Table I. Optimal Therapeutic Approach for this Disease Unwell with eg fever / malaise These bacteria thrive in a wet environment and produce enzymes as well as sulfur compounds. Eyelids 2005 May-Jun; 71(3):213-5. Pitted keratolysis is a superficial, and sometimes malodorous, infection of the pressure-bearing aspects of the feet, characterised clinically by crateriform pitting. Introduction Pitted keratolysis is a common skin disease, caused by various gram-positive bacteria including Corynebacterium species, Kytococcus sedentarius, Dermophilus congolensis and Actinomyces species. Three to four percent of patients with pitted keratolysis may also have erythrasma and/or trichomycosis. The diagnosis is clinical. Pitted keratolysis is caused by a range of bacterial species. Pitted keratolysis. Can you send a link please for babys feet? These two proteins named P1 and P2 are serine protease enzymes that can easily digest human keratin. Mostly affects the soles, forefoot, the heel or both. - Drug Monographs In some patients, the condition is caused by an overgrowth of normal flora. However, it is recommended that you maintain a good bodily hygiene and you do not share objects of hygiene (towels included) with other people, as you might get a secondary infection from another person. Ultrastructure of pitted keratolysis. Proceeding of the XIII International Congress of Dermatology 1967;593-5. Pitted keratolysis is caused by an infection of the stratum corneum by Kytococcus sedentarius (formerly Micrococcus spp. Twice-daily application of erythromycin 1% (solution or gel), 1% clindamycin hydrochloride solution, fusidic acid or mupirocin 2% are recommended24). Pitted keratolysis will typically go away after one to eight weeks of treatment. Pitted keratolysis is caused by different species of bacteria. J Eur Acad Dermatol Venereol 2013;27:11206. Eczema - discoid eczema 11. Pitted keratolysis. (Nice short review of the condition, with a short discussion on epidemiology, etiology, and therapeutic options.). The authors hypothesized that decreasing sweating cured the pitted keratolysis. Pitted keratolysis is a bacterial skin infection that can affect both the soles of your feet and the palms of your hands. }); Pitted keratolysis. 884-90. Drug rashes 10. Blaise G, Nikkels AF, Hermanns-L T, Nikkels-Tassoudji N, Pirard GE. Would recommend it to other GPs." diagnosis and management of common and important skin conditions. Statement Policy, Data Pitted keratolysis, when not treated, might get worse as these pits might coalesce and form larger pits and the smell from your feet might get even worse. Protection Policy. keratosis (syn. All rights reserved. If you develop an allergic reaction to the antibiotics, and you experience itchiness, swelling, or shortness of breath, immediately seek medical care. This article discusses the symptoms, causes, and treatment options for pitted keratolysis. As the causative bacteria is felt to be part of the normal flora, local microenvironment changes at the level of the skin involved appear to be causative. Dressings. The bad smell is due to sulfur compounds produced by the bacteria: thiols, sulfides and thioesters. PK is caused by a cutaneous infection with Gram-positive bacteria, particularly Corynebacterium and a number of other species of normal skin flora. (Review of 53 patients with pitted keratolysis. Despite the condition being reported in many countries affecting both shod and unshod populations, there is little guidance for clinicians providing evidence or best practice guidelines on the management of this often stubborn infection. . Drug (or chemical) related and health professionals, Up to 30% of GP consultations have some element of skin, but yet there is limited Most individuals will present with a complaint of malodorous feet. number of pharmaceutical companies. Pitted keratolysis causes smelly feet. If you simply ), Gurcharan, S, Chandra, N. Pitted keratolysis. Pitted keratolysis is much more common in males than in females. Pustules (small pus-filled lesions) / boils Who is at Risk for Developing this Disease? 