Health guide · Podiatry
Pitted keratolysis: causes, treatment and home care
What pitted keratolysis is, why it makes feet smell, whether it’s contagious, and how to treat it at home or with a doctor so it doesn’t come back.
The short answer
Pitted keratolysis is a harmless but smelly bacterial infection of the soles. Bacteria that thrive on sweaty, damp feet eat tiny pits into the thick outer layer of skin, usually on the heels and balls of the feet, and give off a strong odor. It isn’t considered contagious.
With treatment it usually clears in 2 to 4 weeks. The mainstays are a benzoyl peroxide wash or gel, or a prescription antibiotic gel such as clindamycin or erythromycin, plus keeping your feet dry. See a podiatrist or dermatologist if it doesn’t improve, if the skin is sore or cracked, or if you have diabetes.
Want it checked? Find an Evolve Health podiatrist near you
This guide is for general information and is not a diagnosis. Some services may not be offered at every office; your provider will go over your treatment options at your appointment.
What is pitted keratolysis?
Pitted keratolysis is a bacterial infection of the stratum corneum, the thick, tough outer layer of skin on the soles of your feet. The bacteria responsible, such as Kytococcus sedentarius and Corynebacterium species, normally live on the skin without causing trouble. When your feet stay sweaty and damp for hours at a time, they multiply and do two things:
- They release enzymes that break down the skin, leaving clusters of small pits, like tiny craters.
- They produce sulfur compounds, which cause a strong, unpleasant smell.
It’s not dangerous and it only affects the surface of the skin, but the odor can be embarrassing, and it tends to come back unless you deal with the sweat as well as the bacteria.
Pitted keratolysis symptoms
- Clusters of small pits, usually 1 to 3 millimeters across, on the parts of the sole that take your weight: the heel, the ball of the foot and under the toes. Pits can join up into larger, shallow craters.
- Pits that show up most when the skin is wet, for example after a shower or a day in boots, when the skin looks white and soggy.
- A strong foot odor that doesn’t go away with ordinary washing.
- Very sweaty feet, and sometimes a slippery or sticky feel.
Most people have no pain. Some notice itching, or soreness when walking on the affected areas.
Who gets pitted keratolysis?
Anyone whose feet stay damp for long periods can get it. It’s more common in:
- people who sweat heavily (hyperhidrosis)
- people who wear boots or closed, non-breathable shoes all day, such as military personnel, industrial workers, farmers and fishermen
- athletes, especially those who train in the same damp shoes
- people living in hot, humid places, including much of Florida and Texas
- men, and people with diabetes or excess weight
Is pitted keratolysis contagious?
It isn’t considered contagious. The bacteria that cause it live on most people’s skin already, and the problem comes from moisture that lets them overgrow, not from catching it from someone else. It’s still sensible not to share shoes, socks or towels, since those can hold both bacteria and fungus.
Pitted keratolysis or athlete’s foot?
The two are easy to mix up, and you can have both at once:
| Feature | Pitted keratolysis | Athlete’s foot |
|---|---|---|
| Cause | Bacteria | Fungus |
| Where | Heels, balls of the feet, under the toes | Between the toes, soles, sides of the feet |
| What you see | Clusters of tiny pits, clearest when the skin is wet | Peeling, cracking, redness or small blisters |
| Smell | Strong odor is typical | Can smell, but less typical |
| Itch | Usually little or none | Usually itchy |
| Treatment | Benzoyl peroxide or antibiotic gel, plus sweat control | Antifungal cream |
An antifungal cream won’t clear pitted keratolysis, and an antibiotic gel won’t clear athlete’s foot. If you’re not sure which you have, a doctor can usually tell by looking, and can scrape a little skin to check for fungus. Our guide to athlete’s foot creams covers the fungal side.
Pitted keratolysis treatment at home
Mild pitted keratolysis often improves with home care. Work on the bacteria and the moisture together:
- Wash with benzoyl peroxide. Once or twice a day, wash your soles with a benzoyl peroxide wash, sold over the counter for acne, or apply a thin layer of benzoyl peroxide gel to the pitted areas. It kills the bacteria. It also bleaches fabric, so use white towels and socks.
- Dry your feet completely, including between the toes, before putting on socks.
- Use antiperspirant on your soles. An antiperspirant containing aluminum chloride, applied to clean, completely dry feet at bedtime, cuts down sweating. Wash it off in the morning. Stop if it stings or irritates.
- Change your socks at least once a day, or whenever they get damp. Moisture-wicking athletic socks or wool-blend socks keep skin drier than socks that stay damp all day.
- Rotate your shoes so each pair dries out for at least a day between wears. Take insoles out to dry, and use an absorbent foot powder in shoes.
- Go barefoot or wear sandals at home when you can, to let your feet air out.
Give it 2 to 4 weeks. If it isn’t clearly better by then, see a doctor.
What about vinegar or bleach soaks?
Diluted vinegar soaks are sometimes suggested, but there’s little evidence they help, and long soaks leave skin soggier. Bleach should not be used on your skin at home. If you have diabetes, numb feet or poor circulation, skip foot soaks altogether and see a podiatrist instead.
