Pitted Keratolysis Treatment & Management

Updated: Sep 17, 2020
  • Author: Linda J Fromm, MD, MA, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Medical Care

Although no studies are published on hygiene, several protective measures for preventing pitted keratolysis have been recommended over time. Limit the use of occlusive footwear and reduce foot friction by wearing properly fitted footwear. Absorbent cotton socks must be changed frequently to prevent excessive foot moisture. Wool socks tend to whisk moisture away from the skin and may be helpful. In 2008, Blaise et al recommended that affected patients should wash their socks at a temperature of 60ºC to kill the Corynebacterium that may be transferred to the socks from skin scaling. In some cases, reducing any associated hyperhidrosis with the application of a roll-on antiperspirant, 20% aluminum chloride solution, may be helpful. [41]

The treatment of pitted keratolysis also lacks evidence-based studies; however, historically, dermatologists find that topical antibiotics are effective, even if the recommendations presented above are not followed. Topical antibiotics are certainly easy to use and are well accepted by patients. Twice-daily applications of erythromycin, clindamycin, or fusidic acid are effective. [29, 34, 42, 43] The combination topical gel of clindamycin 1%–benzoyl peroxide 5% has been found effective in 4 patients, but efficacy required the concurrent use of aluminum chloride hexahydrate solution. [38] Either solutions or gel formulations may be used. Topical mupirocin (Bactroban) also has been effective. [44, 45] A study of physicians treating Dutch army personnel concluded that preventive measures, topical antibiotic therapy, and adequate treatment of hyperhidrosis are the mainstay methods in the management of patients with pitted keratolysis. [46, 47]  Other data suggest benzoyl peroxide alone can be effective. [48]

For cases resistant to topical antibiotic treatments and/or associated with hyperhidrosis, the use of botulinum toxin injections has been effective. [49] The use of oral erythromycin was reported by Zaias in 1982 based on personal observation. Effective treatment of pitted keratolysis clears both the lesions and odor in 3-4 weeks.


Long-Term Monitoring

Instruct patients with pitted keratolysis to return to the clinic if therapy is unsuccessful. Otherwise, care for pitted keratolysis proceeds on an as-needed basis.