Pitted keratolysis is a common superficial skin infection that primarily affects the soles of the feet. It is recognizable by clusters of small, crater-like depressions, or pits, on the skin’s surface, and a notably strong, unpleasant odor. The infection results from bacterial activity on the skin. While not medically dangerous, the malodor and appearance prompt people to seek a solution, often wondering if the condition might clear up on its own.
The Nature of Pitted Keratolysis
This skin condition is caused by the proliferation of specific bacteria, most often belonging to the Corynebacterium species, along with other organisms like Kytococcus sedentarius. These bacteria thrive in a warm, persistently moist environment, which is typically created by excessive foot sweating, a condition known as hyperhidrosis. The combination of perspiration and occlusive footwear, such as rubber boots or tight shoes, creates the ideal breeding ground for these organisms.
The bacteria produce enzymes called proteases that actively break down the keratin in the outermost layer of the skin, the stratum corneum. This enzymatic action is what creates the small, shallow, 1 to 3-millimeter pits that give the condition its name. The foul odor associated with PK is due to the sulfur compounds, such as thiols, sulfides, and thioesters, which are by-products of the bacterial activity.
Spontaneous Resolution and Intervention Necessity
The short answer to whether pitted keratolysis goes away by itself is that it rarely, if ever, resolves completely without some form of intervention. Since the underlying cause is an environment of chronic moisture and warmth, the bacterial infection will likely persist indefinitely until that environment is altered or the bacteria are eliminated. While some untreated cases may experience periods of reduced severity, known as spontaneous remissions, the condition typically returns or worsens, sometimes lasting for years.
Without actively breaking the cycle of moisture and bacterial growth, the infection will continue to colonize the skin, sometimes forming larger, confluent erosions. Medical intervention is required to effectively eliminate the infection and address the contributing factors.
Medical Treatment Protocols
The primary goal of medical treatment is to eliminate the bacteria and manage the excessive moisture that allows the infection to flourish. Physicians generally prescribe topical antibacterial medications as the first-line treatment for pitted keratolysis. Common topical antibiotics include erythromycin or clindamycin, which are applied directly to the affected areas, usually twice a day.
These topical agents work by killing the bacteria and allowing the damaged outer layer of the skin to heal, which typically resolves both the pitting and the odor within three to four weeks. In cases where excessive sweating is a significant contributing factor, a physician may also recommend a drying agent, such as a solution containing aluminum chloride. This compound acts as a powerful antiperspirant to reduce sweat production on the soles of the feet.
Preventing Future Infections
Once the acute infection is cleared, preventing recurrence hinges on maintaining a dry environment for the feet to avoid creating the necessary conditions for bacterial overgrowth. This begins with rigorous foot hygiene, including washing the feet daily with an antibacterial soap and ensuring they are dried thoroughly, especially between the toes.
Wearing moisture-wicking socks, which are often made of synthetic materials or wool, can help pull sweat away from the skin better than cotton. It is also important to rotate footwear, avoiding wearing the same pair of shoes two days in a row, which allows shoes to fully dry out between uses. For those who experience persistent excessive sweating, using an over-the-counter antiperspirant or foot powder on the soles can also help manage moisture levels and reduce the risk of the condition returning.