Pitted Keratolysis: Causes, Symptoms, and Effective Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Pitted keratolysis is a non-contagious bacterial infection that primarily affects the soles of the feet, characterized by a foul odor and tiny pits in the skin. It thrives in warm, moist environments, making individuals with sweaty feet or occlusive footwear particularly vulnerable. Treatment typically involves topical antibiotics and improved foot hygiene. With proper care, symptoms usually improve within a few days, though managing underlying excessive sweating is key to preventing recurrence.
Quick Answer
Pitted keratolysis is a bacterial skin infection of the feet that causes foul odor and small, hole-like indentations on the soles. It is caused by bacteria that thrive in moist conditions and destroy the outer layer of skin. Diagnosis is usually based on appearance, and treatment involves prescription topical antibiotics and keeping the feet dry. [1]
What the research says
Treatment evidence is thin and mostly low-level. A clinical review of studies on pitted keratolysis found mostly case reports and small case series. Topical antibiotics such as clindamycin, erythromycin, fusidic acid, and mupirocin showed some efficacy, often combined with hygiene advice and antiperspirants, while there was no suggestion that oral antibiotics alone work. The authors noted there is still no consensus on the best approach (Bristow and Lee, J Am Podiatr Med Assoc, 2014).
Sweaty feet and closed shoes show up in most patients. In a 2-year, two-center prospective survey of 53 patients (average age 24.9 years), the male-to-female ratio was 7.8:1. About 68% (36 of 53) complained of hyperhidrosis, and 96.2% (51 of 53) wore occlusive shoes (Blaise et al., Int J Dermatol, 2008).
Benzoyl peroxide improved lesions at both strengths. In a randomized trial of naval cadets, 42 people used 2.5% benzoyl peroxide gel and 47 used 5% once daily for 2 weeks. Pitted lesions improved in 69.0% and 63.8% of the groups respectively (P = .457), foot odor scores dropped significantly in both, and the authors suggested 2.5% may be preferable (Leeyaphan et al., J Dermatolog Treat, 2021).
Research summaries are based on article abstracts retrieved from PubMed.
What is pitted keratolysis?
Pitted keratolysis is a common bacterial skin infection that targets the weight-bearing (pressure-bearing) areas of the feet, such as the soles, heels, and balls of the feet. The condition is most notable for causing tiny indentations or "pits" in the skin, which can cluster together to form larger, crater-like lesions. These pits are the result of bacteria producing protease enzymes that dissolve the stratum corneum, the outermost layer of the skin. [1]
While the condition can affect anyone, it is most frequently observed in men and individuals who spend long hours in occlusive footwear, such as military personnel, athletes, and industrial workers. The hallmark symptom, a persistent and foul odor known as bromhidrosis, is caused by the release of sulfur compounds as the bacteria thrive in the warm, damp environment of a shoe. [1]
What are the symptoms of pitted keratolysis?
Pitted keratolysis symptoms are often more noticeable when the skin is wet or after wearing shoes for long periods. The most common signs include:
Symptom | Description |
Bromhidrosis | A distinct, foul odor that persists even after washing. |
Tiny Pits | Small, hole-like indentations typically 1-3mm in diameter. |
Skin Color Changes | Patches of skin that appear white or lighter than the surrounding area. |
Itching | A persistent itchy sensation on the affected areas of the sole. |
Lesion Clustering | Pits joining together to form larger, shallow craters. |
Although the feet are the primary site of infection, the condition can rarely manifest on the palms of the hands. It is important to distinguish these symptoms from fungal infections like athlete's foot, as the treatments differ significantly. [1]
What causes pitted keratolysis and who is at risk?
The primary cause of pitted keratolysis is an overgrowth of specific bacteria, including Actinomyces, Corynebacteria, Kytococcus sedentarius, and Dermatophilus congolensis. These microorganisms flourish in environments that are warm, dark, and moist. Consequently, individuals who suffer from hyperhidrosis (excessive sweating) are at a significantly higher risk. [1]
Common Risk Factors
Occlusive Footwear: Wearing tight shoes or rubber boots that prevent airflow.
Tropical Climates: Living in warm, humid regions that promote sweating.
Occupational Demands: Working in jobs that require being on one's feet all day in heavy boots.
Poor Hygiene: Failing to dry feet thoroughly or change wet socks promptly. [1]
How is pitted keratolysis diagnosed and treated?
A healthcare provider can typically diagnose pitted keratolysis through a physical examination due to its unique "pitted" appearance and characteristic odor. In some cases, a culture test or skin biopsy may be performed to rule out other dermatological conditions. [1]
Medical Interventions
The cornerstone of treatment is the application of topical antibiotics to eliminate the bacterial colony. Providers often prescribe:
Clindamycin or Erythromycin: Topical lotions or gels applied directly to the skin.
Mupirocin or Fusidic Acid: Antibiotic ointments used to clear the infection.
