Pitted Keratolysis: throw the kitchen sink at it

pitted keratolysis

Pitted keratolysis is a reasonably common skin condition that mostly affects the soles of the feet and around the toes. It is characterized by the appearance of small, shallow pits or depressions on the skin and is usually associated with an unpleasant foot odor. It is primarily caused by the overgrowth of certain types of bacteria, especially the Corynebacterium species, in the damp and warm environment of the feet within shoes and excessive sweat.

What does pitted keratolysis look like?

Pitted keratolysis typically affects weightbearing areas on the foot with the appearance of pits or multiple small holes in the skin that are usually 1–3mm in diameter. Some of the pits can cluster together to give a ‘crater’ appearance. Some of the pits may have a brown appearance, giving the appearance of the feet being dirty. The appearance of the pits are usually worse when the feet are more moist. There can be white patches of skin due to the accumulation of moisture in the skin. The condition is also accompanied with hyperhidrosis (sweaty feet) and bromhidrosis (unpleasant odor).

Cause of Pitted Keratolysis

Pitted keratolysis is caused by a range of bacterial infection in the damp and moist environment of sweaty feet. The most common bacteria are Corynebacteria, Kytococcus sedentarius, Dermatophilus congolensis, Actinomyces and Streptomyces.  These bacteria thrive under moist and warm conditions inside of footwear. The protease enzymes that they produce are the cause destruction of the stratum corneum layer in the skin to create the characteristic pits. The bacteria also are responsible for the odor by producing sulfur.

Treating Pitted Keratolysis

Pitted keratolysis really is one of those conditions that really does need the kitchen sink thrown at it. Any one of the many recommended treatments on their own has a high probability of not working. However, when all used together, there is a high probability of them working.

Here is how to throw the kitchen sink at pitted keratolysis:

  1. Get rid of moisture. The feet need to be kept as dry as possible for as long and as often as possible. Going barefoot as much as is possible is best. This means that all sweat can evaporate and not accumulate in the skin. If you have to wear shoes, then try to wear open shoes that allow the air to circulate and sweat to evaporate. Rotate the shoes daily, so they have a chance to dry out over 24hrs before being worn again. Wear socks that absorb moisture; change them a few times during the day so that they absorb more moisture. Use charcoal insoles that absorb moisture – use two pairs so that they can dry out for 24hrs before using them again. Sprinkle moisture absorbing powder into the shoes and socks.
  2. Practice good foot hygiene. Wash the feet thoroughly with soap and water. Dry them thoroughly with an absorbing soft towel, so they are thoroughly dried, especially between the toes. Wipe the feet with small amounts of isopropyl alcohol or methylated spirits will help dry it even more. Stay barefoot for as long as possible after bathing to allow for the drying.
  3. Topical medicines. Apply topical erythromycin or clindamycin until it clears up. Topical benzoyl peroxide gel can also be helpful.
  4. Ongoing maintenance. Keep doing (1) and (2) above.

Forum Questions and Discussions on Pitted Keratolysis

Pitted keratolysis
Many cavities under ball of foot ?
Large white spots on feet
Small hole on bottom of foot

Personal Opinion on Pitted Keratolysis

This can be an ongoing problem. Getting rid of pitted keratolysis is not that difficult. You just have to keep working at it, by literally throwing the kitchen sink at it.


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