Pitted Keratolysis Diagnosis
In most cases, the classic appearance and presentation of the pitted lesions and white spots on the feet is proof enough to confidently diagnose pitted keratolysis. There is also the distinctive and unpleasant smell that this disorder is associated with. If there is any doubt, gram's staining of the scraping, along with a culture of the scraped material, can aid in reaching a definitive diagnosis.
It is necessary to differentiate between pitted keratolysis and plantar warts or athlete's foot. Plantar warts typically present with localized areas of hyperkeratosis, which is thickening of the outer layer of the skin, and are very often painful. Athlete's foot presents with itching between the toes not limited to pressure-bearing areas of the foot.