Pitted keratolysis

Pitted keratolysis is a common condition of the feet caused by an overgrowth of bacteria that digest keratin. Patients usually present with unpleasant odour and shallow pitting of the skin on the soles. See here for photos of pitted keratolysis. Plantar hyperhidrosis is often associated with pitted keratolysis. Pitted keratolysis is more common in males than in females. Predisposing factors include prolonged use of occlusive footwear (eg vinyl shoes, rubber boots), thickened skin on the soles and palms, insufficient foot hygiene, hot and humid weather, obesity, diabetes and immunodeficiency. Occupations at higher risk include farmers, athletes, sailors, fishing and industrial workers, and military personnel.

Pitted keratolysis is usually diagnosed clinically.

Treat hyperhidrosis, if present, to promote resolution and prevent recurrence. Advise patients to wash regularly with an antiseptic wash, and to use an antiperspirant on the feet. Also see Primary hyperhidrosis.

If there is no response to general measures for pitted keratolysis, use:

Repeated courses of topical clindamycin may be required.