What is Pitted Keratolysis?

Pitted keratolysis is a skin infection which is most commonly seen in the soles of the feet, although it can also appear in the palms. It occurs when moist, wet feet are kept in tight socks and shoes, as might happen when someone who sweats a lot wears boots most of the time. This condition can be evaluated and treated by a dermatologist who can confirm that it is pitted keratolysis and prescribe a medication to treat the infection, in addition to making recommendations to avoid a recurrence of the infection in the future.

A number of bacteria can be responsible for pitted keratolysis. The infected skin usually turns white to reddish, and develops deep pits around the weight-bearing areas of the foot. Skin may flake or scale away, and in extreme cases, it can look like a patient has been walking on hot coals. Pitted keratolysis is also often accompanied by a strong smell; for people who normally have strong smelling feet, the odor associated with this infection is usually different, and more noticeable.

Topical antibiotics can be applied to treat the infection, and patients can also take oral medications. During treatment, the feet need to be regularly washed, gently dried, and allowed to air out. A doctor may recommend that a patient throw away old socks and buy new ones, seeking out socks which wick away moisture and allow the feet to breathe. Replacement of footwear may also be recommended.

In the long term, prevention of pitted keratolysis relies on keeping the feet clean and relatively dry. Using a mild antibacterial soap on the feet can be beneficial, as can spending time barefoot to give the feet a chance to air out fully. Purchasing footwear which allows the feet to breathe will also prevent future outbreaks.

If a particularly beloved pair of shoes has acquired an unpleasant odor because of a pitted keratolysis infection and the patient cannot replace the shoes or bear to throw them away, the shoes can be cleaned with an enzymatic cleaner. Such cleaners are commonly used to clean wetsuits and dive equipment, and are available from dive shops and some shoe stores. However, patients should be aware that the cleaner may damage the finish of the shoes; suede shoes, for example, usually cannot withstand the use of an enzymatic cleaner. A shoe store may have recommendations for cleaning, or it may be possible to address much of the odor by having the shoe resoled by a cobbler.