Cratered soles and malodor in a teenager: A case of pitted keratolysis

Abstract

Pitted keratolysis is a superficial bacterial infection commonly affecting individuals exposed to prolonged occlusion and hyperhidrosis. Adolescents are often underdiagnosed, particularly in shared living environments. A 16-year-old male presented with a 6-month history of pruritus and excessive moisture on both soles. He lived in a boarding school environment with prolonged footwear use. The patient denied any prior treatments or known allergies. Physical examination revealed clusters of shallow, punched-out pits on the pressure-bearing areas of the plantar surface, accompanied by maceration, malodor, and mild erythema. No signs of fungal infection were noted. Diagnosis of pitted keratolysis was established clinically. The patient was treated with topical fusidic acid applied twice daily for 14 days, along with recommendations to maintain dry feet, use absorbent socks, and alternate footwear. Two weeks later, the lesions had considerably improved, and there was a noticeable decrease in itching and odour. No recurrence was observed after four weeks.