Pitted Keratolysis (+ Foot Sweating): Treatment at Home!

Pitted Keratolysis and Excessive Sweating: What Are They?

Plantar hyperhidrosis is more simply known as excessive foot sweating. This condition affects about 3% of the population.

Pitted keratolysis is a skin issue that occurs on the soles of the feet.

It resembles athlete’s foot. In fact, it is caused by a bacterium known as Corynebacterium.

The texture of the skin on the feet changes, becoming softer. Often, there is a foul odor emanating from the feet.

Why discuss both excessive sweating and pitted keratolysis?

Simply because these two skin problems are often linked. Excessive sweating increases the risk of developing pitted keratolysis because sweat promotes the growth of bacteria on the skin.

Wearing closed, non-breathable shoes throughout the day while being active is also a factor that can cause pitted keratolysis. The bacteria responsible for pitted keratolysis thrive in the moisture created by sweating.

Therefore, athletes are also more prone to it.

Can treating one of these foot skin issues help with the other? That’s what we’re going to explore.

Pitted Keratolysis of the Feet: Treatment

There are three main types of solutions offered for pitted keratolysis:

1. Medical treatments: application of creams on the feet.
2. Lifestyle adjustments.
3. Home remedies and other “natural” treatments (it’s a big debate on what exactly qualifies as “natural”!).

Medical Treatment: Cream Application

A commonly used treatment for pitted keratolysis is the local application of erythromycin. Erythrogel is one of its brand names.

It is an antibiotic applied in cream form directly to the skin on the feet. It is available by prescription and is often given to treat acne on the face.

Sometimes, dermatologists also prescribe over-the-counter antiperspirants containing alcohol and aluminum chloride for patients with pitted keratolysis. In some cases, glycopyrrolate is also recommended (Kontochristopoulos 2019).

These antiperspirants are often used by people suffering from excessive sweating of the feet and underarms.

Frequency of Application: Typically, the antibiotic gel is applied twice a day, in the morning and evening. However, it’s important to follow your doctor’s specific prescription.

Duration of Treatment: The duration of treatment will depend on the severity of pitted keratolysis and how your skin responds to the treatment. Typical treatments usually last from a few days to a few weeks.

Usage Instructions: To use the antibiotic gel correctly, follow these instructions:

1. Thoroughly wash and dry your feet before applying the gel.
2. Apply a thin layer of the gel to the affected areas, focusing on the areas with pitted keratolysis.
3. Gently massage the gel to ensure it penetrates the skin.
4. Avoid covering your feet immediately after application to allow the gel to dry.
5. Wash your hands thoroughly after application, unless your hands are also part of the areas to be treated.
6. Follow the recommended application frequency from your doctor, typically twice a day.
7. If you experience irritation or an allergic reaction, discontinue use immediately and consult your doctor.

Lifestyle Adjustments

Here are some tips to take care of your feet and help treat this problem:

1. Keep your feet clean and dry: Wash your feet daily with lukewarm water and mild soap. Make sure to dry them thoroughly, especially between the toes, as moisture promotes the proliferation of bacteria responsible for pitted keratolysis.
2. Wear breathable shoes: Opt for leather or canvas shoes that allow your feet to breathe. Avoid synthetic shoes that trap moisture.
3. Change your socks regularly: Wear clean socks every day, and if you sweat a lot from your feet, change them during the day if necessary.
4. Use absorbent insoles: You can insert special insoles into your shoes to absorb excess moisture.
5. Avoid tight shoes: Choose shoes that fit properly and do not compress your feet.
6. Air out your shoes: After wearing them, let your shoes air out to eliminate residual moisture.
7. Use antifungal powders (see on Amazon): You can sprinkle antifungal powder on your feet before putting on your socks to help prevent infections.
8. Avoid walking barefoot in public places: Locations like pools, locker rooms, and public showers are places where bacteria can thrive. Always wear shoes or sandals to avoid direct contact.

By following these lifestyle tips, you can often effectively control and prevent pitted keratolysis.

However, sometimes, despite doing everything right, the condition may not improve!