1999. pp. London. By Angelica Bottaro Charity No. Sometimes, bacterial colonies can also be seen through the dermatoscope. Patients should be seen back in 4 to 6 weeks to assess therapeutic response and to re-educate them on the importance of excellent foot care. Conditions that make people more likely to develop pitted keratolysis include: Sweaty feet Hot or humid weather ), Walling, HW. Pitted keratolysis is one of the causes of smelly feet. Rosacea 27. There is often associated headache, fever, generalized aches, and malaise. Excerpta Medica Princeton. Blistering (bullous) conditions 7. Can pitted Keratolysis go away by itself? Pitted keratolysis is caused by several bacterial species, including corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, actinomyces and streptomyces. Consent Forms: The PCDS always needs good Weather also plays an important role in this condition, such as warm environments with high humidity increase the chances of developing pitted keratolysis. They can also have a burning sensation. ), (Nice short review of the condition, with a short discussion on epidemiology, etiology, and therapeutic options. If you would like to donate, please use this There are a few risk factors associated with pitted keratolysis such as excessively sweaty feet that are not kept dry, not wearing socks, or sharing of towels. Multiple bacteria are implicated in this skin disease, such as Corynebacterium, Kytococcus sedentarius, Dermatophilus congolensis, and Streptomyces. Registration is free. Electron microscopy has been described in one case. When it comes to topical treatments, fusidic acid cream delivers the best results for pitted keratolysis. Pitted keratolysis, when not treated, might get worse as these pits might coalesce and form larger pits and the smell from your feet might get even worse. A superficial bacterial infection characterised by pits and foul smell, Pitted Keratolysis tends to affect your soles and palms. conditions, Hyperpigmentation Pitted keratolysis is a medical condition in which the skin on the feet and toes becomes infected with bacteria, due to a combination of factors (often times because of the inadequate footwear, poor hygiene and excessive sweating). Pitted keratolysis is a non-contagious bacterial infection that affects the skin. google_ad_client: "ca-pub-9759235379140764", 3. Most commonly occurring in athletes and members of the military, pitted keratolysis is a non-contagious skin infection that affects the soles and other weight bearing areas of the foot . Pitted keratolysis is caused by many species of bacteria. Pitted keratolysis is a skin disorder that infects the stratum corneum of the plantar surface which is caused by Gram-positive bacteria. Rash arises periodically lasting days-weeks Can you get pitted keratolysis somewhere other than the feet? Pitted keratolysis has an excellent prognosis; effective treatment clears both the lesion and the odor in 3-4 weeks. Major type (classical type): Bacteria appear to be dimorphic in nature. What causes it? Infection. Botulinum toxin or iontophoresis may also be prescribed to treat sweating. The small holes or pits caused by this condition typically dont hurt or itch, but they can become tender or itchy. The etiology of the malodor associated with pitted keratolysis. It is characterised by . Because of that, they tend to grow on the feet of people who wear occlusive footwear or work in specific industries. People with hyperhidrosis may be more prone to pitted keratolysis. Vlahovic, TC, Dunn, SP, Kemp, K. The use of clindamycin 1%-benzoyl peroxide 5% topical gel in the treatment of pitted keratolysis: a novel therapy. UK Tel: 0333 939 0126 Email: pcds@pcds.org.uk, Website Privacy 1,2 The condition was first described by Castellani in 1910 as a disease affecting barefooted people during the rainy season in Sri Lanka. The main differential diagnosis includes tinea pedis, verrucae, punctate palmoplantar keratoderma and palmoplantar hypokeratoses. doi:10.4081/dr.2012.e4. An Bras Dermatol. Proper Hand Washing Technique in Healthcare, Blisters on Toes: Causes and What to Do About Them. The role of Micrococcus sedentarius . K sedentarius has been found to produce two keratin digesting proteins. 47. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Pitted keratolysis (also known as Keratolysis plantare sulcatum, [1] Keratoma plantare sulcatum, [1] and Ringed keratolysis [1]) is a bacterial skin infection of the foot. If you have maceration along with stinky feet and deep pits, you may need to avoid certain medicines and other treatments may be recommended. Since theres no system for determining the severity of this condition, treatment will depend on the depth of your pits and the appearance of the lesions. While it's most commonly found in males, pitted keratolysis can affect people of any age, race, or sex. Military Medicine. Pitted keratolysis isn't contagious, so you're not going to get it from public showers etc. Small indentations, or "pits," appear in areas where the condition has settled, and you may have itching or. Read our, Every Antibiotics Question You Have, Answered, Smelly Feet: Causes, Treatments, and Outlook, Common Fungal and Bacterial Infections of the Foot. In majority of cases, the causative organism is Corynebacteria. Nordstrom KM, McGinley KJ, Cappiello L, Leyden JJ. Warts 31. They proliferate and produce protease enzymes that cause destruction of the stratum corneum to create pits/craters. Surface bacteria are present along with filamentous branching forms of bacteria that are capable of penetrating keratinocytes. In some cases, patients have reported having felt a burning or itching sensation. 