We all know that sometimes, after wearing shoes all day, you get a slight smell of sweat from your feet when you come home and take them off. It's normal. But don't you think that for some people, this is more than just a smell of sweat, it's a bit annoying? Yes, sometimes
an unbearable smell from your feet, along with
the formation of small pits on the soles of your feet, especially on the heels and between the toes, and sometimes accompanied by
itching , could be a symptom of a skin condition called Pitted Keratolysis. Although the name may sound like a big deal,
don't be afraid . Let's talk about this simply, in a way that you can understand.
What exactly is Pitted Keratolysis?
Simply put, Pitted Keratolysis is
an infection of our skin, especially the feet, caused by several types of bacteria . What happens in this is that, as I mentioned earlier, small holes or pits form in some places on the soles of your feet. Not only that, it can also be accompanied by a very unpleasant odor. Sometimes it can also be itchy. This condition is most common
in people who sweat a lot on their feet and wear occlusive footwear that does not allow much air to pass through . Imagine, someone who works in rubber boots all day, or someone who wears tight shoes with synthetic socks that do not allow any air to pass through. The feet of such people sweat and that moisture is trapped inside the shoes, creating the perfect environment for bacteria to grow.
Who is more likely to develop this condition (Pitted Keratolysis)?
Actually, this can happen to anyone. However, it has been found that men are slightly more at risk. Also, there are some factors that can affect the occurrence of this condition. Let's see what they are:
- Wearing tight shoes and socks: The risk is higher if you wear shoes and socks that don't allow air to circulate and that constrict your feet.
- Excessive sweating (Hyperhidrosis): Some people sweat more than normal. In medical terms, this is called ``Hyperhidrosis''. These people are also at high risk of developing Pitted Keratolysis.
- Living in a hot or tropical climate: People living in hot and humid countries like Sri Lanka are more likely to face this problem.
- Engaging in certain jobs: This is common in people who work outdoors and use their legs for most of the day. For example:
- Military officers (because they wear boots all day)
- Athletes (due to sweating during training and competitions)
- Farmers (when working in the fields, plantations)
- Factory workers (especially those who work wearing safety shoes)
- Workers in the construction sector
- Those serving in the security forces
What are the symptoms of Pitted Keratolysis?
If you suspect you have this condition, be aware of these symptoms.
- Bad smell from the feet (Bromhidrosis): This is the main symptom and the first symptom that many people notice. It is not just a smell of sweat, but a more pungent, unpleasant odor . Doctors also call this `(Bromhidrosis)`.
- A white patch on the skin or a spot that is lighter than the natural skin color: Some areas of the underarms may appear white or discolored.
- Small pits or holes in the skin: As I mentioned earlier, small holes in the skin appear, as if someone has carefully dug them. These pits can join together and form a large crater-like lesion .
- Itching of the affected skin: Some people scratch the areas where these pits form.
- Symptoms become more visible when the skin is wet: These pits and white spots become more visible when the feet are in water or when they are wet from sweat.
These symptoms are usually seen
on the soles of the feet, especially the heels, balls of the feet, and web spaces between the toes . Very rarely, the palms of the hands can also be affected.
Why does this (Pitted Keratolysis) occur? What is the cause?
The main cause of this is
a bacterial infection . Yes, a type of microscopic organism that we cannot see with our eyes. There are several main types of bacteria that can cause this:
- `(Actinomyces)`
- `(Corynebacteria)`
- `(Dermatophilus congolensis)`
- `(Kytococcus sedentarius)`
- `(Streptomyces)`
These bacteria
love warm and humid environments . That's why these bacteria grow quickly when you wear tight shoes and sweat on your feet. Now you might be wondering why these pits form on your skin. The reason for this is
an enzyme called `(protease enzyme)` produced by these bacteria. This enzyme destroys the top layer of dead cells of our skin, that is, `(stratum corneum)`. That's when those little pits form.
The reason for that bad smell is that these bacteria release sulfur compounds. Those sulfur compounds have that unpleasant smell.
Is Pitted Keratolysis contagious?
No, Pitted Keratolysis is not a contagious disease. This means that you cannot spread it to anyone else. So there is no need to worry about it.
How does a doctor diagnose this?
When you see a doctor with these symptoms, they will take your complete medical history and examine your feet. They may ask about the type of shoes and socks you wear, and when you first noticed the symptoms. Pitted Keratolysis often doesn't require any special tests because its appearance is so obvious. However, sometimes your doctor may do some tests to check for other skin conditions that may be similar.
- (Culture test): This involves taking a small sample (either with a swab or a small scraping of skin) from the affected area of your skin and identifying the type of bacteria present.
- (Skin biopsy): This involves taking a very small piece of skin and examining it under a microscope. However, this is not necessary in most cases.
What are the treatments for this?
