When A Patient Presents With Malodorous, Macerated Feet
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.
1. Wolff K, Goldsmith LA, Katz S, Gilchrest BA, Paller AS, Leffell DJ (eds). Fitzpatrick’s Dermatology in General Medicine, seventh edition. McGraw-Hill, Philadelphia, p. 2142–2135, 2003.
2. Singh G, Naik CL. Pitted keratolysis. Indian J Dermatol 71(3):213-215, 2005.
3. Hall J. Sauer’s Manual of Skin Disease, ninth edition. Lippincott Williams and Wilkins, pp 450–460, 2006.
4. Halpern AV and WR Heymann. Bacterial Diseases. In: Bolognia JL, Jorizzo JL, Rapini RP (eds). Dermatology, volume 1, second edition. Spain: Elsevier Limited. Ch. 73, pp 1075-1106, 2008.
6. http://www.innvista.com/health/ microbes/bacteria/normal.htm
7. Meffert JJ. Toxic sock syndrome. Am Fam Phys 57(9):2215-6, 1998.
8. Hay RJ, Adriaans BM. Bacterial infections. In: Champion RH, Burton JL, Burns DA, Breathnach SM (eds). Rook/ Wilkinson Ebling Textbook of Dermatology, volume 2, sixth edition. Blackwell Science. Ch. 27, pp 1121-1135, 1998.
9. Takama H, Tamada Y, Yano K, Noitta Y, Ikeye T. Pitted keratolysis: clinical manifestations in 53 cases. Br J Dermatol. 1997 Aug;137(2):282-5.
12. www.doctorfungus.org/mycoses/human/ Candida/Cutan
13. www.emedicine.com/derm/TOPIC110. HTM - 131k
14. ww.nlm.nih.gov/medlineplus/ency/ article/001452
15. wwww.nlm.nih.gov/medlineplus/ency/ article/003386
16. Gupta LK, Singhi MK. Wood’s lamp. Indian J Dermatol Venereol Leprol 2004;70:131-5.
17. Smith ML. Environmental and sports-related skin diseases. In: Bolognia JL, Jorizzo JL, Rapini RP, (eds). Dermatology, volume 1, second edition. Mosby Elsevier, Spain. Ch. 87, pp. 1356–1374, 2008.
18. Ramsey ML. Foot odor: how to clear the air. Physician Sports Med 24(8), 1996.
20. Betsy’s Bacteria. www.wheatoncollege.edu/ Quarterly/q2003fall/bacteria.htnl.