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Pitted keratolysis

Benjamin Barankin, MD, FRCPC
Alexander KC Leung, MBBS, FRCPC, FRCP (UK & Ireland), FRCPCH, FAAP
Section Editor
Ted Rosen, MD
Deputy Editor
Abena O Ofori, MD


Pitted keratolysis (also known as keratolysis sulcata, keratolysis plantare sulcatum, and ringed keratolysis) is a superficial bacterial skin infection confined to the stratum corneum. Clinically, pitted keratolysis is characterized by malodor and multifocal, discrete, superficial crateriform pits and superficial erosions primarily affecting pressure-bearing areas of the plantar surface of the feet (picture 1A-D). Topical antibiotic therapy usually leads to resolution of the disease.

The clinical features, diagnosis, and management of pitted keratolysis will be reviewed here.


Pitted keratolysis has a worldwide distribution but occurs most frequently in tropical and temperate regions with high humidity levels [1]. The disorder is not uncommon; in a mass examination of 4325 Korean industrial workers in 1981, 1.5 percent had pitted keratolysis [2]. In another study, 18 (2.6 percent) of 682 students (aged 14 to 25 years) from two Turkish boarding schools had pitted keratolysis [3]. There is no racial predilection [4-6].

Pitted keratolysis is most common in the age group of 21 to 30 years, with approximately 80 to 96 percent of affected patients between 10 and 40 years of age [7,8]. The male to female ratio is approximately 4:1 [8,9]. Presumably, the male predominance is due to more frequent use of occlusive footwear among males and females' better foot hygiene [8,10-12].

Occupations at risk include athletes, industrial workers, miners, farmers, marine workers, and military personnel [13-15]. Predisposing factors include hyperhidrosis, prolonged use of occlusive footwear such as vinyl shoes or rubber boots, thickened skin of soles and palms, increased skin surface pH, hot and humid weather, poor foot hygiene, obesity, diabetes mellitus, and immunodeficiency [11,16,17].

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Literature review current through: Oct 2017. | This topic last updated: Mar 21, 2017.
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