When A Patient Presents With Malodorous, Macerated Feet

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By M. Joel Morse, DPM

A Guide To Successful Treatment

   Treatment for pitted keratolysis involves keeping the feet as dry as possible because excessive moisture is what triggers this condition. Inert powders such as Desenex (Novartis) and Zeasorb (Stiefel) can help but are not as effective as aluminum chloride 20% solution. Drysol is one such agent that is 25% aluminum chloride and is readily available.

   Since the condition is due to an overproduction of bacterial organisms, the use of topical antibacterials is common. This includes topical erythromycin (Eli Lilly), clindamycin gels (Cleocin, Pfizer) applied twice daily or clindamycin phosphate solution administered bid for 10 days.

   Gels seem to be somewhat more effective than lotions but may be significantly more irritating if the inflammation and pitting are particularly severe. Physicians have used several acne medications such as benzoyl peroxide as well. 3 Other topical applications include mupirocin (Bactroban, GlaxoSmithKline) and clotrimazole (Lotrimin, Schering-Plough) or Mycelex, Bayer).

   For patients with severe cases, one may commonly use oral antibiotics. I prefer to use erythromycin 333 mg TID for 10 days. Others recommend oral Cleocin.

   As with all cases of pitted keratolysis, patients should always wear boots or shoes for a short time and wear socks at all times. They should also wash their feet with soap twice a day and not wear the same shoes two days in a row.

Dr. Morse is the President of the American Society of Podiatric Dermatology. He is a Fellow of the American College of Foot and Ankle Surgeons, and the American College of Foot and Ankle Orthopedics and Medicine. Dr. Morse is board certified in foot surgery.

For further reading, see “How To Handle Common Skin Dermatoses” in the September 2002 issue of Podiatry Today.
To check out the archives and get reprint information, visit www.podiatrytoday.com.


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