In everyday language, pitted keratolysis is known as moon foot. It is a skin condition found predominantly on the feet and characterised by small, round, pitted lesions. Pitted keratolysis is caused by bacteria that have grown out of control and have formed a mass of tissue, which has created the holes in the skin. The over-moistening of the skin and high areas of friction are main causes of pitted keratolysis. It can be exacerbated by failure to clean the feet adequately, by wearing tight footwear, and by being in wet environments (Bristow and Lee, 2014).
Pitted keratolysis is a skin infection that causes crater-like depressions to appear on the bottom of the feet. Most people with pitted keratolysis complain of foul odor from their feet as well as foot pain. Patients typically describe a painful sensation while walking and difficulty putting on shoes. The symptoms of pitted keratolysis can have a profound, negative impact on a person’s life. For example, a person with pitted keratolysis may avoid activities such as going to the beach or pool track out of embarrassment to show the soles of their feet. Patients with pitted keratolysis may also feel self-conscious of the smell of their feet and withdraw from social interactions (Van der Snoek et al., 2013).
Topical antibiotics are commonly prescribed for the treatment of pitted keratolysis. Mupirocin ointment can effectively treat the skin lesions of the feet and help control bacterial spread. In addition to treating the infection, good foot hygiene practices need to be adopted, such as washing the feet daily and drying them thoroughly. It is also recommended for patients with pitted keratolysis to wear more breathable and better ventilated shoes (Greywal and Cohen, 2015; Sical and Chang, 2024).
After treatment for pitted keratolysis, it is possible for the condition to come back. This can happen because of the foot environment (too wet or moisturous) or patient behavior (wearing occlusive (waterproof) shoes. Once pitted keratolysis is treated, the patient must be taught and reminded to keep their feet dry and clean, preventing a recurrence of the condition. Measures to Prevent Pitted Keratolysis Patients with pitted keratolysis must make sure to prevent the recurrence of this condition. Wearing of suitable footwear that breathes and allows the feet to dry out completely is fundamental. If the patient wears synthetic materials or tight fitting shoes, they can encourage moisture build-up which encourages bacterial growth and pitted keratolysis. Choosing moisture-wicking socks is important in preventing this condition as well.
In addition to these measures, maintaining proper foot hygiene is crucial. Clean and dry the feet daily with soap and water, paying special attention to area between the toes where moisture may accumulate. Trim and clean the toenails regularly to prevent bacteria and fungal growth. Check for any cracks or blisters in the skin that could provide an entry point for infections and treat any minor injuries as needed.
In hot and humid climates it is particularly important that your feet remain dry. Using a foot powder will help to keep your feet drier. Many people have sweating feet, in which case using an antiperspirant for your feet may also be worth trying as part of the treatment of pitted keratolysis.
awareness is key to educating both patients and healthcare professionals regarding pitted keratolysis. Learning the manifestations and signs and symptoms of pitted keratolysis is critical for effective diagnosis and timely treatment, preventing progression to more severe stages of disease and restoring patients’ quality of life. To foster greater education and understanding of pitted keratolysis, ISTMA worldwide affiliates are sponsoring awareness campaigns and master workshops.
We want to let you know that pitted keratolysis, or “athletes foot of the foot,” can have some very real psychological effects. Many people suffering from pitted keratolysis feel embarrassed and anxious about the appearance of their feet and the awful odor that may emanate from them. This can keep people from social activities such as going to pools or beaches out of fear someone will notice their feet. By educating our patients and the public about pitted keratolysis we can make it easier for people to come in and address their symptoms with a healthcare provider before the issue becomes severe and harder to treat.
It’s also important to be aware of the psychological and emotional effects of pitted keratolysis. While no two people will experience all the same effects, many are significantly affected by the condition. Sometimes simply discussing issues of this sort in a support group or with a professional counselor can help individuals come to terms with what has happened, quiet fears, and move on with life. Thus, a full appreciation of the effects of pitted keratolysis requires a consideration of both physical and psychological effects, and exploration of measures to prevent, treat, and manage the condition.
Citations:
Bristow, I.R. and Lee, Y.L.H., 2014. Pitted keratolysis: a clinical review. Journal of the American Podiatric Medical Association, 104(2), pp.177-182. https://japmaonline.org/view/journals/apms/104/2/0003-0538-104.2.177.xml
Makhecha, M., Dass, S., Singh, T., Gandhi, R., Yadav, T. and Rathod, D., 2017. Pitted keratolysis–a study of various clinical manifestations. International Journal of Dermatology, 56(11), pp.1154-1160. https://onlinelibrary.wiley.com/doi/abs/10.1111/ijd.13744
Van der Snoek, E.M., Ekkelenkamp, M.B. and Suykerbuyk, J.C.C.W., 2013. Pitted keratolysis; physicians’ treatment and their perceptions in Dutch army personnel. Journal of the European Academy of Dermatology and Venereology, 27(9), pp.1120-1126. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1468-3083.2012.04674.x
Sical, S. and Chang, P., 2024. Pitted keratolysis. Our Dermatology Online/Nasza Dermatologia Online, 15(4). https://www.odermatol.com/odermatology/20244/27.Pitted-SicalS.pdf
Palaniappan, V., Murthy, A.B. and Karthikeyan, K., 2023. Pitted keratolysis. Clinical and experimental dermatology, 48(9), pp.978-983. https://academic.oup.com/ced/article-abstract/48/9/978/7156630
Greywal, T. and Cohen, P.R., 2015. Pitted keratolysis: successful management with mupirocin 2% ointment monotherapy. Dermatology Online Journal, 21(8). https://escholarship.org/uc/item/6155v9wk
Tirado-Sánchez, A., Bonifaz, A. and Gallegos-Ramos, A., 2025. Pitted keratolysis. A systematic review of published cases and a proposed therapeutic algorithm. Journal of Comprehensive Dermatology, 1. https://jcderma.com/pitted-keratolysis-a-systematic-review-of-published-cases-and-a-proposed-therapeutic-algorithm/
Pattanaprichakul, P., Kulthanan, K., Bunyaratavej, S., Eimpunth, S., Rungruang, T., Chanyachailert, P., Ongsri, P., Patthamalai, P., Munprom, K. and Leeyaphan, C., 2021. The correlations between clinical features, dermoscopic and histopathological findings, and treatment outcomes of patients with pitted keratolysis. BioMed Research International, 2021(1), p.3416643. https://onlinelibrary.wiley.com/doi/abs/10.1155/2021/3416643
Kaptanoglu, A.F., Yuksel, O. and Ozyurt, S., 2012. Plantar pitted keratolysis: a study from non-risk groups. Dermatology reports, 4(1), p.e4. https://pmc.ncbi.nlm.nih.gov/articles/PMC4212664/
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