What Causes Pitted Keratolysis?

Moisture softens the outer layer of the sole and makes it easier for certain bacteria to multiply. These bacteria produce substances that break down small areas of the surface keratin, leaving shallow crater-like pits. The soles may look whitish after being wet, and a strong odor can occur because of bacterial by-products. Sweaty feet, tight or non-breathable footwear, long shifts in enclosed shoes and shared damp environments can all support the process.

The pits are usually superficial, but the appearance can resemble other foot problems. Cracking, pain, spreading redness or deeper sores suggest that another issue may be present or that the skin barrier is significantly irritated.

Wash the feet and dry carefully between the toes and across the soles. Change damp socks, rotate shoes so they can dry fully, choose breathable footwear when possible and use a foot antiperspirant if a clinician considers it suitable. Avoid sharing towels or footwear. Medical treatment may include a topical antibacterial medicine, with the choice guided by an examination and the condition of the skin. Keeping sweating under control helps reduce recurrence after treatment.

Arrange an assessment if odor and pits persist despite keeping the feet dry, or if the diagnosis is uncertain. Seek prompt care for increasing pain, warmth, swelling, pus, spreading redness, fever or difficulty walking. People with diabetes, reduced circulation or a weakened immune system should have foot changes assessed earlier because minor skin problems can become more serious.

Ask whether the pits fit pitted keratolysis, how to manage sweating, which topical treatment is appropriate, and how to prevent the problem from returning in work shoes or sports footwear.