Pitted keratolysis. A systematic review of published cases and a proposed therapeutic algorithm

Pitted keratolysis is an infectious disease that presents with superficial erosions and crater-like lesions that evoke itching, primarily on the soles of the feet. The most prevalent causative agent is a Gram-positive bacterium, and at present, there are no established guidelines for effective treatment. A comprehensive literature review was conducted with a view to identifying the efficacy of various topical and systemic therapeutic approaches and to provide a treatment guide based on the available evidence. Twenty-seven pertinent studies, involving 516 patients with the disease, were included. Of the available treatment options, the evidence for the most substantial efficacy is for topical and systemic erythromycin, topical clindamycin, and benzoyl peroxide. Despite the available evidence, there is still a lack of high-quality studies to support the efficacy and safety of these treatments. Furthermore, well-controlled clinical trials are necessary in order to provide the necessary level of evidence to support their use.