Keratoma sulcatum

Castellani, 1910

Plantar pitting, pitted keratolysis, dimpled keratolysis, ringed keratolysis, keratoma plantaris sulcatum.

Dimpled corneal defects on the stressed areas of the soles of the feet.

• Occurring worldwide
• Frequently seen in men
• Sneaker wearers are particularly affected
• Rarely occurring in patients >50 years
• Very common in tropical and subtropical climates
• The disease does not occur in cold climates and is not observed in barefoot people in dry climates
• Frequent association with erythema sulcatum and erythrasma

• Involved:
  • Corynebacteria, Micrococcus sedentarius, Dermatophilus congolensis, Actinomyces spp
• The development is mainly favoured by hyperhidrosis and occlusive footwear. In a warm and humid environment, there is a proliferation of bacteria that occur in the normal skin flora. Damage to the horny layer and enzymatic activity of proteases and keratinases lead to the formation of shallow dimples

• Whitish skin-coloured, as if punched out, circine dimples on the pressure-loaded areas of the sole of the foot. No or little pressure pain, but patients sometimes report pain when walking
• Mostly foetid odour (bromidrosis) and hyperhidrosis

Soles of the feet, especially the pressure-loaded areas.

Urbital defects of the str. corneum. Sometimes bacteria can be detected.

If milieu factors can be eliminated favourably, otherwise there is a risk of a chronic course.

• Remediation of the triggers
• Treatment of the hyperhidrosis
• Regular washing of the feet with disinfecting solutions
• Hygiene measures!
• No occluding footwear, wear breathable shoes
• Erythromycin cream 2-3 times a day
• Clindamycin cream 2-3 times a day
• Clotrimazole cream 2-3 times a day
• Benzoyl peroxide as cream, gel or solution once daily

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9. Takama H, Tamada Y, Yokochi K, Ikeya T. Pitted keratolysis: a discussion of two cases in non-weight-bearing areas. Acta Derm Venereol 1998;78:225-6.
10. Takama H, Tamada Y, Yano K, Nitta Y, Ikeya T. Pitted keratolysis: clinical manifestations in 53 cases. Br J Dermatol 1997;137:282-5.