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Pitted keratolysis: causes and treatment, bulk billed

Small pits in the soles plus a strong odour usually mean pitted keratolysis, a bacterial infection often mistaken for tinea. Bulk billed with no out-of-pocket costs if you're Medicare eligible: a NewDoc GP can diagnose it from photos or video and prescribe treatment where appropriate.

Can a telehealth GP treat pitted keratolysis?

Yes. Pitted keratolysis is a bacterial infection of the outer skin of the soles, not a fungus, and its appearance is distinctive: clusters of small pits on the pressure areas of the feet plus a strong odour. An AHPRA-registered GP at NewDoc can usually diagnose it from clear photos or a video consultation, prescribe a topical antibiotic where appropriate, and help you get on top of the sweating that drives it.

Most cases improve within 2 to 4 weeks of treatment combined with drier feet: rotating footwear, changing socks daily, and using an antiperspirant on the soles. See a GP in person promptly if the skin becomes hot, swollen, or painful, or you develop a fever, as that suggests a deeper infection.

Quick answer: what pitted keratolysis is and how it is treated

Pitted keratolysis is a bacterial infection of the soles that causes clusters of small pits in the skin and a strong foot odour. It is not a fungus, so antifungal creams do not clear it. It develops when bacteria overgrow on feet kept warm, damp, and enclosed for long hours, which is why it is common in tradies, athletes, and defence personnel. Per DermNet, treatment is a topical antibiotic combined with keeping the feet dry, and most cases clear within a few weeks. The consult and any eScript are $0 out-of-pocket, bulk billed, for eligible Medicare cardholders, median 5.0 hours booking-to-consult per NewDoc April 2026 utilisation data.

What is pitted keratolysis?

Pitted keratolysis is a skin infection of the soles of the feet, and occasionally the palms, caused by bacteria rather than a fungus. DermNet describes it as a superficial bacterial skin infection characterised by crater-like pits and malodour. Several bacteria can be responsible, including Corynebacterium species, Kytococcus sedentarius, and Dermatophilus congolensis. These organisms produce enzymes that digest keratin, the protein that makes up the outer layer of the skin, which is what carves out the characteristic small pits.

The same bacteria release sulfur compounds as they grow, producing the strong odour that most people notice before they ever look closely at their soles. The infection sits in the outermost layer of skin only: it does not spread deeper or into the blood, and it is more embarrassing than dangerous. It is, however, persistent until the conditions that caused it change, and it responds well to the right treatment.

Symptoms of pitted keratolysis

Typical features include:

  • Clusters of small, shallow pits in the skin of the soles, usually 1 to 3 mm across, which can join together into larger crater-like areas
  • Pits concentrated on the pressure-bearing areas: the heel, the ball of the foot, and the pads of the toes
  • A strong, unpleasant odour, often the first thing people notice
  • A white, damp, soggy appearance of the affected skin, with the pits usually easier to see after the feet have been wet
  • Little or no pain in most cases, though some people notice itching, burning, or tenderness when walking

Symptoms tend to build gradually over weeks to months rather than appearing overnight. Many people put up with the odour for a long time, assuming they simply have smelly feet or a stubborn case of tinea, before the pits are recognised for what they are. Persistently smelly feet that do not improve with washing and fresh socks are a good reason to look closely at the soles.

What causes it, and who gets it?

The bacteria involved live harmlessly on many people's skin. Problems start when feet are kept warm, damp, and enclosed for long stretches, which lets the bacteria multiply far beyond normal levels. The classic recipe is sweaty feet inside occlusive footwear, day after day. People at higher risk include:

  • Tradespeople and labourers, in steel-capped or safety boots for long shifts
  • Athletes and gym-goers, in sports shoes that stay damp between sessions
  • Defence force members, police, and security staff, in boots for extended duties
  • Farmers and outdoor workers, particularly in gumboots or waterproof footwear
  • Anyone with naturally sweaty feet (hyperhidrosis), whatever their footwear

Hot, humid weather makes all of this worse, and wearing the same pair of shoes every day without letting them dry out is one of the most consistent triggers. Because sweat is the engine of the problem, treatment that ignores the sweating usually fails.

