Treatment for Pitted Keratolysis

Pitted keratolysis often exhibits spontaneous episodes of exacerbations and remissions, and the condition can last for many years if left untreated. Effective treatment of this disorder requires the removal of the moist and warm environment that promotes the growth of bacteria.

Pitted keratolysis treatment is generally quite simple and straight forward. The initial step is of course to treat any co-existing excessive sweating in the palms or soles, also called palmoplantar hyperhidrosis. Sometimes such common sense steps as thorough foot drying and ventilation are enough to clear up the infection. In most cases, a course of topical fusidic acid ointment over two to three weeks is sufficient to clear up the condition. In recurrent or severe cases, a two-week course of oral erythromycin or azithromycin should clear up even the most stubborn lesions completely. Topical clotrimazole is also commonly used to eradicate pitted keratolysis.

An over the counter pitting keratolysis remedy many sufferers swear by is applying acne medication containing 10 percent benzoyl peroxide to the area of infection.

Your health care provider may also recommend a prescription-strength antiperspirant containing aluminum chloride to address any excessive sweating issues. In rare and severe cases of this disease, your physician may suggestion treatment with injections of botulinum toxin.

Did your health care provider prescribe something different? Let us know in the comments!

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- Comments -

  • Becky johndon

    I am 37 & have had this since I was 15-I just didn’t know what it was. Went to podiatrist.She prescribed topical clindomycin gel 1%,Hypercare brand 20% FATaluminum chloride hexahydrste solution for the hyperhidrosis on my feet-nystatin for fungal involvement (she wanted to prescribe something else but insurance wouldn’t pay, & she prescribed oral eurythromycin, but YET AGAIN, the insurance refused & instead I took Ciproflaxin for 10 days. Well, because I am applying clyndomicin every day and it is killing most of the bacteria, the horrible smell is almost completely gone, and I’ve been using the Hypercare nightly for a month–I seem to nONeed to keep using it every day.put on at night & cover w socks-well my feet barely sweat at all anymore. My socks used to reek at the end of the day (& my shoes) but they r completely dry at the end of the day. Great, right? Well, NO bc I’ve been doing this for o ctetbahet ,ver two months & tha weee underlying Pitted Keratylosis has NOT gone away. The second I stop the topical antibiotics the bacteria is going to flower again & the stench will be back- plus the PK looks Gross. What else can my podiatrist & I try? She was even mystified that it was refusing to go away-standard & even aggressive treatment & it is NOT working. Help? Ideas? Experiences? Desperate here…

  • Findlay

    I have this problem and the doctor gave me permi tabs ( potassium permanganate PB) the dont seem to be working. Is there any home remidies? I have used 2 tea bags in a tub of water to keep the smell away. The acid in the tea keeps the smell away.

  • Nelida

    My son get this Pitted Keratolysis in Cuba when he was 9 years old. It was cured with acyclovir cream and the injuries disappeared for 5 years(well I’m not sure now but I can confirm later) Now he start with the smell and having this injuries again. I will try clindamycin and cleaning the area with some acne medication. If you know anything better, please let me know. thanks for your story.

  • andy

    I i have had this condition for 30 years finally doctor referred me to a dermatologist who recommended potassium permanganate crystals a few of the crystals in a bowl of water to get a rose wine colour … soak your feet for a bout 15 mins every other day to begin then every other week allow your feet to air dry before putting socks back on or walking … beware the stuff stains so be careful with carpets etc .. got to say it really works well no more problems .. they use it in the army for soldiers with sweaty feet

  • Applied and tested treatment: Apply [tea tree oil]-(not to be confused with tea oil) to the affected area. I have done so and watched my mild form of this fungus disappear. Forget soaking feet in vinegar and tea and all that stuff (which I found to be pretty intrusive of my time and space), although you could still do that also, as I used all forms as well as applying the [TEA-TREE OIL]. Apply once every morning after shower and dried feet and again at night after shower for bed. Also wear cotton socks and stay away from polyester…Good LUCK! Now all i have left is to find how to remove a wart from my toe and I’m all cool. Any suggestions?

