Condition Spotlight: Pitted Keratolysis

foot with pitted keratolysis.

What is pitted keratolysis?

Pitted keratolysis, also known as keratolysis plantare sulcatum or ringed keratolysis, is a bacterial infection of the skin that commonly affects the feet.

It typically occurs on the areas of feet that are subject to high pressure, such as the heels and the balls of the feet.

It causes clusters of small ‘pits’ in the skin which are usually approximately 1-3mm in size. Sometimes, these clusters can join together to form a larger pit or crater in the skin.

The skin may also appear macerated or soft.

What does pitted keratolysis feel like?

Pitted keratolysis is usually asymptomatic and the first signs include odour and the crater-like pits.

In some cases, redness, itching and soreness can also be experienced, particularly if it is left untreated or not treated properly.

What causes pitted keratolysis?

This condition is caused by a range of bacteria including Corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, Actinomyces, or Streptomyces.

These types of bacteria cause the pits in the skin by producing destructive enzymes that attack the outermost layer of the skin.

The smell or odour that is associated with pitted keratolysis is as a result of the sulphur compounds that these bacteria produce.

There are a number of risk factors that predispose people to pitted keratolysis including:

  • Hot and humid environments
  • Occlusive footwear (footwear that encloses the feet)
  • Hyperhidrosis (excessive swetting)
  • Poor foot hygiene
  • Keratoderma (thickened skin on the soles of the feet)

Who is likely to be affected by pitted keratolysis?

The current research suggests that men are more at risk of developing pitted keratolysis than women.

There are a number of population groups that are at risk of developing pitted keratolysis including:

  • Athletes
  • Farmers
  • Tradies
  • Sailors and fishermen.
  • Those who are barefoot most of the time.
  • Those who are unable to care for or wash their feet properly.
  • Those with medical conditions such as diabetes, obesity or are immunocompromised.

How is the condition diagnosed?

Due to the obvious characteristics of pitted keratolysis, it is often easily diagnosed through thorough history taking and skin observation.

In some cases, skin samples may be taken in order to identify the exact causative bacteria as this will aid in treatment.

How is pitted keratolysis treated?

Thankfully, there are a number of treatment options available which can help to ease symptoms and clear the condition relatively quickly.

These can include:

  • The use of antibiotics to clear the bacterial infection – usually a broad-spectrum antibiotic is used to ensure that as many variants of the infection are targeted, however sometimes a sample of the skin must be taken if the antibiotics are not working. This will help to guide which antibiotic is right for you.
  • Regularly airing out feet.
  • Allowing shoes to dry completely before wearing them again, particularly when working in humid or wet conditions.
  • Apply an antiperspirant or methylated spirits to the feet.
  • Washing feet thoroughly and regularly.
  • Changing socks daily and changing them during the day if able to.
  • Avoid sharing shoes and socks with others.

Are you worried about the skin on your feet?

If you are concerned about the skin on your feet and think you may be suffering from pitted keratolysis, you should come see us here at Watsonia Podiatry in Melbourne.

Our team can accurately diagnose this condition and many others that could be affecting your feet and lower limbs. We can then work with you to create a treatment plan and get you back on the road to recovery.

Call us on (03) 9432 3689 or book online to arrange an appointment at our clinic.


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