A Case of Pitted Keratolysis Treated with Homeopathy

Pitted keratolysis (PK) is a superficial bacterial infection of the stratum corneum of the soles, resulting in malodorous, punched-out pits on weight-bearing surfaces of the feet. Although the diagnosis is typically made on clinical examination, the differential diagnoses include plantar warts (characterized by interruption of normal skin markings), keratosis follicularis, tinea pedis (presenting with erythema and scaling, with fungal elements demonstrable on KOH examination), and punctate keratoderma (manifesting as multiple small, firm, rounded keratotic papules).[ 1 ] [ 2 ] It is most common in the 21 to 30 year age group, and affects males four times more than females, perhaps because of the use of occlusive footwear more common in this gender.[ 2 ] Clinically, the disorder is characterized by malodor and multiple discrete crateriform pits, 1 to 7 mm in diameter, which may coalesce to form larger erosive lesions.[ 3 ] PK is a common bacterial dermatosis, but no consensus has been reached in the management of this disease.[ 4 ] A 36-year-old male presented with a 9-month history of malodorous foot odor, profuse sweating, and multiple erosions with pit-like depressions involving both soles ([ Fig. 1 ]). He had tried several antiseptic lotions and topical antibiotic preparations without relief before coming in for homoeopathic treatment. Fig. 1 Lesion on first visit (before treatment). The patient was quarrelsome and showed despair of recovery from his condition. He had increased appetite, a tendency to suffer from frequent cough with offensive expectoration, and itching of the feet, which was aggravated by the warmth of the bed. Temperamentally, he was chilly. Repertorization was performed using Kent's Repertory, and Psorinum covered the maximum number of rubrics and achieved the highest score with 19/8, followed by Arsenicum album (17/7), Calcarea carbonica (16/7), and Sepia (15/7; [ Fig. 2 ]). Materia medica confirmed the selection of Psorinum as the most suitable constitutional remedy. Fig. 2 Repertorization chart. First prescription: one single dose of Psorinum 1M and a placebo for 1 month. First follow-up (Day 28): significant improvement was observed in the chief complaints. The placebo continued for the next 1 month. Second follow-up (Day 58): improvement continued, so the placebo was continued for another month. Third follow-up (Day 90): no further improvement was seen. Psorinum 1M was administered again in a single dose, followed by placebo for a month. Fourth follow-up (Day 120): the patient reported that all his complaints had subsided ([ Fig. 3 ]). Fig. 3 Outcome at final follow-up, i.e., lesions disappeared. Patients' Consent The patient has given his consent for reporting his clinical information in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Publication History Article published online: 30 July 2026 © 2026. Thieme. All rights reserved. Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India