    Backstory:
    Hello All. I had this [Pitted Keratolysis] condition unknown to me for quite some time(a year?) until one day when my mum was visiting and we were over by a friend where I took my shoes off. She pointed out to me that my feet stunk really bad. I knew that my feet stunk for some time but didn’t know it was to some abnormal level until it was further pointed out to me. there I took my socks off and discovered that my toes were abnormally sweaty and a bad odor emitted from them. I further looked and saw what is now known to me as Keratolysis. I have tried applying stuff such as [Lamsil] (which treats athletes foot) as well as periodically soaking my feet in hot water along with stuff added to that water…I really didn’t like soaking because it took so much preparation, time and space which had to be done daily. The Lamsil seemed to work but i carried on applying it for months and no change! then I finally said this was not working so well, and did further research and found [Tea tree oil](not to be confused with tea oil) to be very effective! try it, it worked for me!

    • Daniel

      I’m going to try the tea-tree oil for sure. For wart removal, if its in a fairly east to get at location, the best thing I’ve ever found was the grey or silver duct/duck tape. Just wrap the area with the wart really well so that the tape won’t come off and leave it there for a week or so. Important thing is to not remove it or quickly reapply it if it comes off. I got rid of two warts with duct tape after trying various pharmacy treatments. Works like magic. The surrounding skin will be in pretty rough shape when the tape comes off, waterlogged and soggy, but the wart will just fall right off when the tape has been on long enough. At least a week, maybe two if you can keep it up, and the wart will just shrivel and fall off.

  • Twisty

    I’ve had this for years and have finally figured out what it is. This weekend I began treating my feet with the 10% benzoyl peroxide acne cream, but I’m having an issue. the infected areas have become overly tender and it’s now painful to walk. It doesn’t matter what kind of shoes I’m wearing, whether I wear socks, or if I’m barefoot. Any pressure placed on the pitted areas causes pain. Is this normal? I can’t find any information to help relieve my pain.

    • Twisty

      Well, doesn’t matter now. I have a coworker going to school for nursing and she’s seen PK before. She looked at my feet and told me I needed to go to the doctor. She said the infection was deep under the skin and that I needed an oral antibiotic. I’m now on Amoxicillin for 7 days and mupirocin ointment 2-3 times a day until empty. we’ll see how it goes. He’d never heard of it before and wanted to say it looked like a weird case of plantar warts but when I showed him pictures of PK, he agreed with my coworker’s assessment.

      • brian

        I used to have it as bad as you where it hurt to walk sometimes. I just went to the dermatologist and they prescribed me a topical treatment i put on 2 times a day and it cleared up within a month. i forget the name of the prescription. I believe it was clindamycin. works like a charm. i highly recommend it.

        • sophie

          hello. I have suffered with this for a few years and am in the process of getting my sweat glands removed via private healthcare. this is all well and good but the infection is still there I have ordered Clindamycin Gel 10g online as my doctor ‘cant’ prescribe it. How long did you need to use it before it was effective and should I continue to use it. Also can I use it on my hands as the infection has spread there too.

      • Alex

        Try drysol I’m in the army got it really bad in Afghanistan drysol
        And letting ur feet be uncovered for like two days helps alot
        But u need the antibiotic to kill it

  • Bob

    Hi all
    I had pitted keratolysis for about 20 years and after trying to find a cure had pretty much given up. All I read online was going from ‘ there is no cure just wear sandals’ to ‘ soak feet in tea’ . Neither was promising….

    I gave it one more try and went to a dermatologist here in Japan who ( after prescribing various creams which I knew wouldn’t help as moisture was an issue) finally prescribed me ‘FLOMOX’ ( as the drug is named in Japan). Active ingredient :

    Cefcapene pivoxil hydrochloride hydrate.

    30 days later the symptoms are gone. I’m not saying it will work the same for everyone but talk to your doctor about this ingredients as it worked for me. Remember** Flomox is the name in Japan ** which your doctor probably won’t know which is why I included the name of the active ingredients. Don’t give up trying to cure it! 20 years of embarrassing symptoms gone in 30 days with no follow up treatment required. And if you’re wondering I didn’t need to change any habits such as drying shoes outside every night or throwing away all my (possibly infected) socks etc.

  • diamondflamer

    Does anyone here have experience of using clotrimazole cream as a treatment? I am giving it a try. I’ve had this PK for a couple of years now, but always pretty mild until recently when, due to a foot injury, I can only wear a couple of pairs of shoes in my collection and they’re not the kind I can wear with socks. I just read here about clotrimazole as an effective treatment and happened to have some cream containing it already so thought I would give it go twice a day and try my best not to wear shoes as much as possible. I am going to try treating my shoes with tea tree oil to kill any of the bacteria in them so it doesn’t transfer back to my skin. I will report back.

