2006, Number 5
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ABSTRACTIntroduction: Pitted keratolysis (PK) is a bacterial infection of the feet, with a typical malodour and erosions. Most reports are from tropical or temperate environments and not from colder climates or the Andean regions.
Materials and methods: 10 cases of PK from the Andean regions of Cusco. Peru are reported Clinical, microbiologycal, histopathological, ultrastructural and therapeutical features are described from patients seen in the Social Security Hospital of Cusco wich is located at 3,400 metres above sea level.
Results: The study included 6 men and 4 women. Pruritus and malodour were present for 3 months to 2 years. Clinically bromhidrosis, pits, larger erosions and sulci were noted in the pressure bearing areas of the plantar skin. Skin swabs revealed a lot of cocoid and filamentous organisms on the gram stain, but bacteria could not be cultured. Skin scrapins grew M. canis, T. rubrum and Candida sp.in 3 cases. Histopathology with hematoxylin-eosine stains revealed microorganisms in the stratum corneum and only slight dermal inflamation. Electron microscopic studies revealed bacteria with and without transverse septae in the the stratum corneum, lysis of corneocytes, and persistent keratohyalin granules. 5 cases studied with a filaggrin monoclonal antibody showed a positive reaction. Treatment with oral eryth-romycin or cephalexyn plus topical mupirocin or erythromycin was effective in almost all cases.
Conclusions: PK is an emerging disease in Cusco, Peru, manifesting as malodour and pits or mild erosions on the plantar surfaces. Gram, HE and ultrastructural studies are very demonstrative Electron microscopy and staining with filaggrin monoclonal antibodies suggests that there is an alteration in epidermal differentiation in this condition. 3 of 10 patients were co infected with dermatophytes or yeasts. Controlling environmental factors and using topical and oral antibiotics for at least 2 weeks are effective therapies.
1.Hayward S, Zwarteveen, Landorf K. Pitted keratolysis: a common dermatological condition causing foot malodour. Aust J Pod Med 1999;33:129-132.
2.Takama H, Tamada Y, Yano K. Pitted keratolysis: clinical manifestations in 53 cases. Br J Dermatol 1997;137:282-5.
3.Longshaw CM, Wright JD, Farrel AM. Kytococcus sedentarius, the organism associated with pitted keratolysis, produces two keratin-degrading enzymes. J Ap Microbiol 2002;93:810-6.
4.Nordstrom KM, McGinley KJ, Capiello L. Pitted keratolysis. The role of Micrococcus sedentarius. Arch Dermatol 1987;123: 1320-5.
5.Ramsey M. Pitted keratolysis. A common infection of active feet. Phys Sports Med 1996;24.
6.Peñaloza JA, López A. Corinebacteriosis cutánea. Rev Cent Dermatol Pascua 2001; 10:141-6.
7.Wohlrab J, Rohrbach D, Marsch WC. Keratolysis sulcata (pitted keratolysis): clinical symptoms with different histological correlates. Br J Dermatol 2000;143:1365.
8.Tilgen W. Pitted keratolysis. Ultrastructural study. J Cutan Pathol 1979;6:18-30.
9.De Almeida Jr H, De Castro L, Rocha N. Ultrastructure of pitted keratolysis. Int J Dermatol 2000;39:698-709.
10.Stenn K, Brawan J. The normal histology of the skin. En Farmer E, Hood A. Pathology of the skin. 2nd ed. New York: McGraw-Hill 2002;88-93.
11.Arenas R. Micología Médica Ilustrada. Segunda ed. México DF: McGraw-Hill 2003: 261-5.
Vásquez-López F, Pérez-Oliva N. Mupirocine ointment for symptomatic pitted keratolysis. Infection 1999;24:55.
13.Zaias N, Taplin D, Rebel G. Pitted keratolysis. Arch Dermatol 1965;92:151-4.
Sarkany I. Keratolysis plantare sulcatum. Br J Dermatol 1965;281-2.
15.Gillum RL, Qadri SM, Al-Ahdal MN. Pitted keratolysis: a manifestation of human der- matophilosis. Dermatologica 1988;177: 305-8.
16.Luther M, Kromayer E. Keratolysis sulcata (pitted keratolysis): clinical symptoms with different histological correlates. Br J Dermatol 2000;143:1348-9.
Hanel H, Kalisch J, Keil M. Quantification of keratinolytic activity from Dermatophilus congolensis. Med Microbiol Inmunol 1991; 180:45-51.
18.Sampaio S, Rivitti E. Dermatologia. 1a ediçao. Brasil: Artes Médicas, 1998;450.
19.Filho AM, Primavera GM, Rosa IP et al. Hiperhidrose plantar, ceratólise plantar sulcada e pontuada. An Bras Dermatol 1978;53:147-50.
20.Murray P, Rosenthal K, Kobayashi G. Microbiología Médica. 4a ed. USA: Mosby Inc, 2002;246-51.
21.Seghal VN, Ramesh V. Crateriform depression-an unusual clinical expression of pitted keratolysis. Dermatologica 1983;166:209-11.
22.English J. Pitted keratolysis. www.emedicine.com/derm/topic332.htm