Pitted Keratolysis: Treatment, Symptoms, Hands, And More

Maybe your like

HealthlineSubscribe

Skin Care

What to Know about Pitted Keratolysis

Medically reviewed by Raechele Cochran Gathers, MD — Written by Mariah Adcox — Updated on April 11, 2023

Symptoms
Pictures
Causes
Diagnosis
Treatment
Prevention
Outlook

Pitted keratolysis is a bacterial skin infection that can affect both the soles of your feet and the palms of your hands. For this reason, it’s also known as holes in the feet, holes in the skin, and holes in the hand.

Here are its defining characteristics:

It most often affects the feet.
It causes small depressions, or pits, especially in pressure-bearing areas
It can be a cause of smelly feet and is more common in men than women, according to 2012 research.

We explain how to spot pitted keratolysis, why it happens, and how to get treatment if you discover symptoms.

What are the symptoms of pitted keratolysis?

Pitted keratolysis is usually asymptomatic. However, when you do have symptoms, the most common effect is a noticeable odor from the feet. This is due to the skin infection on the bottom of the feet.

Other symptoms include:

Small holes in the skin. Those with this condition will usually have clusters of “punched-out” pits on the soles of their feet or the palms of their hands. Most often, these lesions appear on the pressure points of the soles. The pits will be more noticeable when the skin is wet.
Larger lesions. Sometimes these pits can join together, or coalesce, to form larger lesions.
Redness. In one type of pitted keratolysis, the affected areas of the skin turn red.
Itching and soreness. While the pits themselves usually won’t occur with other symptoms, they may sometimes feel sore or itch when you put pressure on the foot while walking.

Pictures of pitted keratolysis

Pitted keratolysis takes on the following appearance:

Share on Pinterest

Pitted keratolysis is an infection usually seen on the foot that causes punched-out lesions on the skin and smelly feet. Evan Saap, CC BY-SA 4.0, via Wikimedia Commons

What causes pitted keratolysis?

Several different bacterial species can cause pitted keratolysis. The most common are:

Corynebacteria
Dermatophilus congolensis
Kytococcus sedentarius
Actinomyces
Streptomyces

These bacteria often multiply in wet or moist conditions. Pitted keratolysis often develops when people don’t let their feet air out enough.

The bacteria on the feet or palms will produce protease enzymes that destroy the outermost layer of the epidermis. This causes the characteristic pitting. The odor comes from the bacteria’s production of sulfur compounds.

Diagnosing pitted keratolysis

If you think you have pitted keratolysis, contact a healthcare professional. To diagnose pitted keratolysis, a doctor will swab the area or perform a procedure called skin scraping.

During a skin scraping, the doctor obtains a sample of skin to check for bacteria and parasites under a microscope. After identifying the pathogen, they can recommend the appropriate antibiotics for treating this bacterial infection.

How to treat pitted keratolysis

To treat pitted keratolysis, your doctor will most likely prescribe a topical antibiotic or antiseptic, most commonly:

clindamycin
erythromycin
mupirocin

Doctors also recommend that you avoid tight-fitting socks and shoes. In rare cases, your doctor may suggest a drying agent like Drysol.

In extreme cases, your doctor may recommend shots of botulinum toxin (Botox) to treat the condition. This can help reduce sweating.

Q:

What happens if I don’t receive treatment for pitted keratolysis?

A:

Without treatment, the pits can coalesce together to form larger crater-like depressions in the skin. The odor may also get worse.

Raechele Cochran Gathers, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Preventing pitted keratolysis

Because this bacterial infection thrives in moist environments, it’s important to keep your feet as dry as possible to prevent pitted keratolysis.

Take the following precautions to keep feet healthy and dry:

Wear shoes for as little time as possible.
Wear socks made of moisture-wicking materials, such as polyester and nylon.
Wear open-toed sandals as frequently as possible.
Wash your feet frequently with antiseptic cleanser.
Avoid sharing footwear with others.

What is the outlook for pitted keratolysis?

The outlook for pitted keratolysis is excellent, as it is easy to treat and prevent.

By using topical antibiotics and other precautions, this condition will usually clear up in about 3 to 4 weeks.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Cortesia C, et al. (2014). Acetic acid, the active component of vinegar, is an effective tuberculocidal disinfectant.https://journals.asm.org/doi/10.1128/mBio.00013-14
Fernández-Crehuet P, et al. (2015). Pitted keratolysis: An infective cause of foot odour.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401600/
Kaptanoglu AF, et al. (2012). Plantar pitted keratolysis: A study from non-risk groups.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212664/
Oakley A. (2016). Pitted keratolysis.https://www.dermnetnz.org/topics/pitted-keratolysis/
Pitted keratolysis. (n.d.).http://www.aocd.org/?page=PittedKeratolysis
Sakkas H, et al. (2016). In vitro antimicrobial activity of five essential oils on multidrug resistant Gram-negative clinical isolates.https://www.bibliomed.org/mnsfulltext/55/55-1443611315.pdf?1640116793

Share this article

Medically reviewed by Raechele Cochran Gathers, MD — Written by Mariah Adcox — Updated on April 11, 2023

Health Conditions

Condition Spotlight

Wellness Topics

Product Reviews

Featured Programs

Featured

Lessons

Newsletters

Lifestyle Quizzes

Health News

This Just In

Top Reads

Video Series

Find Your Bezzy Community

Follow us on social media