What condition causes peeling of the palms and soles and is treated with antibacterial soap?

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Pitted Keratolysis

The condition you're describing is most likely pitted keratolysis, a superficial bacterial infection of the palms and soles that causes characteristic peeling and is indeed treated with antibacterial soap.

What is Pitted Keratolysis?

Pitted keratolysis is a bacterial infection of the stratum corneum (outermost skin layer) caused by Corynebacterium species, Kytococcus sedentarius, Dermatophilus congolensis, and occasionally other gram-positive bacteria. The infection creates small pits or erosions in the skin, particularly affecting weight-bearing areas of the feet and occasionally the palms.

Clinical Presentation

The condition presents with:

  • Superficial peeling of the palms and/or soles
  • Small punched-out pits (1-7mm) in the affected skin
  • Malodor (often described as sulfur-like or cheesy)
  • Maceration of the skin, especially between toes
  • Hyperhidrosis (excessive sweating) is almost always present
  • Usually asymptomatic, though some patients report itching or tenderness

The bacteria thrive in moist, occluded environments, which is why the condition is common in people who wear occlusive footwear for prolonged periods, athletes, military personnel, and those with hyperhidrosis.

Treatment Algorithm

First-line treatment:

  • Antibacterial soap (such as benzoyl peroxide wash or chlorhexidine) applied daily 1
  • Keep feet dry and well-ventilated
  • Wear moisture-wicking socks
  • Alternate footwear to allow complete drying

If antibacterial soap alone is insufficient:

  • Topical antibiotics: Erythromycin 2% gel or clindamycin 1% solution applied twice daily
  • Topical benzoyl peroxide 5-10% gel or wash

For severe or refractory cases:

  • Oral antibiotics: Erythromycin 250mg four times daily for 2 weeks
  • Address underlying hyperhidrosis with aluminum chloride 20% solution

Essential adjunctive measures:

  • Reduce moisture exposure
  • Use antifungal powder (to prevent secondary fungal infection)
  • Avoid occlusive footwear when possible

Important Differential Diagnoses to Exclude

While pitted keratolysis is the most likely diagnosis given the treatment response to antibacterial soap, consider:

  • Recurrent focal palmar peeling (keratolysis exfoliativa): Presents with peeling but lacks pitting and odor; is idiopathic and not bacterial 2
  • Tinea pedis/manuum: Would require antifungal treatment, not antibacterial
  • Contact dermatitis: Would show erythema and vesiculation
  • Juvenile plantar dermatosis: Affects children, involves fissuring of weight-bearing areas

Common Pitfalls

  • Misdiagnosing as fungal infection: This leads to inappropriate antifungal treatment that will fail
  • Overlooking hyperhidrosis management: The condition will recur if excessive moisture isn't addressed
  • Inadequate drying time for footwear: Bacteria persist in moist shoes and reinfect treated skin
  • Stopping treatment too early: Continue antibacterial measures for at least 2-4 weeks even after visible improvement

Prognosis

With appropriate treatment combining antibacterial therapy and moisture control, pitted keratolysis typically resolves within 3-4 weeks. However, recurrence is common if predisposing factors (hyperhidrosis, occlusive footwear) are not addressed. Long-term maintenance with periodic use of antibacterial soap may be necessary for patients with persistent hyperhidrosis.

References

2
Research

Recurrent focal palmar peeling.

The Australasian journal of dermatology, 1996

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.