Not a fungus: pitted keratolysis vs tinea

Pitted keratolysis is one of the most commonly misdiagnosed foot conditions, because almost everyone's first assumption about smelly, damp-looking feet is tinea (athlete's foot). The two are different conditions with different treatments:

  • Tinea is fungal. It typically causes itchy, scaly, peeling skin, often starting between the toes, and it responds to antifungal creams.
  • Pitted keratolysis is bacterial. It causes pits on the pressure areas of the soles and a much stronger odour, and antifungal creams do nothing for it.

Weeks of failed antifungal treatment is a very common part of the story by the time people see a GP. The two conditions can also occur together on the same foot, in which case both need treating.

Other conditions can be mistaken for pitted keratolysis too. Plantar warts cause discrete rough lumps rather than clusters of shallow pits, hard skin and calluses lack the odour, and dermatitis such as eczema tends to itch and crack rather than pit. If your feet do not match the classic picture, a GP can work through the alternatives; our conditions library covers many of them.

When to see a doctor, and when to seek in-person care

Pitted keratolysis itself is not dangerous, and a telehealth consultation is usually the easiest way to get it diagnosed and treated. Book a GP if the pits or odour are persisting despite good foot hygiene, if you are not sure whether it is tinea or something else, or if it is affecting your work or confidence.

See a GP in person the same day, or attend an emergency department, if you develop any of the following, which point to a deeper skin infection such as cellulitis rather than pitted keratolysis:

  • Spreading redness, warmth, or swelling of the foot
  • Increasing pain, rather than the usual painless pits
  • Fever, chills, or feeling generally unwell
  • Pus, ulcers, or broken skin that is worsening

If you have diabetes, treat any foot skin problem with a lower threshold for review: foot infections can escalate faster and matter more. Mention your diabetes when you book so the GP can factor it in, and expect to be directed to in-person care earlier if there is any doubt.

How a telehealth GP can help with pitted keratolysis

Pitted keratolysis is one of the skin conditions best suited to telehealth, because the diagnosis rests on the appearance of the soles and the story behind it, both of which come across well on photos or video. A NewDoc GP can:

  • Confirm the diagnosis from clear photos or a video consultation, and distinguish it from tinea, warts, and dermatitis
  • Send an eScript for a topical antibiotic to your phone where treatment is appropriate
  • Advise on sweat management, including prescription-strength antiperspirant options for the soles where suitable
  • Arrange skin scrapings through a pathology lab if the diagnosis is unclear, and treat any co-existing tinea
  • Tell you clearly if anything about your feet needs an in-person examination instead

In guideline terms, first-line treatment is a topical antibiotic such as clindamycin or fusidic acid applied to the affected skin, with the choice, strength, and duration decided by your GP based on your skin and history. Antibacterial washes such as benzoyl peroxide are sometimes added. Oral antibiotics are rarely needed. For eligible Medicare cardholders the telehealth consultation is bulk billed, with no out-of-pocket cost for the appointment.

Treating sweaty feet: the other half of the cure

Antibiotics clear the bacteria, but if your feet stay damp all day the problem tends to return. Managing the moisture is just as important as the prescription:

  • Wash your feet daily and dry them thoroughly, including between the toes
  • Change socks at least once a day, and mid-shift if they are damp
  • Choose moisture-wicking socks (wool or technical fibres) over plain cotton
  • Rotate footwear so each pair gets a full 24 to 48 hours to dry out; avoid wearing the same boots two days running
  • Apply an antiperspirant to clean, dry soles; regular underarm products work
  • Go barefoot or wear open footwear at home to air your feet

For heavy sweating that does not respond to over-the-counter antiperspirants, stronger clinical-strength products containing aluminium chloride are available, and a GP can talk through further prescription options for hyperhidrosis where suitable. Healthdirect Australia has more on excessive sweating and when it is worth medical review.

