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What is Pitted keratolysis and explain in detail?
Pitted keratolysis (also known as Keratolysis plantare sulcatum, Keratoma plantare sulcatum, and Ringed keratolysis) is a bacterial skin infection of the foot. The infection is characterized by craterlike pits on the sole of the feet and toes, particularly weight bearing areas.
The infection is caused by Corynebacterium species bacteria and Kytococcus sedentarius. Excessive sweating of the feet and use of occlusive footwear provide an environment in which these bacteria thrive and therefore increase the risk of developing pitted keratolysis.The condition is fairly common, especially in the military where wet shoes/boots are worn for extended periods of time without removing/cleaning. Skin biopsy specimens are not usually utilized, as the diagnosis of pitted keratolysis is often made by visual examination and recognition of the characteristic odor. Woods lamp examination results are inconsistent. Treatment of pitted keratolysis requires the application of antibiotics to the skin such as benzoyl peroxide, clindamycin, erythromycin, fusidic acid, or mupirocin. Prevention efforts aim to keep the feet dry by using moisture-wicking shoes and socks as well as antiperspirants.

Signs and symptoms
Pitted keratolysis typically presents with white discoloration of the skin and numerous discrete, "punched-out" pitted lesions or erosions, usually located on the soles of the feet. The pits are typically 1–7 millimeters in diameter. These circular and shallow pits are characteristic of pitted keratolysis, and often overlap to produce larger areas of erosion. The appearance of this condition’s characteristic lesions becomes more pronounced when the affected area is wet or submerged in water. Occasionally these lesions present with a green or brown hue around and within the pits.These superficial erosions are found under the toes and on the soles of the feet, and especially at the pressure bearing points such as the heel. Typically, both feet are equally affected. Rarely, the condition affects the palms.

Cause
The most common cause of pitted keratolysis is Corynebacterium species. However, several other bacteria may also cause the condition, particularly Actinomyces keratolytica, Dermatophilus congolensis, Kytococcus sedentarius, and Streptomyces. Less frequently, it is due to Acinetobacter, Clostridium, Klebsiella, and Pseudomonas species.

Pathogenesis
Pitted keratolysis is associated with excessive sweating of the palms or soles (palmoplantar hyperhidrosis.) The pits seen in pitted keratolysis are caused by bacteria secreting proteinase enzymes which cause the breakdown of the keratin proteins in the stratum corneum layer of the affected skin. This results in the formation of sulfur compounds which leads to a very strong and foul foot odor. The bacteria that cause pitted keratolysis thrive in warm and humid environments. Irritation is generally minimal, though occasionally burning, itching, and soreness are experienced with pitted keratolysis.

Diagnosis
The diagnosis of pitted keratolysis is based primarily on the physical examination, with recognition of the classic pitted lesions and pungent odor. Dermoscopic examination can facilitate visualization of pits and pit walls. A Woods lamp may show coral red fluorescence, as seen in erythrasma.  However, this finding is not uniformly present, as the condition may be caused by bacteria that do not produce fluorescent pigments. Further laboratory testing is not typically required for the diagnosis. However, a potassium hydroxide preparation can help rule out the presence of a fungal infection. Imaging and biopsy are not necessary.

Differential diagnosis
Acid
Athletes foot (Tinea pedis)
Erythrasma
Hyperhidrosis

Treatment
As of 2014, there is little high-quality evidence to provide guidance and support one treatment method over another. Therefore, the optimal treatment approach for pitted keratolysis remains unclear as the condition has not been well-studied. One review suggested a treatment approach requiring modification of risk factors (e.g., keeping feet clean and dry) and treating the underlying bacterial infection. Effective antibiotic options include clindamycin, erythromycin, mupirocin, and fusidic acid. Topical clindamycin is generally preferred as the first-line choice due to lower cost and better availability