From the Research
The most effective treatment for pitted keratolysis involves topical antimicrobials and lifestyle modifications, as evidenced by the most recent study in 2023 1.
Treatment Approach
The treatment approach for pitted keratolysis typically involves:
- Topical antibiotics, such as clindamycin 1% solution or erythromycin 2% solution, applied twice daily for 2-4 weeks
- Antiseptics, such as benzoyl peroxide 5-10% gel or wash, used once or twice daily
- Lifestyle modifications, including keeping feet dry, wearing moisture-wicking socks, and using absorbent foot powders
Rationale
The rationale behind this treatment approach is to eliminate the causative bacteria, usually Corynebacterium species, and create an environment unfavorable for bacterial growth. The bacteria produce proteolytic enzymes that digest the stratum corneum, creating the characteristic pits, so controlling moisture and killing the bacteria effectively resolves the condition in most cases.
Additional Considerations
Additional considerations in the treatment of pitted keratolysis include:
- Reducing sweating with antiperspirants containing aluminum chloride applied to the soles
- Allowing shoes to dry completely between wearings
- Using absorbent foot powders containing miconazole or clotrimazole These measures help to create an environment that is unfavorable for bacterial growth and reduce the risk of recurrence.
Evidence-Based Recommendation
Based on the most recent and highest quality study in 2023 1, the use of topical antimicrobials and lifestyle modifications is the most effective treatment approach for pitted keratolysis. This study highlights the importance of lifestyle modifications in the management of pitted keratolysis, and supports the use of topical antimicrobials as a first-line treatment.