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October 1980

Pitted Keratolysis: A New Form of Treatment

Author Affiliations

Toledo, Ohio

Arch Dermatol. 1980;116(10):1104. doi:10.1001/archderm.1980.01640340014011

To the Editor.—  Pitted keratolysis is a noninflammatory bacterial infection characterized by discrete crateriform pits of the stratum corneum on the plantar surface. The causative microorganism has been shown to be a Corynebacterium.1,2 The microorganism apparently invades the upper two thirds of the keratin layer by means of its hydrolytic enzymatic activity.2Environmental factors are important in inducing the overgrowth of Corynebacterium. Hyperhidrosis is almost universally present in patients with pitted keratolysis.3,4 Continuous foot moisture during three-day military field trials caused pitted keratolysis to develop in 53% of 387 volunteers.4 Evidently, skin friction is also important in the pathogenesis of this condition, as weight-bearing plantar surfaces are primarily involved.Various medications, including oral erythromycin,1 0.1% triamcinolone acetonide, iodochlorhydroxyquin-hydrocortisone cream, flexible collodion, benzoic and salicylic acid ointment, and formaldehyde solution,5 have been used with limited success for this disease. I am reporting here the successful use