Pitted keratolysis is a skin disorder that’s caused by bacteria. It creates crater-like pits or small holes on the top layer of your skin. It usually affects the soles of your feet, but can also develop on the palms of your hands. This condition can cause itchiness and smelly feet.
It’s more common in people who:
- Often go barefoot and live in tropical areas
- Wear occlusive shoes, which are shoes that create warm and moist environments for bacteria to thrive
What Are the Symptoms of Pitted Keratolysis?
Symptoms of pitted keratolysis include:
- Bad odor from the soles of your feet or the palms of your hands (the most common symptom)
- Small round pits or holes on your soles or palms, usually 0.5-7 millimeters wide (smaller than a pencil eraser)
- Hyperhidrosis (too much sweating that is not necessarily caused by heat or exercise)
- Maceration (when your skin becomes lighter and wrinklier from prolonged moisture, mostly due to too much sweating
- Pain and itching while walking
- Slimy skin
The small holes or pits caused by this condition typically don’t hurt or itch, but they can become tender or itchy. They can also have a burning sensation.
How Do You Get Pitted Keratolysis?
Pitted keratolysis is linked to stinky feet and too much sweating, but it’s not caused solely by sweating. It’s actually caused by tight socks and shoes, which trap moisture and encourage bacteria to grow.
The following kinds of bacteria are responsible for this condition:
- Kytococcus sedentarius (formerly classified as a Micrococcus species)
- Dermatophilus congolensis
- Some species of Corynebacterium
These bacteria grow on the sites of infection and break down the top layer of skin to create small holes or indentations. The strong odor is due to sulfur compounds made by bacteria as they break down the skin.
Who is most at risk of developing the condition?
Research shows that pitted keratolysis is more likely to occur in men.
It’s more common in people who:
- Often go barefoot and live in tropical areas
- Wear tight shoes that create warm and moist environments for bacteria to thrive
- Sweat a lot
- Work or spend a lot of time outdoors on their feet
“People that are in shoes all the time usually have a higher predisposition,” says Sari J. Priesand, DPM, DAPM, DABFAS, clinical associate professor of surgery in the Division of Vascular Surgery and Internal Medicine at the University of Michigan Medical School. This could include people in the military, as well as athletes, industrial workers, and farmers.
You may also be more likely to develop pitted keratolysis if you:
- Have a weakened immune system due to chemotherapy or other reasons
- Are overweight
- Have diabetes
- Have poor hygiene
How Is Pitted Keratolysis Diagnosed?
Your doctor will look at your soles or palms to diagnose this condition.
They may use a dermatoscope, which is a handheld tool used to examine skin lesions. If you have pitted keratolysis, your doctor will see many pits with well-marked walls. Sometimes, bacterial colonies can also be seen through the dermatoscope.
They may also order bacterial cultures to be taken. This can help them find out what kind of bacteria is causing your pitted keratolysis.
Your doctor will probably not use a Wood’s light, which is a special light that can be used to find out if you have a fungal infection. That's because a Wood’s light may not show positive results if your pitted keratolysis is caused by Corynebacterium spp.
How Is Pitted Keratolysis Treated?
To treat pitted keratolysis, you will need to make certain lifestyle changes and use medication as needed.
Lifestyle changes. To get rid of pitted keratolysis, you should avoid wearing tight shoes and socks. Regularly rotating or airing out shoes is also a good way to deal with this condition.
In addition to lifestyle changes:
- Don’t share towels or shoes with others.
- Use absorbent cotton socks.
- Dry your feet properly every time you take a bath or wash your feet.
Medication. Talk to your doctor instead of relying on over-the-counter products, which may contain antiperspirants, antifungals, or ointments that make it get worse.
To treat your pitted keratolysis, your doctor may prescribe antibacterial creams and gels such as clindamycin, erythromycin, or mupirocin.
If necessary, they may also prescribe drying agents such as Drysol. Botulinum toxin, glycopyrronium cloth, or iontophoresis may also be prescribed to treat sweating.
Treatment will depend on how bad your pitted keratolysis is. Since there’s no system for checking the severity of this condition, treatment will depend on the depth of your pits and the appearance of the lesions.
For instance, if you only have small pits and stinky feet, you may only need to apply erythromycin gel. If you have stinky feet along with deep pits, you may need the gel as well as another antibiotic.
If you have maceration (lightened, wrinkly skin) along with stinky feet and deep pits, you may need to avoid certain medicines, and other treatments may be recommended.
Pitted keratolysis will typically go away after one to eight weeks of treatment.
What are the best topical antibiotics for pitted keratolysis?
“Topical clindamycin is a first-line therapy, sometimes benzyl peroxide,” says Priesand. She typically recommends using clindamycin gel once or twice a day for two to four weeks, although this depends on the patient. She also highlights the importance of practicing good foot hygiene during treatment.
What to do if you have trypophobia and develop pitted keratolysis?
If you have trypophobia — a fear of small holes — and get pitted keratolysis, try to avoid looking at the bottoms of your feet. You might want to wear clean, dry socks to help cover up the holes. Talking to a therapist can also help with your anxiety.
How to Prevent Pitted Keratolysis
Good foot hygiene is crucial to preventing pitted keratolysis.
Here are some tips:
- Wear well-fitting, breathable shoes with good airflow.
- Avoid wearing rubber boots.
- Keep your shoes dry.
- Regularly wash your feet. Dry them well, including between the toes.
- Quickly change out of wet shoes and socks.
If you have to wear shoes that don’t have a lot of airflow, try taking breaks with your shoes off, suggests Priesand.
Takeaways
Pitted keratolysis is a bacterial skin infection that mainly affects the bottoms of your feet.
It’s more common in people who wear tight shoes for long periods of time.
You can help prevent it by wearing well-fitted, breathable shoes and keeping your feet clean and dry.
Pitted Keratolysis FAQs
Is pitted keratolysis contagious?
No, it’s not contagious.
Will Epsom salt help pitted keratolysis?
Not really, says Priesand. Stick to a regular bath with soap and water. Afterward, make sure to dry your feet well.
Can you scrape off pitted keratolysis?
“No, you can’t scrape them [the holes] off,” says Priesand. “It’s not like a callus. You need to use the medication.”
Can pitted keratolysis spread to other parts of the body?
In rare cases, it can spread to the palms of your hands.