Medical treatment for pitted keratolysis
If home care hasn’t worked, or the pits are widespread or sore, a podiatrist or dermatologist may prescribe:
- An antibiotic gel, cream or solution, such as clindamycin, erythromycin or mupirocin, usually applied twice a day. Some products combine clindamycin with benzoyl peroxide.
- Antibiotic tablets, such as erythromycin, occasionally, for severe cases that don’t respond to treatment on the skin.
- Treatment for heavy sweating, such as prescription-strength aluminum chloride, iontophoresis (a device that passes a mild electrical current through water to reduce sweating), or botulinum toxin (Botox) injections for severe cases.
A doctor can usually diagnose pitted keratolysis by looking at your feet, and sometimes takes a skin scraping to rule out fungus.
How long does pitted keratolysis take to heal?
With treatment, the smell often improves within days and the pits usually clear in 2 to 4 weeks as new skin replaces the damaged layer. It comes back easily if your feet go back to being sweaty and closed in all day, so keep up the prevention habits below once it has cleared.
How to prevent pitted keratolysis from coming back
- Wash your feet every day and dry them thoroughly.
- Keep using an antiperspirant on your soles a few nights a week if you sweat heavily.
- Change your socks at least once a day, and carry a spare pair on long or hot days.
- Rotate your shoes and let them dry out between wears.
- Choose breathable shoes where you can, and take boots off during breaks.
- Don’t share shoes, socks or towels.
If sweaty feet also itch at night, our guide to itchy feet at night covers other causes and quick relief.
When to see a doctor about pitted keratolysis
Get seen promptly if:
- the skin is cracked, red, swollen, hot or oozing, which can mean a secondary infection
- you have diabetes, neuropathy or poor circulation, even if it looks mild
Book a visit if:
- it hasn’t improved after 2 to 4 weeks of home care
- it keeps coming back
- walking is sore
- you’re not sure whether it’s pitted keratolysis or athlete’s foot
- heavy sweating is affecting your daily life, since there are effective treatments for it
If you have diabetes, check your feet every day and have any change in the skin of your soles looked at, because small breaks in the skin can lead to serious infections. Learn more about diabetic foot care and our guide to diabetic foot check-ups.
Next step
Start with a benzoyl peroxide wash, a bedtime antiperspirant and dry socks, and give it a few weeks. If the pits and smell don’t clear, a podiatrist can confirm the diagnosis and prescribe an antibiotic gel or treatment for heavy sweating. You can find a podiatrist near you or see all our locations, and book online.
Questions, answered
It’s caused by bacteria that normally live on the skin, such as Kytococcus and Corynebacterium. When feet stay sweaty and damp for long periods, these bacteria multiply and release enzymes that eat small pits into the thick outer layer of skin on the soles. Heavy sweating and closed, non-breathable shoes are the main triggers.
It isn’t considered contagious. The bacteria that cause it live on most people’s skin, and the problem comes from moisture that lets them overgrow. It’s still sensible not to share shoes, socks or towels.
Wash your feet once or twice a day with a benzoyl peroxide wash, or apply a benzoyl peroxide gel, and dry them thoroughly. Use a strong antiperspirant on your soles at bedtime, change into clean, dry socks at least once a day, and rotate your shoes so they dry out. If it hasn’t improved in 2 to 4 weeks, see a doctor for a prescription antibiotic gel.
The fastest results come from treating the bacteria and the sweat together: a prescription antibiotic gel such as clindamycin or erythromycin, or benzoyl peroxide, plus an antiperspirant on the soles and dry socks and shoes. The smell often improves within days, and most cases clear within 2 to 4 weeks.
It can settle if your feet stay dry for long enough, for example when you switch from boots to sandals. But while your feet keep sweating in closed shoes, it usually lingers or comes back. Treatment plus better sweat control clears it faster.
Very strong foot odor that soap doesn’t fix is often caused by bacteria growing in sweaty skin, and pitted keratolysis is a common reason. Check your soles for clusters of tiny pits, especially when the skin is wet. Benzoyl peroxide, antiperspirant, dry socks and rotating shoes usually help.
No. Pitted keratolysis is a bacterial infection that causes tiny pits and a strong smell on the soles, usually with little itching. Athlete’s foot is a fungal infection that causes itching, peeling and cracking, often between the toes. You can have both at once, and they need different treatments.
Choose moisture-wicking athletic socks or wool-blend socks and change them at least once a day, or whenever they get damp. Wear breathable shoes, alternate between pairs so each dries out for a day, and wear sandals when you can. Boots and rubber shoes worn all day make it worse.
This guide is for general education and doesn’t replace advice from your own doctor. Everyone’s situation is different, so talk to a healthcare provider about symptoms that are new, getting worse or worrying you. If you think you may have a medical emergency, call 911. Reading this guide doesn’t make you a patient of Evolve Health.
Want a specialist to take a look?
A guide can explain, but it can’t examine you. Evolve Health providers see patients across Florida and Texas, and you can book online any time.
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