Pitted Keratolysis

It is a superficial, localized, non-contagious bacterial infection of the foot skin. It most commonly affects the soles and the pads of the toes. This condition often occurs alongside excessive foot sweating (hyperhidrosis) and prolonged wearing of non-breathable footwear.

What does pitted keratolysis look like?

The changes appear as:

• small depressions or “holes” in the skin (as if hollowed out)
• whitish or grayish spots
• softened, moist skin
• a characteristic sharp and unpleasant odor

The skin changes on the feet are not painful but may cause burning sensations and discomfort while walking.

Causes

The main cause is bacteria that release enzymes breaking down keratin – the protein forming the outer layer of skin. Infection occurs especially when:

• the feet remain constantly moist (excessive sweating)
• non-breathable shoes are worn
• there is a lack of proper daily foot hygiene or infrequent changing of socks

Foot care recommendations:

1. Apply antiperspirant once a day for at least 2 weeks.
2. Wash feet daily and dry them thoroughly, especially between the toes.
3. Use antibacterial and antifungal substances (thyme, sage, rosemary in the form of herbal foot salts or application of Microdacyn 60).
4. Frequently 'air out' the feet and walk barefoot or wear cotton socks or silver-ion socks.
5. Wear breathable shoes and avoid staying in wet footwear.
6. Use anti-inflammatory agents (zinc oxide, potassium permanganate).
7. Probiotic sprays, soaps, or foams to restore healthy foot microbiome (Pharmaceris A, Tołpa physio microbiome, Pedi Pro, Podopharm).
8. Wash socks at 60°C or replace them entirely.
9. Recommended professional foot care at the clinic – once a month.