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What is Pitted Keratolysis?

Mary McMahon
Updated: Mar 03, 2024

Pitted keratolysis is a skin infection which is most commonly seen in the soles of the feet, although it can also appear in the palms. It occurs when moist, wet feet are kept in tight socks and shoes, as might happen when someone who sweats a lot wears boots most of the time. This condition can be evaluated and treated by a dermatologist who can confirm that it is pitted keratolysis and prescribe a medication to treat the infection, in addition to making recommendations to avoid a recurrence of the infection in the future.

A number of bacteria can be responsible for pitted keratolysis. The infected skin usually turns white to reddish, and develops deep pits around the weight-bearing areas of the foot. Skin may flake or scale away, and in extreme cases, it can look like a patient has been walking on hot coals. Pitted keratolysis is also often accompanied by a strong smell; for people who normally have strong smelling feet, the odor associated with this infection is usually different, and more noticeable.

Topical antibiotics can be applied to treat the infection, and patients can also take oral medications. During treatment, the feet need to be regularly washed, gently dried, and allowed to air out. A doctor may recommend that a patient throw away old socks and buy new ones, seeking out socks which wick away moisture and allow the feet to breathe. Replacement of footwear may also be recommended.

In the long term, prevention of pitted keratolysis relies on keeping the feet clean and relatively dry. Using a mild antibacterial soap on the feet can be beneficial, as can spending time barefoot to give the feet a chance to air out fully. Purchasing footwear which allows the feet to breathe will also prevent future outbreaks.

If a particularly beloved pair of shoes has acquired an unpleasant odor because of a pitted keratolysis infection and the patient cannot replace the shoes or bear to throw them away, the shoes can be cleaned with an enzymatic cleaner. Such cleaners are commonly used to clean wetsuits and dive equipment, and are available from dive shops and some shoe stores. However, patients should be aware that the cleaner may damage the finish of the shoes; suede shoes, for example, usually cannot withstand the use of an enzymatic cleaner. A shoe store may have recommendations for cleaning, or it may be possible to address much of the odor by having the shoe resoled by a cobbler.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a The Health Board researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments
By shell4life — On Sep 09, 2011

@seag47 - Maybe your dad could do what mine did to prevent his pitted keratolysis from coming back. He had two pairs of work boots, and he would alternate them.

He would let one pair air out by pulling the tongue forward and outward and placing them near a vent or window. He would wear the other pair while the first one aired out, and the next day, he would switch pairs.

He also blow dries his feet once he gets out of the shower. He uses a towel first, but that doesn’t always get all the moisture off, and if he puts socks on his feet right away, he could be trapping that moisture in there. Blow drying gets rid of the water he can’t see on the surface.

These methods worked for my dad. He hasn’t gotten another infection. I hope maybe your dad can benefit from this information.

By seag47 — On Sep 08, 2011

My dad got pitted keratolysis from having to wear boots at his construction job. He had to wear protective footwear in case he dropped something on his feet, and he wore them even in extremely hot weather, all day long.

It looked like his feet were growing mold. They had patches of white with tiny holes all in them. I would describe it as areas of mold on a piece of bread.

There’s nothing he can do about the type of shoes he has to wear. He did switch to special socks designed to hold moisture away from his feet, though, and maybe that will help.

By lighth0se33 — On Sep 07, 2011

My husband got pitted keratolysis. He has to wear boots at work, and he sweats all day long. It is hard for him to keep his feet aired out because of this.

He works in a refrigerated warehouse at a food distribution center. Though it is cold in there, he works up a sweat by lifting and stacking heavy boxes all day. His feet pay the price for this.

He got an antibiotic to treat it, and he airs his feet out on days that he doesn’t have to work. He has started putting an antiperspirant on the soles of his feet to control the sweating.

Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

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