These same steps are the prevention plan once the infection has cleared. Most people who keep their footwear rotated and their feet dry do not see the pits return, and if they do, earlier treatment means a faster clear-up.

References

This content is informational and does not replace individual medical advice. For personal assessment, book a consultation with your GP. In emergencies, call 000.

Reviewed by Dr. Jason Yu FRACGP

Last reviewed 2 August 2026. Editorial policy

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Frequently asked questions

What causes the smell with pitted keratolysis?

The bacteria behind pitted keratolysis feed on the outer layer of the skin and release sulfur compounds as they grow, which is what produces the strong, distinctive odour. The smell usually improves within a couple of weeks once the infection is treated and the feet are kept drier, because the bacteria can no longer thrive.

Is pitted keratolysis contagious?

Not in the way most skin infections are. The bacteria involved live harmlessly on many people's skin, and pitted keratolysis develops when warm, damp, enclosed feet let them overgrow. It is not typically passed from person to person, although sharing shoes or socks is still unwise. Good foot hygiene, daily sock changes, and letting footwear dry out fully protect both you and your household.

Can I treat pitted keratolysis at home?

Mild, early cases sometimes settle with strict moisture control: washing and thoroughly drying the feet daily, changing socks at least once a day, rotating shoes so each pair dries for a full day or two, and applying an antiperspirant to the soles. Established pits and persistent odour usually need a prescription antibiotic cream as well, so see a GP if things are not clearly improving after a couple of weeks of good home care.

Is pitted keratolysis a fungus?

No. Pitted keratolysis is a bacterial infection, even though it is very commonly mistaken for tinea (athlete's foot), which is fungal. The distinction matters because antifungal creams do not clear pitted keratolysis, and failed antifungal treatment is one of the most common reasons people finally seek help. A GP can usually tell the two apart from the appearance and history, and can arrange skin scrapings if the picture is unclear.

How long does pitted keratolysis take to clear with treatment?

Most cases improve noticeably within 2 to 4 weeks of starting a prescription antibiotic cream combined with proper sweat and footwear management. The odour often settles first, with the pits filling in as the skin renews. If there is no clear improvement after about 4 weeks, book a review: the diagnosis may need a second look, or the sweating side of the problem may need more targeted treatment.

Does pitted keratolysis come back?

It can. The bacteria return whenever the same conditions return, so recurrence is common in people who go back to long days in the same enclosed boots without addressing sweating. Rotating footwear, moisture-wicking socks, antiperspirant on the soles, and airing your feet whenever possible substantially reduce the chance of another episode. If it keeps returning despite these steps, a GP can look at longer-term options for sweat control.

Can a GP diagnose pitted keratolysis from a photo?

Usually, yes. The clusters of small pits on the pressure areas of the soles, combined with the odour and the story of sweaty, enclosed feet, are distinctive enough that a GP can often make the diagnosis from clear photos or a video consultation. If the appearance is unusual, the GP can arrange skin scrapings through a pathology lab to rule out tinea, and will tell you if an in-person examination is needed.

Do I need oral antibiotics for pitted keratolysis?

Usually not. Pitted keratolysis sits in the outermost layer of the skin, so a topical antibiotic applied directly, along with keeping the feet dry, clears most cases. Oral treatment is occasionally considered for widespread or stubborn infection, and that is a decision your GP makes based on how your skin responds.

Is the pitted keratolysis consultation bulk billed?

Yes. NewDoc bulk bills telehealth consultations for eligible Medicare cardholders, so there is no out-of-pocket cost for the GP appointment. Any eScript or pathology referral issued during the consultation is included at no extra charge. Medicines themselves may be subsidised under the PBS at your pharmacy.

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