Pitted Keratolysis (PK) is a common, non-serious skin condition caused by a superficial bacterial infection, often Corynebacterium. This infection affects the outermost layer of the skin, typically on the soles of the feet, thriving in moist, warm environments. The bacteria release enzymes that break down keratin, leading to characteristic visual symptoms and a pungent odor. Home management involves a dual approach: eliminating the bacteria and controlling the excessive moisture.
Identifying Pitted Keratolysis
PK is confirmed by two distinct signs: a specific skin appearance and a pungent odor. Affected areas, usually the weight-bearing parts of the foot like the heel and ball, display numerous small, shallow, circular depressions or pits. These pits are typically one to three millimeters in size and often cluster, sometimes creating larger lesions. The skin may also appear whitish and macerated, especially when wet.
The foul odor is caused by sulfur compounds, such as thiols and sulfides, produced as a byproduct of the bacteria breaking down skin protein. PK is strongly associated with hyperhidrosis, or excessive sweating, which creates the ideal damp conditions for the bacteria to multiply.
Primary At-Home Treatment Strategies
Successful home treatment focuses on reducing the bacterial population and managing moisture using readily available over-the-counter (OTC) products. Antibacterial soaps and washes are helpful for targeting bacteria on the skin surface.
Products containing benzoyl peroxide or chlorhexidine should be used as a wash or scrub on affected areas twice daily. Benzoyl peroxide releases oxygen, which is toxic to the bacteria, while chlorhexidine is a broad-spectrum antiseptic. Thoroughly washing the entire sole and then drying the feet completely is a foundational step in managing the infection.
Controlling excessive moisture is equally important, as dampness fuels bacterial growth and recurrence. Strong antiperspirants, such as those containing aluminum chloride, are highly effective. A 20% aluminum chloride solution is commonly recommended to reduce sweating. To maximize effectiveness, the antiperspirant should be applied to completely dry feet before bedtime, when sweat glands are less active. Applying it at night allows the active ingredient to form plugs in the sweat ducts, reducing moisture throughout the day.
Essential Foot and Shoe Hygiene
Environmental management of the feet and footwear is paramount for preventing recurrence. After washing, feet must be dried meticulously, paying special attention to the spaces between the toes where moisture is easily trapped. Also, avoid prolonged periods of foot soaking, as this promotes skin maceration.
Choosing the right materials helps actively manage moisture throughout the day. Socks made from moisture-wicking materials like wool or synthetic blends are superior to cotton, which holds sweat against the skin. Changing socks at least once or twice daily, especially after physical activity, helps maintain a dry environment.
Shoe management is also a significant factor in controlling the bacteria’s habitat. Since the inside of shoes retains moisture, it is advisable to rotate shoes daily, allowing each pair 24 to 48 hours to air out and dry completely. For added sanitation, using antibacterial or antifungal sprays inside the shoes can help eliminate residual bacteria and odors.
When Home Treatment Isn’t Enough
While home strategies are effective for mild cases, professional medical guidance may be necessary if the condition persists. If two to three weeks of consistent home treatment, including rigorous hygiene and the use of OTC products, fail to show improvement, a doctor should be consulted.
A medical professional, such as a dermatologist or podiatrist, can confirm the diagnosis and prescribe more potent treatments. This often involves prescription-strength topical antibiotics like clindamycin or erythromycin, which more directly target the Corynebacterium species. They may also consider stronger prescription antiperspirants or other advanced treatments for severe hyperhidrosis.