Pitted keratolysis - a study of various clinical manifestations.

BACKGROUND: Pitted keratolysis (PK) is a common bacterial infection of skin characterized by noninflammatory superficial pits. Very few studies have focused on variations in clinical manifestations of PK. We conducted this study so that diagnosis of this treatable condition is not missed when it presents in an uncommonly perceived way. AIMS AND OBJECTIVES: Assessment of PK patients for various sites and morphologies. MATERIALS AND METHODS: A total of 30 patients with PK were assessed for various sites and morphologies. Bacterial and fungal cultures along with histopathology were performed. RESULTS: Of 30 patients, 24 were females. Hyperhidrosis and malodour were the most common symptoms. Interdigital interface skin of the toes was the first site affected in most patients. Plantar skin was affected in all patients with involvement of interface skin of the toes in 29 patients. Other sites affected were palms, finger web spaces, nonglabrous skin, paronychium, and nail. Other than classical pits, scaly crusted inflammatory lesions with post-inflammatory hyperpigmentation (PIH) were noted. Associated keratoderma was also reported in some patients. DISCUSSION: The presence of hyperhidrosis, malodour, and plantar lesions is consistent with previous studies. Interface skin between toes as the first site affected, involvement of toe web spaces, and associated keratoderma have been reported rarely. However, female preponderance, involvement of finger web spaces, nonglabrous skin, paronychium, nail changes, the presence of inflammation with crusting, and PIH have never been reported previously. CONCLUSION: PK can involve web spaces, nonglabrous skin, and paronychium, and can cause nail changes. The lesions can be inflammatory with crusting and PIH.

Trichobacteriosis: contribution of dermoscopy.

We report a case of axillary trichobacteriosis in a 34-year-old patient whose complaints were bromhidrosis and hyperhidrosis axillaris. The condition can be diagnosed clinically; dermoscopy may be useful and reveal typical signs.

Pitted keratolysis, erythromycin, and hyperhidrosis.

Pitted keratolysis (PK) is a plantar skin disorder mainly caused by coryneform bacteria. A common treatment consists of the topical use of erythromycin. Hyperhidrosis is considered a predisposing factor for bacterial proliferation and, consequently, for the onset of PK. The aim of this study was to evaluate the relationship between PK erythromycin and hyperhidrosis. All patients with PK seen in Sant'Andrea Hospital, between January 2009 and December 2011, were collected. PK was clinically and microscopically diagnosed. All patients underwent only topical treatment with erythromycin 3% gel twice daily. At the beginning of the study and after 5 and 10 days of treatment, a clinical evaluation and a gravimetric measurement of plantar sweating were assessed. A total of 97 patients were diagnosed as PK and were included in the study. Gravimetric measurements showed that in 94 of 97 examined patients (96.90%) at the time of the diagnosis, there was a bilateral excessive sweating occurring specifically in the areas affected by PK. After 10 days of antibiotic therapy, hyperhidrosis regressed together with the clinical manifestations. According to these data, we hypothesize that hyperhidrosis is due to an eccrine sweat gland hyperfunction, probably secondary to bacterial infection.