Pitted keratolysis

What is pitted keratolysis?

Pitted keratolysis is a superficial skin infection which usually affects the soles of the feet. It can affect patients of any age and is more common in males. It can usually be easily treated.

What does pitted keratolysis look and feel like?

Pitted keratolysis can be sore or itchy, but often gives no symptoms apart from the malodour (i.e. an unpleasant smell).

Pitted keratolysis is characterised by small crater-like pits in the pressure-bearing areas of skin on the sole of the foot. Sometimes the pits can join together to form larger erosions in the skin. These pits may be more noticeable when the skin is wet. Rarely, it can affect the palms of the hands.

What causes pitted keratolysis?

It is caused by a superficial bacterial infection of the skin known as of Corynebacterium. The bacteria produce enzymes which break down the top layer of the skin to cause pits and this process can also lead to malodour.

What else may also contribute to pitted keratolysis?

It is commonly associated with having sweaty feet and in people who wear occlusive footwear for prolonged periods of time. Poor foot hygiene and certain medical conditions, such as diabetes, may increase the risk of developing pitted keratolysis.

Things you can do to help yourself

• Limit the use of occlusive footwear (i.e. shoes that don’t let your feet ‘’breath’’, making them more likely to sweat) wherever possible and ensure that footwear is properly fitted to reduce friction. If you have to wear occlusive footwear at work, be sure to remove them when you get home
• Wear socks with breathable fabric (e.g. cotton) and wash them frequently and use moisture-absorbing insoles (e.g. charcoal)
• Wash the feet frequently (at least twice daily) will either with normal soap or topical antiseptic solution (e.g. Clinisept+ Skin) ensuring that feet are thoroughly dried after washing, including between the toes
• If your feet are sweaty, antiperspirants can be applied to the feet to help reduce sweating
  
  

Make an appointment at your GP surgery

If the above measures do not help then make an appointment to see your healthcare provider. Treatment options provided by a health professional include topical treatments (applied directly to the skin) and occasionally oral antibiotics (taken by mouth). The list of available treatments can be found on the pitted keratolysis chapter in the A-Z Guidelines of Clinical Conditions at www.pcds.org.uk.

Your mental health

Pitted keratolysis can have a significant psychological impact. If pitted keratolysis is affecting your mental health, you should discuss this with a health professional.

Referral to a specialist

If the diagnosis is uncertain or you have increased sweating (hyperhidrosis) and have not responded to treatment, you may need to be referred to a specialist, who will be either a Dermatologist or a GPwER/GPwSI in Dermatology (a GP who has also been trained in relevant areas of dermatology).

What will happen when you are referred?

The appointment may be face-to-face (the person attends the clinics), or a video call (teledermatology). Other treatment options for hyperhidrosis may need to be considered.

Helping with other skin conditions

If you, a family member, or friend have an undiagnosed skin condition; or you want to learn more about how to treat skin conditions, please view our short video on how to get the best from this website.