Pitted keratolysis is a bacterial infection that affects the skin on your feet. The condition causes a foul odor and itchiness. You’re most at risk if you have sweaty feet and wear shoes that don’t offer adequate airflow. Antibiotics treat the infection to remove the bacteria from your body.
Pitted keratolysis is a bacterial skin infection that causes a foul odor and itchiness. It most often affects the skin on your feet. You’re most at risk of developing pitted keratolysis if you have sweaty feet and wear shoes with limited airflow.
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Pitted keratolysis can affect anyone who has feet but it’s most common among men and people assigned male at birth (AMAB).
You might be more at risk of developing pitted keratolysis if you:
Pitted keratolysis is common among people who work in certain occupations where you spend most of your day on your feet or among people who participate in strenuous physical activities, including:
Symptoms of pitted keratolysis include:
You might notice your symptoms become more apparent when your skin is wet.
Symptoms of pitted keratolysis affect your feet, specifically the web spaces between your toes and the ball, heel and soles of your foot. Although rare, it can also affect the palm of your hand.
A bacterial infection causes pitted keratolysis. The most common types of bacteria that can cause infection include:
These types of bacteria grow and thrive in warm and moist conditions, which is why it commonly affects your feet if you’re wearing tight socks and shoes with minimal airflow.
Your skin “pits” or forms small indentations because the bacteria (protease enzyme) destroys layers of your skin cells that continuously shed dead skin cells (stratum corneum or the horny layer).
The odor caused by the infection occurs because the bacteria release a stinky sulfur compound.
No, pitted keratolysis isn’t contagious and can’t spread from person to person.
Your healthcare provider will diagnose pitted keratolysis after reviewing your complete medical history and performing a physical exam to learn more about your symptoms. They might ask questions about the type of shoes and socks you wear, especially around the time you noticed your symptoms.
Tests aren’t always necessary, as pitted keratolysis has a distinct appearance on your skin, but your healthcare provider might offer tests to rule out similar conditions, which could include:
Treatment for pitted keratolysis focuses on removing the bacterial infection from your body. Your healthcare provider will prescribe topical antibiotics that you rub on your skin like a lotion. Antibiotics could include:
Antiseptics like benzoyl peroxide gel or cream can help clear the infection from your feet.
If you have a condition that causes excessive sweating, like hyperhidrosis, your healthcare provider will offer additional treatment for your sweating to prevent pitted keratolysis from returning in the future.
The condition rarely goes away on its own without treatment from your healthcare provider.
There are possible side effects of taking antibiotics, which could include:
Before starting any treatment, talk to your healthcare provider about side effects and discuss the current medications you take to avoid drug interactions.
It’s dangerous to apply at-home remedies to your skin without approval from your healthcare provider. If you regularly use essential oils, like tea tree oil, ask your healthcare provider before using it on your affected skin. Don’t apply bleach or apple cider vinegar to your skin to make the odor from pitted keratolysis go away.
You can soak your feet in a diluted mixture of hydrogen peroxide and water to clean your feet. The peroxide solution should be no more than one part hydrogen peroxide to three parts warm water. Use this soak for a few minutes. After the soak, you can use a pumice stone to remove dry skin from your feet.
After you start taking an antibiotic, it will begin working within your body to rid it of bacteria. It could take between two to three days before you start to feel better. If you take an antibiotic and don’t see an improvement in your symptoms after a week, talk to your healthcare provider.
You can reduce your risk of pitted keratolysis by:
Pitted keratolysis causes your feet to smell bad. After a long day on your feet, you might notice a foul odor coming from your feet, shoes and socks. If you have pitted keratolysis, that odor will still be present after you wash your feet and change your socks and shoes. If you notice an odor, along with tiny indentations in the skin on the bottom of your foot, visit your healthcare provider. Antibiotics effectively treat the condition to make the odor go away.
If you work in an environment where you’re on your feet all day, choose shoes with good ventilation to improve how much air reaches your feet. For example, rubber boots don’t offer sufficient airflow.
Your socks can play a role in how much air gets to your feet too. The best material to improve airflow to your feet through your socks is cotton. Synthetic materials or blended materials in socks can restrict airflow to your feet.
Visit your healthcare provider if your symptoms don’t improve after taking antibiotics for one week. Visit the emergency room if you have symptoms of an allergic reaction from taking antibiotics, including:
If you have a fear of patterns with a lot of holes (trypophobia), a pitted keratolysis diagnosis can be a trigger for your fear. Visit your healthcare provider if you experience anxiety related to your phobia, as well as symptoms of pitted keratolysis. Your healthcare provider will offer treatment to make the bacteria that cause pits in your feet go away, which will ease your fear.
Pitted keratolysis and athlete’s foot are both conditions that affect your feet. Pitted keratolysis occurs as a result of a bacterial infection that causes smelly and itchy feet. Athlete’s foot is a contagious fungal infection that causes an itchy rash on your feet.
A note from Cleveland Clinic
Pitted keratolysis is a bacterial infection that can cause your feet to smell bad. If you still have an odor coming from your feet after you wash your feet at the end of the day, it’s a sign that you have pitted keratolysis. Visit your healthcare provider if you have symptoms so they can offer treatment to remove the infection from your body. Prevent the bacteria from returning by changing your shoes and socks when they get wet and wearing shoes with good airflow.
Last reviewed by a Cleveland Clinic medical professional on 06/17/2022.
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