Keratoma sulcatum

Last Updated: 2020-11-19

Author(s): Anzengruber, Navarini

Castellani 1910.

Plantar pitting, pitted keratolysis, ringed keratolysis, Keratoma plantaris sulcatum.

Pit-shaped corneal defects on the stressed areas of the soles of the feet.

  • Occurring worldwide
  • Frequently among men
  • Sports shoe wearers are particularly affected
  • Hardly ever seen in patients >50 years
  • Especially in tropical and subtropical climate zones
  • The disease does not occur in cold climates and is not observed in people walking barefoot in dry climates
  • Frequent association with erythema sulcatum and erythrasma
  • Pathogens:
    • Especially corynebacteria, Micrococcus sedentarius, Dermatophilus congolensis, Actinomyces spp., Dermatophilus congolensis
  • The onset is mainly caused by hyperhidrosis and occlusive footwear. In a warm and humid environment, the proliferation of the above-mentioned bacteria occurs, which are part of the normal skin flora. Damage to the horny layer and enzymatic activity of protease and keratinase lead to the formation of shallow pits.
  • Whitish, skin-coloured as if punched out, circular pits on the pressure-loaded areas of the sole of the foot. No or little pain under pressure, but patients sometimes report pain when walking
  • Mostly foetider smell (Bromidrosis) and hyperhidrosis

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

Circumscribed defects of the stratum corneum. Sometimes bacteria can be detected.

If environmental factors can be eliminated, the prognosis is favourable, otherwise a chronic course threatens.

  • Trigger remediation
  • Treatment of hyperhidrosis
  • Regular washing of the feet with disinfectant solutions
  • Hygiene measures!
  • No occlusive footwear, wear breathable shoes
  • Erythromycin cream 2-3x daily
  • Clindamycin cream 2-3x daily
  • Clotrimazole cream 2-3x daily
  • Benzoyl peroxide as cream, gel or solution 1x daily
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