Pitted keratolysis is a superficial bacterial skin infection that primarily affects the soles of the feet and, less commonly, the palms. It’s caused by a group of Gram-positive bacteria—most commonly Corynebacterium species, but also Kytococcus sedentarius and Dermatophilus congolensis. These bacteria thrive in warm, moist environments, which makes individuals who wear occlusive footwear for extended periods—like soldiers, athletes, or industrial workers—particularly susceptible. The condition is more common in tropical and subtropical regions where sweating and humidity are constant issues.
Clinically, pitted keratolysis presents as clusters of small, shallow pits on the thick skin of the weight-bearing areas of the soles. These pits can sometimes coalesce into larger erosions, giving the skin a cratered or “moth-eaten” appearance. A hallmark feature is the foul odor, resulting from sulfur compounds produced by the bacteria as they digest keratin. Patients often report a burning sensation or itching, though many remain asymptomatic apart from the smell and visual appearance, which can cause social discomfort or embarrassment.
The pathophysiology revolves around the degradation of the stratum corneum by bacterial proteases and keratinases. The bacteria colonize the skin surface and digest keratin, creating the characteristic pits. Occlusive footwear, excessive sweating (hyperhidrosis), and lack of foot hygiene all contribute to the environment that allows the bacteria to flourish. Importantly, the infection is non-contagious, but the presence of moist skin and secondary maceration can increase susceptibility to other infections like tinea pedis.
Treatment focuses on both eliminating the bacteria and modifying predisposing factors. Topical antibiotics like clindamycin, erythromycin, or mupirocin are effective, and in severe or resistant cases, oral antibiotics may be prescribed. Addressing hyperhidrosis is crucial—this can involve antiperspirants (e.g., aluminum chloride hexahydrate), breathable footwear, or even iontophoresis in chronic cases. Hygiene practices such as regular washing, drying thoroughly, and rotating shoes to allow them to air out are essential to prevent recurrence.
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- Pitted Keratolysis
What is pitted keratolysis
How to get rid of pitted keratolysis?
What are those tiny holes or craters under the ball of the foot?
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https://foothealthpractitioner.info/pitted-keratolysis-and-small-holes-in-the-bottom-of-the-foot/
Pitted Keratolysis Resources