Pitted keratolysis or smelly feet  is a skin condition affecting the soles of the feet and less commonly, the palms of the hands. It is caused by a bacterial infection of the skin and may give off an unpleasant odor.
Causes- Pitted keratolysis is caused by several bacterial species, including corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, actinomyces and streptomyces.
The bacteria proliferate in moist conditions. The pitting is due to destruction of the horny cells ( stratum corneum ) by protease enzymes produced by the bacteria. The bad smell is due to sulphur compounds produced by the bacteria , thiols, sulphides and thioesters.
Pitted keratolysis is much more common in males than in females. Occupation at risk include-
·         Farmers
·         Athletes
·         Sailors or fisherman
·         Industrial workers
·         Military personnel
Females offering pedicure and foot care in a spa saloon may also be affected by pitted keratolysis.
Factors that lead to the development of pitted keratolysis include-
·         Hot, humid weather
·         Occlusive footwear, such as rubber boots or vinyl shoes
·         Excessive sweating of hands and feet
·         Thickened skin of palms and soles
·         Diabetes mellitus
·         Advanced age
·         Immunodeficiency
·         Very smelly feet, due to infection of the soles.
·          Either the forefoot or the heel or both become white with clusters of punched –out pits. The appearance is more dramatic when the feet are wet.Very rarely the fingers are similarly affected.
·         Pits often join together to form larger , crater like lesion.
·         There is a variant of pitted keratolysis where there are more diffuse red areas on the soles.
The most commonly  reported symptom is malodor. The pits themselves are usually asymptomatic but may  cause soreness or itching when walking.
Diagnosis – Pitted keratolysis is usually diagnosed clinically . Swabs are rarely required . However the causative organisms may be identified from the pitted lesions and cultured on brain heart infusion agar.Skin scrapings are often taken to exclude fungal infection . Woodlight examination displays a characteristic coral red fluorescence in some cases.
The diagnosis is sometimes made by skin biopsy revealing characteristic histopathological features of pitted keratolysis .
Prevention- Pitted keratolysis will quickly recur unless the feet are kept dry. The following precautions should be taken to prevent recurrence-
·         Wear foots for as short a period as possible
·         Wear socks which effectively absorb sweat, ie cotton and /or wool
·         Wear open –toed sandals whenever possible
·         Wash feet with soap or antiseptic cleancer twice daily
·         Apply antiperspirant to the feet at least twice daily
·         Do not wear the same shoes two days in a row-dry them out
·         Do not share footwear or towels with clothes

Well selected Homoeopathic remedies are effective for managing Pitted keratolysis. Some of the important remedies are given below-

SILICEA 200- Silicea is one of the top remedies for smelly feet with offensive sweat. The feet becomes icy cold with copious sweat. Another leading character is presence of offensive sweat on feet which is acrid, itching and destroying shoes. There is soreness in soles from instep through to the sole. Pits and exfoliation of the skin are seen on the sole.

BARYTA CARBONICUM 200- Baryta carb is another effective remedy for Pitted keratolysis with offensive foot sweat, especially in children. There is cold, foul foot sweat, the feet is cold and clammy. Toes and sole sore, soles painful on walking. Soles feel hot or bruised at night during sleeping. Most of the Baryta carb children are suffering from chronic throat complaints.

GRAPHITES 30- Graphites is best for smelly feet with fissures, cracks and pits in soles and in between toes. The sweat is foul and excoriating , worse in evening. The feet is cold and wet. The acrid foot sweat chafes the toes. Habitual constipation is present in Graphites patient.

CALCAREA CARB 30- Calcarea carb is prescribed where sour foot sweat is present on the feet. Soles of the feet feel raw. Burning of soles of feet. Calcrea carb is suited to fat , flabby persons.

LYCOPODIUM CLAVATUM 200- Lycopodium is best for smelly feet with profuse foot sweat. There is pain in the heels and soles while walking. In Lycopodium one foot hot and other cold. Lycopodium patients prefer warm drinks and food. They have a craving for sweets.

ANTIMONIUM CRUDUM 200- Antim . crude is considered a good remedy for Pitted keratolysis where the skin on soles is withered on account of foot sweat. The feet is very sensitive due to the presence of large horny places.

SEPIA 30- Sepia is effective for smelly feet with offensive foot sweat. There is itching, stinging and burning ulcers in the toes and heels. The itching is not relieved by scratching. There is pricking and burning sensation of feet.There is profuse or offensive perspiration of feet causing soreness in heel and between toes.

SULPHUR 200- Sulphur is another effective medicines for smelly feet with icy cold feet with an offensive sweat. The foot feels sore from the top through to the sole. Sulphur patient put the feet out of bed due to excessive heat in soles at night.

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