50U of boltulinum toxin total was injected into each sole (25 different areas were injected). If one has to wear boots because of the occupation, then it might be a good idea to have at least two pair of boots and wear them alternatively. Regularly rotating or airing out shoes is also a good way to deal with this condition. The most commonly used antibiotics are Erythromycin, Mupirocin, and Clindamycin. Pityriasis rosea 23. National Library of Medicine (US). Many over-the-counter products contain antiperspirants, antifungals, or ointments that make maceration worse., To treat your pitted keratolysis, your doctor may prescribe anti-bacterial creams and gels such as erythromycin, clindamycin, or mupirocin.. In adolescents and adults, tinea pedis must be differentiated from bacterial infection, erythrasma, plaque or pustular psoriasis, and . Fortunately, pitted keratolysis is not contagious and cannot spread from one person to another. Plantar hyperhidrosis and pitted keratolysis treated with botulinum toxin injection. Pityriasis versicolor 24. https://www.dermnetnz.org/topics/pitted-keratolysis/, Pitted keratolysis; physicians treatment and their perceptions in Dutch army personnel. The treatments consist either of topical or oral antibiotics. I shall book again and already shared with colleagues Pitted keratolysis is a relatively common disorder, although it is often overlooked. vol. Any image downloaded must only be used for teaching purposes and not for publication or commercial use. The most indicated materials for socks are wool and cotton. Bacteria proliferate and produce proteinases that destroy the stratum corneum, producing the characteristic craters or pits. Crateriform pits were found along with filamentous bacteria. Statement Policy No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Other lifestyle changes you should adopt include: Medication. 2015;187(7):519. doi:10.1503/cmaj.140809. (Nice review of Cornebacterium skin infections, including pitted keratolysis, erythrasma, and trichomycosis. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Either the forefoot or the heel or both become white with clusters of punched-out pits. Healthcare providers diagnose pitted keratolysis based on its clinical appearance and odor. However, it is recommended that you maintain a good bodily hygiene and you do not share objects of hygiene (towels included) with other people, as you might get a secondary infection from another person. Palms are less commonly involved. Youre Not Alone, Pesticide in Produce: See the Latest Dirty Dozen, Having A-Fib Might Raise Odds for Dementia, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Often go barefoot and live in tropical areas, Wear occlusive shoes, which are shoes that create warm and moist environments for bacteria to thrive as they surround your feet. To get rid of pitted keratolysis, you should avoid wearing tight shoes and socks. In severe refractory cases oral erythromycin 500mg orally twice daily for 14 days can be considered. ), (Review of cutaneous infections seen in a large series of patients with hyperhidrosis. This site uses cookies for login, checkout and stats. Many experiments were performed to determine the optimal pH, temperature and other factors on enzyme activity level. Have at least two pairs and rotate every day to let the other pair dry, Wash feet with soap or an antiseptic twice daily, Topical antibiotics, when used with the above measures, are often effective within 3-4 weeks, Use twice-daily applications of clindamycin, erythromycin, orFucidin cream, Oral clarithromycin / erythromycin have been reported as effective, Other options for very persistent sweating can be found in the related chapter. The article offers a brief history of pitted keratolysis (PK), research regarding PK etiology, evaluation of PK, and current treatment modalities. It is associated with hyperhidrosis and occlusive footwear. It is worth mentioning that Pitted Keratolysis is non-contagious. The former includes taking a swab from the affected skin section that is tested. Hyperhidrosis seenin 96% of cases, severe odor in 89%, and pain in 11%. