Pitted Keratolysis

Who's At Risk?

Pitted keratolysis can occur in people of any race, any age, and either sex, though it is more common in males. Conditions that make people more likely to develop pitted keratolysis include:

• Sweaty feet
• Hot or humid weather
• Unventilated footwear, such as rubber boots or vinyl shoes

Athletes and military personnel tend to develop pitted keratolysis most commonly.

Signs & Symptoms

The most common locations for pitted keratolysis include:

• Pressure-bearing sites on the soles of the feet, especially the heels
• Non-pressure-bearing sites on the soles of the feet
• Palms of the hands

In these areas, the condition appears as white patches studded with small (0.5–5 mm), shallow pits in the superficial skin. These pits can sometimes join together (coalesce) to form larger, crater-like lesions.

Pitted keratolysis may occasionally be itchy or painful. The foot odor often associated with pitted keratolysis may be socially embarrassing.

Self-Care Guidelines

With pitted keratolysis, keeping the feet as dry as possible is important. Have your child try the following:

• Wear absorbent cotton socks and change them frequently.
• Wear wool socks, which may wick moisture away from the foot.
• Wash the feet with antibacterial soap or antiseptic cleanser daily.
• Consider using a hairdryer to dry feet thoroughly after washing.
• Apply antiperspirant to the soles of the feet daily.
• Minimize the use of tight-fitting, unventilated footwear. (Try sandals if possible.)
• Avoid wearing the same pair of shoes 2 days in a row.
• Avoid sharing towels and footwear with others.

Treatments

In addition to recommending the above steps to minimize moisture, a physician may try:

• Prescription-strength antiperspirant containing aluminum chloride.
• Prescription antibiotic lotions such as clindamycin, erythromycin, or mupirocin.
• Antifungal cream such as miconazole or clotrimazole.
• Prescription oral antibiotics such as erythromycin.

With some combination of these treatments, the skin lesions and odor of pitted keratolysis usually disappear within 4 weeks.

Visit Urgency

See your child’s doctor or a dermatologist if attempts to minimize moisture do not improve the condition.

Trusted Links

• Clinical Information and Differential Diagnosis of Keratolysis, Pitted

References

Bolognia, Jean L., ed. Dermatology, pp.1129. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6^th ed, pp.1875-1876. New York: McGraw-Hill, 2003.