Pitted keratolysis is a skin condition affecting the soles of the feet. Pitted keratolysis is usually easily diagnosed because of its distinctive clinical appearance and odor. Participating in a sport that makes the feet hot and sweaty often contributes to this condition.
It affects those who sweat profusely [hyperhydrosis] especially if they wear occlusive shoes or boots for long periods. It is caused by a bacteria.
The result is 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. There is a variant of pitted keratolysis where there are more diffuse red areas on the soles.
Pitted keratolysis can be successfully treated with topical antibiotics such as topical Erythromycin or oral Erythromycin.
Treatment Options
Pitted keratolysis may undergo spontaneous remissions or exacerbations, and it may last for many years if not treated. In general, the condition is worse in warm weather and when the feet are damp. Effective long-term treatment and prevention require removal of the warm, moist conditions that promote bacterial growth.
When bathing, patients should scrub their feet with an antibacterial soap, rinse them, then dry them well. A blow dryer can dry the skin more thoroughly. An underarm antiperspirant spray may then be applied. Going barefoot or wearing only socks or sandals when possible exposes the feet to more air.
Patients should wear socks made of either cotton or absorbent synthetic material and change them frequently, taking extra socks to work or school. Socks should also be changed after strenuous workouts. Shoes should be made of materials that allow ventilation, such as mesh, cloth, or leather. Patients should avoid shoes made of vinyl, an occlusive material. Shoes should be allowed to air out at least 24 hours after use; it is a good idea to alternate wearing at least two pairs of shoes. Patients should always wear socks when wearing shoes.
Sometimes simple measures such as proper foot drying and ventilating procedures are enough to clear the infection. Pitted keratolysis, a skin infection of the feet, is common in active people because it thrives in their warm, sweaty sneakers. Its distinct clinical appearance and odor make it easy to diagnose. Treatment generally consists of hygienic measures, sometimes supplemented by topical medications and perhaps an oral medication.
Pitted keratolysis has to be differentiated from plantar warts and tinea pedis (athlete's foot). Plantar warts typically have localized areas of hyperkeratosis and are often painful. Athlete's foot involves pruritus (itching) between the toes and is not limited to pressure-bearing areas. Less common considerations in the differential diagnosis include punctate hyperkeratosis, porokeratosis, (plugged sweat gland).
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