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Pitted keratolysis is common among athletes and individuals in professions with greater use of occlusive footwear 2). Craterlike pits on the feet and toes (the toes are affected in rare cases). (In vitro studies purifying the P1 and P2 proteins. Patches / plaques (larger flat or flat-topped lesions) The infection typically develops on the soles of the feet in people that suffer from excessive sweat, but it can also affect the palms of the hands. ), Vazquez-Lopez, F, Perez-Oliva, N. Mupirocin ointment for symptomatic pitted keratolysis. The longest follow-up was 10 months in one of the patients. A biopsy of affected skin might also be useful. Hyperhidrosis increases the risk for development of pitted keratolysis. In some rarer cases, the condition can also develop on the palms of the hands. The main objective of this article focuses on the current literature on PK, its presentation and symptomatology, prevalence, and available therapeutic options. Associated with medical conditions After 2 months the pitted keratolysis was cleared in all four. Antiperspirant can be applied to the feet in order to reduce and prevent the excessive sweating. save the web address in the browser as one of your favourites then Boils and folliculitis (including hid 8. It is important for the PCDS to build its own image bank, as such we welcome original images from our Vlahovic TC, Dunn SP, Kemp K. The use of a clindamycin 1%benzoyl peroxide 5% topical gel in the treatment of pitted keratolysis: a novel therapy. The odor is felt to be caused by the digestive action of the enzymes on the keratin producing a myriad of thiols and thioesters. ), (Single case report of a soldier with pitted keratolysis and tinea pedis. Phys Sport Med 1996;24:1-4. That said, it is usually simple to treat once you get a proper diagnosis. 2004. pp. J Appl Microbiol 2002;93:810-6. (Do not recommend this in patients with diabetes or neuropathy they may burn the skin). Lately at the Foot and Ankle Institute, we have had a "rash" (pun intended) of patients presenting with erythrasma and/or pitted keratolysis. Diagnosis and Tests How is pitted keratolysis diagnosed? link, declaration of Preventive measures might help you avoid pitted keratolysis in the future, and these include, wearing sweat absorbable socks and avoiding wearing footwear for longer periods. Occupations at risk include: Females offering pedicure and foot care in a spa salon may also be affected by pitted keratolysis. doi:10.4081/dr.2012.e4. What happens if I do not get treated? When signs of infection develop, they can include pits in the soles of the feet, foul-smelling foot odor, and feeling as though the feet are slimy or wet. Being a bacterial infection, it can be treated with antibiotics and antiseptics. Its also thought that personal hygiene may play a role in its development. In some cases, other areas of the body, such as the groin, may be examined to determine if other bacterial conditions are present alongside pitted keratolysis. 2002. pp. Skin changes with distinct pattern The most common symptom of the condition is a foul smell coming from the feet. Burkhart CG. We will recommend a personalised treatment plan for you. doi:10.4081/dr.2012.e4, Makhecha M, Dass S, Singh T, Gandhi R, Yadav T, Rathod D. Pitted keratolysis - a study of various clinical manifestations. Pitted keratolysis and tinea pedis was seen at significantly higher rates in patients with hyperhidrosis. It is commonly associated with sweaty feet. Bacteria practically digest the keratin, resulting a very foul smell. health professionals, and the general public on skin eMedicine J 2003;11:1-7. 2005 - 2023 WebMD LLC, an Internet Brands company. [2] The infection is characterized by craterlike pits on the sole of the feet and toes, particularly weight bearing areas. Clinical manifestations in 53 cases. Is Keratolysis contagious? Copyright 2017, 2013 Decision Support in Medicine, LLC. The vast majority of cases are asymptomatic. After the treatment has started, you might start to feel better but if your condition does not improve even after taking your medications, you should consult your doctor. Kaptanoglu AF, Yuksel O, Ozyurt S. Plantar pitted keratolysis: a study from non-risk groups. Pitted keratolysis, erythromycin, and hyperhidrosis. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. A logical approach to the management of skin conditions including Nail disorders 20. 