Home remedies for Pitted Keratolysis?

There is a lot of information on the internet about home remedies for various skin problems. Personally, even though I would like these easy-to-implement remedies to work, there is nothing to suggest that they do.

I have never directly encountered anyone who described these methods as being truly effective for them.

And no studies are aimed at evaluating their effectiveness.

They don’t really rely on a solid theoretical basis (issue of concentration of applied substances to penetrate the thick skin of the feet).

Nevertheless, I will list the natural treatments that are most commonly mentioned on both English and French websites for pitted keratolysis.

1. Apple Cider Vinegar Foot Soaks: Add apple cider vinegar to lukewarm water and soak your feet in this mixture for 15 to 20 minutes. Apple cider vinegar is often used for its antibacterial and antifungal properties.
2. Coconut Oil: Some people have applied virgin coconut oil to the affected areas to help moisturize the skin and prevent dryness.
3. Baking Soda: Baking soda mixed with lukewarm water can be used to gently exfoliate the skin. Be sure not to scrub too hard, as it could worsen the condition.
4. Aloe Vera: Aloe vera gel can be applied to the skin for its soothing properties. Make sure to use pure aloe vera gel and not products containing additives.
5. Tea Tree Essential Oil: Tea tree oil is known for its antifungal properties. You can dilute a few drops of tea tree essential oil in a carrier oil (like olive oil) and apply it to the skin. However, be sure to do a patch test beforehand to avoid any irritation.

Is Pitted Keratolysis Linked to Foot Sweating?

A study in Italy aimed to precisely determine the link between these two foot skin problems.

All patients with pitted keratolysis seen at Sant’Andrea Hospital between January 2009 and December 2011 were pre-selected. Pitted keratolysis was diagnosed clinically and microscopically.

All patients were treated only with a locally applied gel containing 3% erythromycin to be applied twice a day.

At the beginning of the study and after 5 and 10 days of treatment, a clinical evaluation and a measurement of plantar sweating were performed. 97 patients were diagnosed with pitted keratolysis and included in the study.

The measurements showed that, at the time of diagnosis, in 94 out of the 97 examined patients (90%), there was excessive sweating on the area affected by pitted keratolysis.

After 10 days of antibiotic therapy, excessive foot sweating decreased along with other clinical signs.

Can Excessive Sweating be Stopped by Treating Pitted Keratolysis?

The researchers of the study suggest that hyperhidrosis in these patients is due to hyperfunction of a sweat gland, probably caused by a bacterial infection.

So, bacteria are responsible for both pitted keratolysis and hyperhidrosis. In these patients, foot hyperhidrosis can be stopped by treating pitted keratolysis since the bacteria are eradicated.

However, not everyone with excessive foot sweating necessarily has pitted keratolysis.

For those without pitted keratolysis, there is no need to apply antibiotics to the soles of the feet. It is better to turn to the application of antiperspirants or undergo iontophoresis sessions.

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Do you have any comments or questions? Your comments are welcome 🙂 !

You may also like:

• My blog on hyperhidrosis

 📚 SOURCES

Pranteda et al., 2014, Pitted keratolysis, erythromycin, and hyperhidrosis [Kératolyse ponctuée, erythromycine et hyperhidrose]

Sil A, Bhanja DB. Pitted Keratolysis. Indian Pediatr. 2020 Sep 15;57(9):875. PMID: 32999128.

Pattanaprichakul P, Kulthanan K, Bunyaratavej S, Eimpunth S, Rungruang T, Chanyachailert P, Ongsri P, Patthamalai P, Munprom K, Leeyaphan C. The Correlations between Clinical Features, Dermoscopic and Histopathological Findings, and Treatment Outcomes of Patients with Pitted Keratolysis. Biomed Res Int. 2021 Oct 25;2021:3416643. doi: 10.1155/2021/3416643. PMID: 34734082; PMCID: PMC8560252.

Palaniappan V, Murthy AB, Karthikeyan K. Pitted keratolysis. Clin Exp Dermatol. 2023 Aug 25;48(9):978-983. doi: 10.1093/ced/llad175. PMID: 37151115.