A Bad Case of Bromhidrosis in a Teenage Girl

A 17-year-old girl is seen for extreme foot odor.

Patient history: Over the past 4-6 months, patient has noticed "holes" on the soles of her feet. The malodor has become progressively worse.

Patient history: Patient describes mild discomfort, some foot pain upon weight bearing. Reports no trauma.

Physical examination finds "holes" and plaque-like areas of ulceration.

Physical examination finds "holes" and plaque-like areas of ulceration.

Plaque-like ulcerations on the heel of left foot.

Pits and small ulcerations on the ball of the foot and great toe.

Physical examination: No callous formation found; no bruising, petechiae. Plantar surfaces are moist, malodorous.

Differential diagnosis: Basal cell nevus syndrome; circumscribed acral hypokeratosis; focal acral hyperkeratosis; keratolysis exfoliativa; tinea pedis; pitted keratolysis; plantar warts

Diagnosis: Pitted keratolysis.

Pitted keratolysis: Crateriform pitting on pressure-bearing aspects of plantar surface. Superficial cutaneous bacterial infection caused by

Kytococcus sedentarius

.

Pitted keratolysis:

K. sedentarius

produces keratin-degrading enzymes. Odor related to production of sulfur compound byproducts.

Pitted keratolysis: Treatment. Keep feet dry; use topical aluminum chloride hexahydrate, erythromycin; clindamycin for 3-4 weeks.

Pitted keratolysis: Treatment. Acne medication off-label--combination of clindamycin and benzoyl peroxide.

Pitted keratolysis: Resolution. 4-wk course of QD topical clindamycin and BID topical aluminum chloride solution.