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Pitted Keratolysis

Bacterial superficial infection of the soles characterized by punched-out depressions

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Pitted Keratolysis?

Pitted keratolysis is a superficial cutaneous infection caused by Corynebacterium species (Kytococcus sedentarius), Dermatophilus congolensis, and Actinomyces, mostly affecting the weight-bearing plantar surfaces. The bacteria produce keratolytic proteases that erode the stratum corneum, resulting in characteristic 1-3 mm punched-out pits and erosions.

Hyperhidrosis, occlusive footwear, and prolonged exposure to moist environments are the main predisposing factors. Bacterial sulfur compounds (methanethiol, dimethyl sulfide) cause the typical malodor. In some cases, lesions extend to the interdigital areas and palms.

Diagnosis is mostly clinical; in atypical cases, KOH preparation excludes fungal infection and Wood's lamp examination shows coral-red fluorescence (Corynebacterium). Topical antibiotics (clindamycin, erythromycin) and benzoyl peroxide are first-line treatment.

Symptoms

Multiple, well-defined 1-3 mm depressions on the soles
Malodor (bromhidrosis)
Hyperhidrosis
White-colored macerated areas
Mostly painless (some patients describe burning)
Pruritus and discomfort

Risk Factors

Hyperhidrosis (essential or secondary)
Occlusive shoes and synthetic socks
Athletes, military personnel, miners
Tropical and humid climate
Diabetes mellitus
Immunosuppression

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent malodor and pits
  • Inadequate response to topical treatments
  • Suspected concomitant fungal infection
  • Coexisting hyperhidrosis impairing quality of life
  • Suspected secondary cellulitis

Treatment Methods

01
Foot hygiene and frequent sock changes
02
Topical clindamycin or erythromycin (1-2x/day)
03
Benzoyl peroxide 5% gel
04
Aluminum chloride solution (for hyperhidrosis)
05
Botulinum toxin injection (refractory hyperhidrosis)
06
Selection of breathable shoes and antifungal/antibacterial powders

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Dermatoloji Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.