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What is Pitted Keratolysis?

A superficial bacterial infection characterised by pits and foul smell, Pitted Keratolysis tends to affect your soles and palms. Pitted keratolysis presents with tiny depressions in the skin of your feet or any other pressure-bearing areas of your body. This skin condition is quite common among workers that are required to wear shoes for longer periods, such as farmers, soldiers, and athletes, and occurs at a higher rate in tropical areas. This provides bacteria with a favorable environment to grow and infect predominantly the skin of your soles or, sometimes even palms.

Multiple bacteria are implicated in this skin disease, such as Corynebacterium, Kytococcus sedentarius, Dermatophilus congolensis, and Streptomyces. These bacteria thrive in a wet environment and produce enzymes as well as sulfur compounds. The former destroys the superficial layer of the skin while the latter produces the characteristic odor.

There are a few risk factors associated with pitted keratolysis such as excessively sweaty feet that are not kept dry, not wearing socks, or sharing of towels. Weather also plays an important role in this condition, such as warm environments with high humidity increase the chances of developing pitted keratolysis. Diabetes and age also play a role.

Symptoms associated with pitted keratolysis include pitting of the skin of the soles of your feet. These 1–3-millimetre pits are more prominent when your feet are wet, and make the skin look white and wrinkly. Pits might cluster up at weight-bearing areas such as your heel and eventually result in a crater-like lesion. You might not experience typical signs of inflammation such as redness or swelling.

Treatment of Pitted Keratolysis

Your doctor might do a clinical exam as well as evaluate your medical history to get to the diagnosis. A doctor might suggest other investigations such as skin scrapings or a biopsy. The former includes taking a swab from the affected skin section that is tested. A biopsy of affected skin might also be useful.

Being a bacterial infection, it can be treated with antibiotics and antiseptics. Your healthcare provider may prescribe specific antibiotics, usually topical, that may help deal with the bacteria involved. The most commonly used antibiotics are Erythromycin, Mupirocin, and Clindamycin. Benzoyl Peroxide gel might be prescribed as an antiseptic. Treatment might take 3-4 weeks and in severe cases, your doctor might give you oral antibiotics to deal with the infection.

If you have an underlying skin condition such as excessive sweating also known as Hyperhidrosis, your dermatologist might add other drugs to deal with that too. Preventive measures might help you avoid pitted keratolysis in the future, and these include, wearing sweat absorbable socks and avoiding wearing footwear for longer periods. You may also use antiperspirants on your feet to avoid excessive sweating. Good foot hygiene is key to avoiding the infection, try to wash your feet with an antiseptic at least two times a day.