In patients with associated foot pain and with erythematous to violaceous macular lesions and pits, histological examination reveals only a mild dermal inflammatory reaction. The treatment of pitted keratolysis consists of the following steps. First, limit the use of occlusive footwear and reduce foot friction with properly fitting footwear. Absorbent cotton socks must be changed frequently to prevent excessive foot moisture. Wool socks tend to whisk moisture away from the skin and may be helpful.
Many clinicians find that topical antibiotics are effective, even without the preceding steps.
They are certainly easy to use and well accepted by patients. Twice daily applications of erythromycin or clindamycin are effective. Either solutions or gel formulations may be used. Oral erythromycin is another option. Effective treatment of pitted keratolysis clears both the lesions and odor in 3-4 weeks.