Pitted Keratolysis: Symptoms, Causes, and Treatment - Verywell Health

Pitted keratolysis is a non-contagious bacterial infection that affects the skin.

The infection typically develops on the soles of the feet in people that suffer from excessive sweat, but it can also affect the palms of the hands.

This article discusses the symptoms, causes, and treatment options for pitted keratolysis. 

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Pitted Keratolysis Symptoms

Many symptoms can develop in a person with pitted keratolysis. The most common symptom of the condition is a foul smell coming from the feet. As many as 100% of people with the condition will have this particular symptom. Other common symptoms include:

• Pits or holes in the skin that typically develop over pressure points on the feet
• Pits can be brown and more visible when the feet are wet
• A feeling of wetness or sliminess on the feet
• A painful or burning sensation
• Intense itching
• Thickening of the outer layer of skin on the soles of the feet
• Lightening of the skin on the soles of the feet
• Wrinkly soles
• Splits in the skin known as fissures
• An inflamed, red rash on the bottom of the feet

While the soles of the feet are the most commonly affected areas, the condition can develop in other places, such as:

• The palms of the hands
• In between the fingers
• In between the toes
• Around the nails on both the hands and the feet

Can Pitted Keratolysis Be Asymptomatic?

In many cases, people with pitted keratolysis do not experience any symptoms.

Causes

Pitted keratolysis is caused by different species of bacteria. The most common bacteria associated with the condition include:

• Corynebacteria
• Dermatophilus congolensis
• Kytococcus sedentarius
• Actinomyces
• Streptomyces
  

These bacteria species thrive in areas that are warm and moist. Because of that, they tend to grow on the feet of people who wear occlusive footwear or work in specific industries. It can also be found in people who often go barefoot. Pitted keratolysis can be commonly found in:

• Farmers
• Laborers
• Sailors
• Soldiers
• Industrial workers
• Athletes or others involved in sports activities

Many research studies regarding pitted keratolysis have found that people who work outside of these industries or in office settings are also found to commonly have the condition.

The most common associated factor with pitted keratolysis is sweaty feet and occlusive footwear. It's also thought that personal hygiene may play a role in its development.

Hyperhidrosis and Pitted Keratolysis

Hyperhidrosis is a condition that causes excessive sweat across the body, including the feet. People with hyperhidrosis may be more prone to pitted keratolysis.

Diagnosis

Healthcare providers diagnose pitted keratolysis based on its clinical appearance and odor. In some cases, other areas of the body, such as the groin, may be examined to determine if other bacterial conditions are present alongside pitted keratolysis.

There are specific tests used to confirm a diagnosis before beginning treatment. Those tests include:

• Wood's lamp exam: A Wood's lamp exam uses ultraviolet light to look closely at the skin. The light can aid in diagnosis because the bacteria that cause pitted keratolysis will appear red under the light. 
• Skin scraping: Skin scraping is done as a way to rule out other infections, such as a fungal infection that may present with similar symptoms.
• Skin biopsy: If a healthcare provider is unsure of the cause of the symptoms, a skin biopsy is taken. Skin biopsies take a sample of the affected area and send it to a lab to confirm the species of bacteria found within the skin.
• Culture: A culture may be used to determine what type of bacteria is causing the infection. However, this test is typically rare in the diagnosis of pitted keratolysis.

What Could Be Mistaken for Pitted Keratolysis?

Other skin conditions may appear similar to pitted keratolysis; thus, a correct diagnosis is required. Those conditions include:

Treatment

Effective treatment options are available for people with pitted keratolysis. Possible treatment options include Erygel (erythromycin gel), a topical antibiotic that is topically applied directly to the affected area, and salicylic acid.

How Long Does Treatment Last?

The treatment for pitted keratolysis depends entirely on the severity of the infection. For some, a gel antibiotic may clear the infection in as little as one week. Others with a worse infection may need antibiotics for as long as eight weeks.

Summary

Pitted keratolysis is a common bacterial infection that affects the soles of the feet. Many people with the infection do not experience any symptoms. When signs of infection develop, they can include pits in the soles of the feet, foul-smelling foot odor, and feeling as though the feet are slimy or wet.

Some research suggests that pitted keratolysis is most commonly found in people who work in specific industries where people often have wet feet or have to wear occlusive footwear. However, the infection can occur in anyone that wears occlusive footwear and has excessively sweaty feet. Other recommended lifestyle changes you might adopt are not sharing towels or shoes with others, using absorbent cotton socks, and drying your feet properly every time you take a bath or wash your feet.

Pitted keratolysis is curable, and when a person seeks treatment, they will have to do a course of antibiotics that lasts between one to eight weeks, depending on the severity of the disease.

A Word From Verywell

Having pitted keratolysis can be uncomfortable and even painful. That said, it is usually simple to treat once you get a proper diagnosis. If you notice any odd symptoms, such as pits in the feet or a strong and foul foot odor, visit your healthcare provider.

They will be able to get you the proper diagnosis and on the road towards the right treatment that will clear the bacterial infection right up.

Frequently Asked Questions

• Pitted keratolysis isn't serious, and not everyone with it will experience uncomfortable symptoms. It is highly treatable with antibiotics.

  That said, the foot odor that develops because of the infection can be strong and foul. Because of that, people may deal with social repercussions or self-esteem issues before getting it treated. 
  

• Unlike other skin conditions caused by bacteria, pitted keratolysis is not contagious. That means you cannot get it from another person or transmit it to others. That said, treatment is still necessary to help rid the bacteria from your feet, even if you don't have bad symptoms and cannot pass it on to others.

• Pitted keratolysis is typically localized to the feet, specifically, the soles of the feet. In some rarer cases, the condition can also develop on the palms of the hands. Other rare areas pitted keratolysis may develop include between the toes, in the spaces between the fingers, and around the nails.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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2. Kaptanoglu AF, Yuksel O, Ozyurt S. Plantar pitted keratolysis: a study from non-risk groups. Dermatol Reports. 2012;4(1):e4. doi:10.4081/dr.2012.e4

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4. Makhecha M, Dass S, Singh T, Gandhi R, Yadav T, Rathod D. Pitted keratolysis - a study of various clinical manifestations. Int J Dermatol. 2017;56(11):1154-1160. doi:10.1111/ijd.13744

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By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.

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