Definition

Pitted keratolysis is a skin condition affecting the soles of the feet and, less commonly, the palms of the hands. It is caused by a bacterial infection of the skin and may give off an unpleasant odor. The condition causes pitting (crater like shapes) on the soles of the feet (characteristically, on weight bearing areas) together with a strong odour.

Cause

It is generally caused by coryneform bacteria, though several other strains of bacteria have been discovered in the lesions, including Micrococcus sedentarius, Actinomyces keratolytica and Dermatophilus congolensis. The tell-tale crater-like pitting is a direct result of the proteolytic enzymes manufactured by the bacteria digesting the keratin, which is a resilient protein that gives the skin its strength and toughness. It is also important to note that pitting keratolysis is non-contagious.

Pitted keratolysis can occur in people of any race, any age, and either sex, though it is more common in males. Athletes and military personnel tend to develop this condition most commonly. Conditions that make people more likely to develop pitted keratolysis include:

• Sweaty feet
• Hot or humid weather
• Unventilated (occlusive) footwear, such as rubber boots or vinyl shoes

Treatment and Prevention

Keeping the feet as dry as possible is important. Try the following:

• Wear absorbent cotton socks and change them frequently.
• Wear wool socks, which may wick moisture away from the foot.
• Wash your feet with antibacterial soap or antiseptic cleanser daily.
• Consider using a hairdryer to dry feet thoroughly after washing them.
• Apply antiperspirant to the soles of your feet daily.
• Minimize the use of tight-fitting, occlusive footwear. (Try sandals if possible.)
• Avoid wearing the same pair of shoes 2 days in a row.

In addition to recommending the above steps to minimize moisture, your podiatrist or doctor may advice any of the following treatments:

• Antiperspirants containing aluminum chloride
• Topical antibiotic creams or lotions such as fucidic acid, clindamycin, erythromycin, or mupirocin.
• Antifungal cream such as miconazole or clotrimazole

With some combination of these treatments, the skin lesions and odor of pitted keratolysis usually disappear within 4 weeks.