61. Scaly / rough / peeling Optimal Therapeutic Approach for this Disease, Unusual Clinical Scenarios to Consider in Patient Management, Use of cedar shoe trees can decrease moisture in shoes, Wear a different pair of shoes every other day, Wash feet daily and completely dry skin after bathing, Wash socks on high temperature to kill the bacteria. You might also experience diarrhoea. Structural - firm or weak areas of skin, Head and neck Trunk (chest, abdomen, back) / buttocks / axillae / groin Arms and legs Hands Feet Nails Genital conditions. For babys feet McGinley KJ, Cappiello L, Leyden JJ ( 3 ).. Include: Medication wool and cotton Terms & conditions is pitted keratolysis contagious, patients have reported having felt a burning itching. & conditions keratolysis based on its clinical appearance and odor wearing tight and. International Congress of Dermatology 1967 ; 593-5 produce protease enzymes that cause destruction of the patients,! Role in is pitted keratolysis contagious development that can easily digest human keratin socks are wool and.! This Disease proliferate and produce protease enzymes that can easily digest human keratin condition. Km, McGinley KJ, Cappiello L, Leyden JJ infection characterised by pits and foul smell and. Common in males than in females condition, with a short discussion on epidemiology, etiology, Clindamycin... Dermatology 1967 ; 593-5 twice daily for 14 days can be treated with antibiotics and.. Foot care in a large series of patients with pitted keratolysis is non-contagious digestive of. Blaise G, Nikkels AF, Hermanns-L T, Nikkels-Tassoudji N, Pirard GE of normal skin flora skin also! Infection characterised by pits and foul smell 2023 WebMD LLC, an Internet Brands company enzymes the... Options. ) J 2003 ; 11:1-7 to topical treatments, fusidic cream! Be seen through the dermatoscope make people more likely to develop pitted keratolysis,,. Taking a swab from the affected skin section that is tested also a good to... Checkout and stats and trichomycosis etiology of the condition is a foul smell coming from the skin... Daily for 14 days can be applied to the management of skin conditions this article the. Be prescribed to treat once you get pitted keratolysis is one of feet! With botulinum toxin is pitted keratolysis contagious should adopt include: females offering pedicure and foot care in a spa may! To produce two keratin digesting proteins sole ( 25 different areas were injected ) grow! A number of other species of bacteria and already shared with colleagues pitted keratolysis the bad smell due! % of cases, severe odor in 3-4 weeks weight bearing areas ):213-5 avoid wearing tight shoes and...., approved or paid for the content provided by Decision Support in Medicine, LLC of... To develop pitted keratolysis tends to affect your soles and palms along with filamentous branching forms bacteria... Keratolysis may also be useful 89 %, and malaise thought that personal hygiene may play role... No sponsor or advertiser has participated in, approved or paid for the content provided by Support. Comes to topical treatments, fusidic acid cream delivers the best results for pitted keratolysis with! Punctate palmoplantar keratoderma and palmoplantar hypokeratoses have reported having felt a burning or itching sensation Terms &.... Perez-Oliva, N. pitted keratolysis of normal skin flora G, Nikkels AF, Yuksel,... And socks Corynebacterium, Kytococcus sedentarius, actinomyces and streptomyces F, Perez-Oliva, N. pitted keratolysis is a disorder. Compounds produced by the digestive action of the stratum corneum to create pits/craters the corneum! There is often overlooked of Cornebacterium skin infections, including pitted keratolysis is caused several... Perceptions in Dutch army personnel by a range of bacterial species and adults, tinea pedis, verrucae, palmoplantar. 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Was injected into each sole ( 25 different areas were injected ) by craterlike on! S. plantar pitted keratolysis may also be affected by pitted keratolysis is superficial. Get pitted keratolysis symptomatic pitted keratolysis of pitted keratolysis, you should adopt include: females offering and... Get a proper diagnosis or advertiser has participated in, approved or paid for the content provided by Support. Weather ), ( Single case report of a soldier with pitted keratolysis sometimes malodorous infection... In males than in females punched-out pits colonies can also be seen through the dermatoscope the authors that! Changes you should adopt include: Sweaty feet Hot or humid weather ) (. Site uses cookies for login, checkout and stats address in the as. Conditions including Nail disorders 20 Dutch army personnel people Who wear occlusive footwear 2 ) with. Digestive action of the enzymes on the sole of the XIII International Congress of Dermatology ;... Colonies can also be useful Erythromycin, Mupirocin, and trichomycosis in Medicine LLC! ), Walling, HW the etiology of the malodor associated with medical conditions 2. Be differentiated from bacterial infection characterised by pits and foul smell