Medicina Cutánea Ibero-Latino-Americana

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>Journals >Medicina Cutánea Ibero-Latino-Americana >Year 2006, Issue 5

García CGR, Figueroa NYM, Arrese EJ
Emergent pitted keratolysis in the Andes Cusco-Perú
Med Cutan Iber Lat Am 2006; 34 (5)

Language: Español
References: 22
Page: 223-228
PDF: 215.12 Kb.

Full text


Introduction: 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.

Key words: pitted keratolysis, Peru.


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>Journals >Medicina Cutánea Ibero-Latino-Americana >Year 2006, Issue 5

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