SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences

Information for Patients

View all Images (24)

Pitted keratolysis in Adult
Other Resources UpToDate PubMed

Pitted keratolysis in Adult

Contributors: Daniel Gutierrez MD, Noah Craft MD, PhD, Lindy P. Fox MD, Susan Burgin MD
Other Resources UpToDate PubMed


Pitted keratolysis (also known as keratoma plantare sulcatum and ringed keratolysis) is a noninflammatory bacterial infection of the plantar stratum corneum caused by any of the following bacteria: Kytococcus sedentarius (formerly Micrococcus sedentarius), Dermatophilus congolensis, or species of Corynebacterium or Actinomyces.

Affected areas are generally asymptomatic but can emit a foul odor due to the production of isovaleric acid by the bacterial metabolism of the leucine in sweat. Rarely, pruritus, pain, or burning may be present. Predisposing factors are excessive sweating and prolonged occlusion in a warm, humid environment. Although rare, the hands may be affected.


L08.89 – Other specified local infections of the skin and subcutaneous tissue

51212009 – Pitted keratolysis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Tinea pedis – Usually scaly and erythematous. Hyphal elements can be demonstrated using a potassium hydroxide (KOH) preparation.
  • Tinea nigra – Presents with a black pigmented patch.
  • Dyshidrotic eczema – Presents with pruritus, scale, and pinpoint vesicles on the palms, soles, and lateral digits.
  • Subacute and chronic hand and foot eczema, including nummular and contact dermatitis.
  • Punctate keratoderma – Has firm keratotic papules.
  • Webspace erythrasma – Typically hyperkeratotic but can be erosive. This shows coral-red fluorescence on Wood's lamp examination. Concomitant erythrasma and pitted keratolysis may be seen. 
  • Mosaic warts – Show more vascularity and sometimes the black dots of thrombosed capillaries. 
  • Arsenic toxicity – Pitting is associated with the other features of arsenism such as teardrop pigmentation.
  • Nevoid basal cell carcinoma syndrome (Gorlin syndrome) – Palmoplantar pits can be seen but usually in the presence of other stigmata of the condition, including odontogenic keratocysts and numerous basal cell carcinomas, among other findings.

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required


Subscription Required

Last Reviewed:10/28/2019
Last Updated:12/05/2019
Copyright © 2023 VisualDx®. All rights reserved.
Patient Information for Pitted keratolysis in Adult
Print E-Mail Images (24)
Contributors: Medical staff writer


Pitted keratolysis is a skin condition affecting the soles of the feet and, less commonly, the palms of the hands. It is caused by a bacterial infection of the skin and may give off an unpleasant odor.

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. Athletes and military personnel tend to develop this condition most commonly. Conditions that make people more likely to develop pitted keratolysis include:
  • Sweaty feet
  • Hot or humid weather
  • Unventilated (occlusive) footwear, such as rubber boots or vinyl shoes

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

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

When to Seek Medical Care

If attempts to minimize moisture do not improve the condition, make an appointment with a dermatologist or another physician.


In addition to recommending the above steps to minimize moisture, a physician may try the following:
  • 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
  • Injections of botulinum toxin (in severe cases)
With some combination of these treatments, the skin lesions and odor of pitted keratolysis usually disappear within 4 weeks.


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

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1875-1876. New York: McGraw-Hill, 2003.
Copyright © 2023 VisualDx®. All rights reserved.
Pitted keratolysis in Adult
A medical illustration showing key findings of Pitted keratolysis : Macerated skin, Pits, Hyperhidrosis, Plantar foot
Clinical image of Pitted keratolysis - imageId=230692. Click to open in gallery.  caption: 'Multiple tiny keratin pits on the heel.'
Multiple tiny keratin pits on the heel.
Copyright © 2023 VisualDx®. All rights reserved.