What can be done for pitted keratolysis?

Pitted keratolysis is a relatively rare and often misunderstood dermatological condition that primarily affects the soles of the feet. While it may not be a well-known condition, understanding pitted keratolysis just what it is essential for those who are seeking relief from its symptoms. Pitted keratolysis typically manifests as small, shallow pits or depressions on the weight-bearing areas of the soles of the feet and around heels. These pits are usually surrounded by a white or greyish rim and can range in size from a pinhead to several millimetres in diameter. In some cases, these smaller pits may merge to form larger lesions. The condition is typically asymptomatic, but can be itchy and develop an odour (which often described as a foul, cheesy type odour) due to bacterial overgrowth.

Pitted keratolysis is primarily caused by a combination of factors, including bacteria, sweat, and keratin breakdown. The condition is most commonly associated with bacterial species such as Corynebacterium species, Kytococcus sedentarius, and Dermatophilus congolensis. These bacteria thrive in warm, moist environments and are often found on the skin's surface. Excessive sweating, often due to factors like hot and humid weather, wearing tight and occlusive footwear that does not breath, or engaging in activities that induce foot sweating, creates an ideal environment for these bacteria to flourish. As the bacteria multiply, they produce enzymes that break down keratin, a protein found in the outermost layer of the skin. This keratin degradation leads to the formation of the characteristic pits on the soles of the feet. The diagnosis of pitted keratolysis is primarily clinical, based on the characteristic appearance of the pits and the associated odour.

The treatment of pitted keratolysis primarily focuses on eliminating the causative factors and controlling bacterial overgrowth. Of most importance is proper foot hygiene. Regularly washing the feet with soap and water and drying them thoroughly can help reduce bacterial growth. Staying barefoot after bathing to make sure the foot is totally dry is important. Wearing footwear that can breath made from natural materials like leather can help reduce sweat accumulation. Frequent shoe changes and using moisture-wicking socks can also be beneficial. Ideally, going barefoot as often as is possible can be helpful at allowing the sweat to evaporate and reduce the conditions that the bacteria that cause this problem like to thrive in. Some cases will need topical antibiotics like clindamycin or erythromycin are often prescribed to control bacterial overgrowth. These antibiotics can be applied as creams or lotions. In some cases, aluminium chloride solutions applied regularly to the feet can be used to reduce foot sweating. Over-the-counter antiperspirants can help control sweating of the feet, as well as the use of drying agents like talcum powder or baking soda can help keep the feet dry. In severe cases that do not respond to conservative treatment, oral antibiotics may be prescribed. It's important to note that treatment should be continued for an extended period to prevent recurrence, especially the use of good foot hygiene practices. Pitted keratolysis can easily recur if the conditions are right.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.