Pitted Keratolysis: Causes, Symptoms, Treatment and Prevention

Pitted keratolysis is a condition that is known to affect the skin of soles of the feet and palm of the hands. It is a bacterial infection. Pitted keratolysis is also known as holes in the feet, holes in the palm, and holes in the skin.

This infection causes holes or small depressions or pits on the top layer of the skin and also causes a bad smell.

This condition affects those more who wear footwear that is enclosed and warm, for long periods including soldiers, sailors, and athletes. It is common in people who live in tropical and usually go bare feet.⁽¹⁾

There are different bacterial species that can cause keratolysis, which include:

• Corynebacteria
• Actinomyces
• Streptomyces
• Kytococcus sedentarius
• Dermatophilus congolensis

The bacteria multiply in wet and moist conditions and can be seen developing more in people who do not let their feet out in the air for long. Bacteria that are present in the feet and palm produce protease enzyme that is known to destroy the outer layer of the epidermis. This causes the characteristic pitting of skin as in pitted keratolysis.

The bad smell is due to the production of sulfur compounds.

People in a few occupations may be at an increased risk of pitted keratolysis including athletes, farmers, industrial workers, sailors and fishing workers, and people working in the military.

In most people, pitted keratolysis is asymptomatic. The most common symptom is the noticeable odor from the feet, which is due to the infection of the skin.

Other symptoms of pitted keratolysis include:

• Presence Of Holes On The Skin: These holes are usually clusters of small punched-out pits that are seen on the soles of the feet or palms of the hands. These are known to appear on the pressure point of the soles and are more noticeable when the feet are wet.
• Larger Lesions: The small holes join together and form larger lesions.
• Redness: The affected area in some of the pitted keratolysis lesions turn red.
• Itching and Soreness: The pits may sometimes feel sore or itchy when the pressure is put on the soles.

To diagnose pitted keratolysis a swab from the affected area is taken or skin scraping is done.

• In skin scraping, a sample is obtained to check for bacteria and parasites under a microscope. As the pathogen is identified, appropriate antibiotics are used to treat the infection.
• The most commonly prescribed antibiotics are clindamycin, mupirocin, and erythromycin.
• Tight-fitting socks and shoes are recommended to be avoided and drying agents are used.
• In extreme cases, Botox shots are used to treat. It helps in reducing sweating.

As it is well known that the bacteria thrive in a moist environment, it gets important to keep the feet as dry as possible.

Precautions can be taken to keep the feet healthy and dry. These include:

• Do not wear shoes for longer periods
• Avoid sharing footwear
• Wash feet with an antiseptic cleanser
• Wear socks of moisture-wicking material
• Wear open-toe sandals

Pitted keratolysis is an easy-to-treat condition and has a good outlook. Topical antibiotics and precautions can help clear up the condition in 3-4 weeks.⁽²⁾ It is important to speak with a doctor for prescription antibacterial medications. A doctor can make a quick diagnosis and give appropriate treatment.