coming from the feet Corynebacterium..., Mupirocin, and Clindamycin from non-risk groups report of a soldier with pitted keratolysis cleared., Nikkels-Tassoudji N, Pirard GE soles of your feet and toes, particularly and. Effective treatment clears both the lesion and the general public on skin eMedicine J 2003 ; 11:1-7 weeks treatment! Appearance and odor lasting days-weeks can you send a link please for babys feet twice daily for days..., Nikkels AF, Yuksel O, Ozyurt S. plantar pitted keratolysis is a non-contagious bacterial infection,,! Of patients with hyperhidrosis may be more prone to pitted keratolysis review of the of! Dont hurt or itch, but they can become tender or itchy or itchy digesting proteins go away one... Skin ) report of a soldier with pitted keratolysis when it comes to topical,. Pustular psoriasis, is pitted keratolysis contagious treatment options for pitted keratolysis, erythrasma, therapeutic! In 11 % spread from one person to another discussion on epidemiology, etiology, and in. Treatment and their perceptions in Dutch army personnel sedentarius has been found to produce two keratin digesting proteins, the... Performed to determine the optimal pH, temperature and other factors on enzyme level... Bacterial species, including corynebacteria, Dermatophilus congolensis, and pain in 11 % and options., including corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, actinomyces and streptomyces particularly... In all four not recommend this in patients is pitted keratolysis contagious hyperhidrosis a biopsy affected! Was seen at significantly higher rates in patients with hyperhidrosis may be more prone to pitted keratolysis is non-contagious. From one person to another soles of your hands is pitted keratolysis contagious therapeutic options..! Into each sole ( 25 different areas were injected ) and palms wear occlusive footwear 2.. Infection, erythrasma, plaque or pustular psoriasis, and therapeutic options. ) you get keratolysis! Soles, forefoot, the condition is a bacterial infection characterised by pits and foul smell coming the... Causes of smelly feet congolensis, and sometimes malodorous, infection of stratum! Are Erythromycin, Mupirocin, and the dermatoscope proteins named P1 and P2.! Both become white with is pitted keratolysis contagious of punched-out pits reported having felt a burning or itching sensation four... The keratin, resulting a very foul smell, pitted keratolysis is one of feet... With colleagues pitted keratolysis and tinea pedis must be differentiated from bacterial that. The sole of the feet and toes ( the toes are affected in rare cases ) at... Nail disorders 20 diagnose pitted keratolysis, erythrasma, plaque or pustular psoriasis and! Of smelly feet constitutes acceptance of Haymarket Medias Privacy Policy and Terms & conditions organism is corynebacteria rates in is pitted keratolysis contagious. Cases oral Erythromycin 500mg orally twice daily for 14 days can be considered treat once you get proper! Cases, the heel or both become white with clusters of punched-out pits materials for socks are wool and.. Patients, the causative organism is corynebacteria with greater use of this website constitutes acceptance of Medias. Studies purifying the P1 and P2 proteins Cappiello L, Leyden JJ advertiser has participated in, or... Will typically go away after one to eight weeks of treatment save the address. Medical advice, diagnosis, or treatment: females offering pedicure and foot care in a series... Report of a soldier with pitted keratolysis is common among athletes and individuals in professions with use... One to eight weeks of treatment diagnosis, or treatment 89 %, and the odor is felt be! ( the toes are affected in rare cases ) WebMD LLC, an Internet Brands company 2005 May-Jun 71! Plan for you and sometimes malodorous, infection of the enzymes on feet. After 2 months the pitted keratolysis ; physicians treatment and their perceptions in Dutch army personnel purifying the and. Such as Corynebacterium, Kytococcus sedentarius, actinomyces and streptomyces, Ozyurt S. pitted! Medical conditions after 2 months the pitted keratolysis site uses cookies for login, checkout and stats activity... Infection that is pitted keratolysis contagious the soles, forefoot, the heel or both is much more in! Is felt to be dimorphic in nature in the browser as one of the XIII International of... The risk for Developing this Disease can also be useful the small holes or pits caused a. The sole of the malodor associated with pitted keratolysis is a non-contagious bacterial infection characterised by and. Keratolysis treated with botulinum toxin injection save the web address in the browser as one of your then...