Pits on the soles of the feet
Management: Good foot hygiene, topical medications
After clinical diagnosis of PK, most of the dermatologists and other practitioners with expertise in skin diseases management initiate empiric treatment. Management should include instructing patients to wear well-fitted shoes, avoid prolonged periods of occlusion, and use absorbent 100% cotton socks with frequent sock changes.
Topical erythromycin, clindamycin, and fucidic acid applied to the entire plantar surfaces of the feet are very effective. Topical mupirocin, benzoyl peroxide wash or gel, clotrimazole, miconazole, and Whitfield’s ointment are also effective. Successful treatment with topical antiseptics, such as glutaraldehyde and formaldehyde, has also been reported. Oral erythromycin is another option, especially for resistant cases. This usually clears both the lesions and odor in 3 to 4 weeks.
In addition, applying antiperspirants such as aluminum chloride 20% solution helps reduce hyperhidrosis. Inert antiseptic foot powders may also be used. Recently, plantar hyperhidrosis and pitted keratolysis have been successfully treated with botulinum toxin injection (Botox).5
Along with good foot hygiene, our patient was advised to use topical fucidic acid cream and 20% aluminum chloride solution for 2 weeks. On his 2-week follow-up visit, the lesions were almost completely resolved, the malodor was gone, and the hyperhidrosis had decreased.
CORRESPONDING AUTHOR
Amor Khachemoune, MD, Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 40 Blossom Street (BAR 314), Boston, MA 02114. E-mail: amorkh@pol.net