  • josh

    Hello,
    my dermatologist told me to use this mixture:

    acid salicyl 10.0 g
    isopropanol 70% isopropanol ad 100.0 g

    It was about 5-6 euros in the pharmacy.

    My expirience is:
    Bad smell vanishes immediately.
    Dead skin will peel off.
    After initial success (using it daily for about 2 weeks)
    I use it 2 or 3 times about every 2 months.

    Be careful: wash hands thoroughly. If not, skin there may peel off too.
    Use it on your own risk.
    greetings, josh

  • ben

    I use a benzoyil acne wash in y feet than I let dry and use a pumice stone to smooth it out but it still comes back. Idk what to do anymore please help!

    Bennyryan35@gmail.com

  • Jim Campbell

    I’ve had this off and on since I was a kid. A couple of practices have helped to clear it up for me.

    1) wash feet with soap 2x a day. Really lather your feet up, and wash each foot at least 1x for at least 30 seconds.
    2) Apply a topical antibiotic at least 1x a day. I use clindamycin phosphate gel (1%)
    3) Wear cotton or wool socks and get out of your shoes when you can.
    4) Apply benzoyl peroxide cream at night.

    Stay with this for at least a month. PK won’t go away easily. Stay with it!

  • Eddie

    I have been having trouble with this evil little annoyance for the past four years. I visited a number of G.P.s who could not identify this skin disorder and went down the route of regular shoe and sock changes, rigorous drying and going without shoes as much as possible. None of these ideas had the slightest effect.

    Recently I visited another doctor and she instantly identified Keratolysis Pitting and prescribed clindamycin in a topical anti-biotic lotion form. The effects were startling. Noticeable after one day and all symptoms cleared within a week. I would definitely endorse the treatment – you get to keep all your shoes too!!

  • Put coconut oil (virgin) on your feet every night

  • Junior

    Hi I think I must have had the worst of this infection possible ( just wish I,d have taken photos of it 2 weeks ago) I work as a driver and must wear safety boots all day long so what I done was brought an extra pair of socks to work with me and purchased a bottle of bacteria killer, the stuff you put on your hands when going into the hospital and nursing homes etc half way threw the day, of with the socks apply the bacteria cleaner and don’t hold back.then when I got home washed the feet right away with anti_bacterial soap and nail brush thourghly dry,then more bacteria killer and don’t hold back, a couple of hours later more bacteria killer then before going to bed wash feet again with the soap dry thourghly and more bacteria killer , get up in the morning apply more bacteria killer then do this as often as possible and so on 2 weeks later I,m not fully cured but by god I can now walk on my feet and my feet are starting to look and feel great again . Hope this helps some one out there.

  • Michael

    I had suffered with this for 10 years. Came out of the blue, I ignored it but was very obvious on my heels when wet, and my feet definitely smelled more when sweating. I went to my GP in the UK and mentioned fuscidic acid but she instead prescribed Trimovate Cream ( which contains clobetasone butyrate, calcium oxytetracycline and nystatin) which she thought would work better being both anti fungal and bacterial in the one cream.

    This stuff smells horrible but within two weeks of daily applications it is completely gone. I didn’t even need to rub my heels down with a pumice stone/ ped egg and now my heels are smooth and don’t smell.

    I came back to this site as I had previously looked for help to find what was going on with my feet and after ten years had just given up hope, but it’s been about 3 months since it’s cleared up and no return issues even with plenty of running and exercise.

    Good luck everyone, M

  • Ava McI

    I didn’t know what the heck was going on! My feet sweat a lot but I hadn’t noticed much of an odor, just an itchy, burning, scaly, patchy, weird looking and painful area on my foot and in between my toes. I treated it for athlete’s foot for over two weeks with little relief. Went to the primary care doctor who diagnosed this condition. He prescribed an oral antibiotic called Erythromycin. He also told me to use an antibiotic cream such as neosporin. Be warned about the prescription medication though…it’s not cheap. Another thing I did was soak my foot in Listerine. It’s a germ killing antiseptic that’s cheap and soothing to my foot.

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