Benzoyl Peroxide: An antiseptic that can help dry the area and kill bacteria. [1]
If excessive sweating is the underlying cause, additional treatments for hyperhidrosis may be recommended to ensure the infection does not return once the antibiotics are finished. [1]
Supportive Home Care
While medical treatment is necessary, certain home practices can support recovery:
Foot Soaks: A diluted mixture of one part hydrogen peroxide to three parts water can help clean the area (consult a provider first).
Pumice Stones: Used gently to remove dead skin cells after a soak, provided the skin is not irritated.
Avoid Irritants: Do not apply bleach or undiluted vinegar, as these can damage the skin. [1]
How can you prevent and manage pitted keratolysis long term?
Preventing the recurrence of pitted keratolysis requires a proactive approach to foot health and moisture management. The goal is to keep the feet as dry and well-ventilated as possible throughout the day. [1]
Key Prevention Strategies
Breathable Footwear: Choose shoes with good airflow and avoid non-breathable materials like rubber or plastic.
Sock Selection: Wear absorbent cotton socks rather than synthetic blends that trap moisture.
Shoe Rotation: Avoid wearing the same pair of shoes two days in a row; give them 24 hours to dry completely.
Prompt Hygiene: Wash feet with soap and water immediately after removing shoes and dry thoroughly, especially between the toes. [1]
Conclusion
Pitted keratolysis is a manageable condition that responds well to targeted antibiotic therapy and consistent hygiene practices. By understanding the environmental factors that allow these bacteria to thrive, individuals can take effective steps to protect their foot health and eliminate the discomfort and odor associated with the infection.
Frequently Asked Questions
Is pitted keratolysis a fungal infection?
No, it is a bacterial infection. While it may look similar to athlete's foot (which is fungal), it requires antibiotics rather than antifungal medication to heal.
Why do my feet smell so bad with this condition?
The bacteria responsible for the infection release sulfur compounds as they break down the skin, which creates a strong, persistent foul odor.
Can I catch this from someone else at the gym?
No, pitted keratolysis is not contagious and cannot be spread from person to person through contact or shared surfaces.
How long does it take for the "pits" to go away?
Most patients see an improvement in odor and skin appearance within 2 to 3 days of starting treatment, though the skin may take longer to fully smooth out.
Can I use over-the-counter acne cream for this?
Some providers suggest benzoyl peroxide (common in acne creams) as an antiseptic, but you should consult a professional for a proper prescription antibiotic.
What kind of socks are best for preventing this?
Cotton socks are highly recommended because they are more breathable and better at absorbing moisture than synthetic or blended fabrics.
Is it okay to scrape the dead skin off my feet?
You can use a pumice stone gently after a foot soak to remove dead skin, but only if your healthcare provider has approved it and your skin isn't sore.
Does pitted keratolysis cause pain?
While usually just itchy or smelly, the pits can sometimes cluster into larger sores that may become tender or uncomfortable when walking.
Why does my trypophobia get triggered by this?
Trypophobia is a fear of patterns of holes. Because this condition creates tiny indentations in the skin, it can be a significant trigger for those with the phobia.
Will the infection come back after I finish my antibiotics?
The infection may return if the underlying cause—usually excessive sweating and moisture—is not addressed through better footwear and hygiene.
Related Reading
Hyperhidrosis: Symptoms, Causes & Treatment — A Complete Guide explains excessive sweating, a main risk factor for pitted keratolysis.
Erythrasma: Symptoms, Types, Causes, Diagnosis, Treatment and Prevention — What You Need to Know covers a related bacterial skin infection of moist skin folds.
Athlete's Foot: Symptoms, Causes, Prevention & Treatment — Complete Guide explains athlete's foot, a fungal infection often confused with it.
Iontophoresis: A Noninvasive Solution for Excessive Sweating and Skin Delivery describes a treatment that reduces sweaty feet and hands.
References
Cleveland Clinic. Pitted Keratolysis. Cleveland Clinic Health Library. Last updated June 17, 2022. https://my.clevelandclinic.org/health/diseases/23285-pitted-keratolysis
Bristow IR, Lee YL. Pitted keratolysis: a clinical review. J Am Podiatr Med Assoc. 2014;104(2):177-182. PMID: 24725039. DOI: https://doi.org/10.7547/0003-0538-104.2.177
Blaise G, Nikkels AF, Hermanns-Lê T, et al. Corynebacterium-associated skin infections. Int J Dermatol. 2008;47(9):884-890. PMID: 18937649. DOI: https://doi.org/10.1111/j.1365-4632.2008.03773.x
Leeyaphan C, Limphoka P, Kiratiwongwan R, et al. Randomized, controlled trial testing the effectiveness and safety of 2.5% and 5% benzoyl peroxide for the treatment of pitted keratolysis. J Dermatolog Treat. 2021;32(7):851-854. PMID: 31868055. DOI: https://doi.org/10.1080/09546634.2019.1708244
Medical disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have about a medical condition.
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