What Is the First-Line Treatment for Pitted Keratolysis?
Clinical overview
Pitted keratolysis (ICD-10 L08.8 / ICD-11 1C44.1) is a superficial bacterial infection of the plantar skin characterised by pitted erosions. Management centres on topical therapy, with the treatment plan tailored when hyperhidrosis is also present as a contributing factor.
Treatment approach
First-line management involves a course of topical antibiotic or antimicrobial therapy. When hyperhidrosis contributes to the presentation, targeted topical treatment addressing excessive sweating is also incorporated into the regimen.
Full agent selection, strengths, and the complete algorithm are in the protocol — see below.
References
DOI: 10.25259/JCD_10_2024
Following diagnosis, the first-line treatment is typically a topical antibiotic or benzoyl peroxide 5% for a period of 4 weeks.
Erythromycin gel 2–4%, or Clindamycin gel 1%, or Benzoyl peroxide gel 5%
If hyperhidrosis, treat with 20–25% aluminum chlorohydrate or 2% Glycopyrrolate cream
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