The main goal of treating Pitted Keratolysis is
to eliminate the bacterial infection . To do this, your doctor will prescribe topical antibiotics. These can come in the form of a cream or lotion. Some examples are:
- `( Clindamycin )`
- `(Erythromycin)`
- `(Fusidic acid)`
- `(Mupirocin)`
Also, you may be asked to use gels or creams containing antiseptics like benzoyl peroxide. These can help control the infection. If you have a condition called hyperhidrosis that I mentioned earlier that causes excessive sweating, your doctor will also prescribe treatment for that. Because if you don't control your sweating, there is a high chance that Pitted Keratolysis will recur.
The most important thing is that this condition rarely resolves on its own without medical advice. So, be sure to see a doctor and get treatment.
Are there any side effects of the treatment?
Some side effects can occur when using antibiotics. Not everyone gets them, but it's good to be aware of them.
Therefore,
before starting any treatment, don't forget to talk to your doctor about side effects and the medications you are currently taking. Are there any remedies that can be done at home?
It's a little dangerous to put things on your skin without consulting a doctor.. Some people use natural oils like tea tree oil. If you're thinking about doing this, be sure to ask your doctor first.
Never apply bleach or apple cider vinegar directly to your skin, hoping it will remove the odor. However, you can keep your feet clean by soaking them in a solution of hydrogen peroxide. Remember, you should mix
one part hydrogen peroxide to three parts warm water . Soak your feet in this solution for a few minutes, then use a pumice stone to remove the dead skin.
How soon will I feel better after starting treatment?
When you start taking an antibiotic, it starts to kill bacteria in your body.
You will usually start to feel better within two to three days . If your symptoms don't improve after taking the medicine for about a week, see your doctor again.
How to prevent pitted keratolysis?
To avoid this annoying situation, keep these things in mind:
- Wear shoes that are well ventilated. Avoid rubber boots as much as possible.
- Wear dry shoes every day. If you wear the same pair of shoes every day, let one dry before putting on the other.
- Choose shoes and socks that fit your feet well and are not tight.
- After taking off your shoes and socks, wash your hands and feet thoroughly with soap.
- Change your shoes and socks immediately if they get wet.
- It is best to use cotton socks, as socks made of synthetic materials restrict air circulation.
What should someone with Pitted Keratolysis expect?
The main thing that causes your feet to smell bad is Pitted Keratolysis. After spending all day in your shoes, your shoes, socks, and feet can smell really bad. If you wash your feet, change your socks, and shoes, and the smell persists, it could be a sign of Pitted Keratolysis. If you have these little pits and this smell, you should definitely see a doctor. Antibiotics can cure this. If you work on your feet all day, it is very important to choose shoes that are well ventilated.
When should you see a doctor?
If your symptoms do not improve after a week of taking antibiotics, see your doctor. Also, if you have an allergic reaction to antibiotics, this means:
- Severe itching
- Skin swelling
- Skin rash or hives
- Difficulty breathing
If you experience symptoms like this
, go to a hospital immediately. What questions should you ask your doctor?
When you go to see the doctor, it will be helpful for you to ask these questions:
- What is the best type of shoe for me to wear?
- What should I do to prevent this situation from happening again?
- What are the side effects of this treatment?
- How many times a day should I apply topical antibiotics to my skin, and how?
- Will this medicine cause problems with other medicines I am currently taking?
How does Trypophobia affect the diagnosis of Pitted Keratolysis?
Some people have
a fear of seeing patterns with lots of holes . This is called `(Trypophobia)`. So, when you see those small holes that form on the soles of your feet in (Pitted Keratolysis), it can affect a person with this `(Trypophobia)` mentally, causing fear and discomfort. If you have such a condition, tell your doctor about your fear along with the symptoms of (Pitted Keratolysis). Then, when the doctor treats the bacterial infection that causes those holes, your fear will also decrease.
What is the difference between (Pitted Keratolysis) and (Athlete's Foot)?
Pitted Keratolysis and Athlete's Foot are both conditions that affect the feet.
- (Pitted Keratolysis): This is a bacterial infection. The main symptoms are the formation of small pits with a bad odor and itching.
- Athlete's Foot: This is a fungal infection . It is contagious. The main symptom is an itchy rash on the legs.
Finally, things to remember (Take-Home Message)
Pitted Keratolysis is a bacterial infection that can cause your feet to smell bad. If you have these symptoms even after washing them at the end of the day, it could be a sign of Pitted Keratolysis. If you have these symptoms,
don't be embarrassed or afraid to see a doctor . He or she can prescribe the right treatment for you and get rid of this infection from your body. To prevent this bacteria from coming back,
change your shoes and socks as soon as they get wet, wear well-ventilated shoes, and always keep your feet clean and dry. If you follow these simple steps, you can easily avoid this annoying condition.
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