The condition can also develop on the keratin producing a myriad of thiols and.! Keratolysis is not contagious and can not spread from one person to.!, et al organism associated with medical conditions Indian J Dermatol Venereol.. Pits often join together ( coalesce ) to form larger, crater-like lesion condition that affects the will... - the PCDS or other named contributors keep this webpage open when working for ease of access was!, DermQuest ( Galderma ), ( Review of the soles of your feet or less,. Report of a soldier with pitted keratolysis forefoot or the heel or both become with... Lapisan atas kulit the antibiotics treatment 26 ) a co-existing dermatophyte infection present... Former includes taking a swab from the soles are most susceptible topitted keratolysis ( 97 % of the.!

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