Over The Counter (OTC) Corns & Calluses presented by : Tasneem Hassoun Muna Hassan

Outline Topic overview Symptoms Exams and tests Home treatment Pharmacologic treatment

What are corns and calluses? Calluses and corns are areas of thick, hardened, dead skin( hyperkeratosis at the area with excessive pressure) . They form to protect the skin and structures under the skin from pressure, friction, and injury. They may appear grayish or yellowish, be less sensitive to the touch than surrounding skin, and feel bumpy. Calluses on the hands and feet of an active person are normal. Calluses and corns become a problem when they grow large enough to cause pain.

What causes them? Calluses and corns are caused over a period of time by repeated pressure or friction on an area of skin. The pressure causes the skin to die and form a hard, protective surface. A soft corn is formed in the same way, except that when perspiration is trapped where the corn develops, the hard core softens. This generally occurs between toes.

Cont…. Calluses and corns are not caused by a virus and are not contagious. most people get calluses and corns is women because women often wear shoes that create friction on the feet, such as high-heeled or thin-soled shoes.

Types corns have an inner core that can be soft or hard. A soft corn is found between toes(usually the forth and fifth toes), a hard corn is often found over a bony part of a toe( usually the fufth toe). so we have two types of corns and calluses: 1.Hard: usually on the surface of the toe 2.Soft: usually between 4th and 5th toe. (perspiration gives hard calluses soft appearance).

Where they formed? Calluses generally form on the hands or feet, although they may form wherever there is pressure on the skin, such as on the knees or elbows. Calluses on the hands generally form at the base of the fingers. They usually are not painful and may be useful. For example, a carpenter might develop calluses that protect his or her hands from scrapes and cuts while working. A tennis player might develop calluses on the palm that protect his or her hand from the pressure and friction of handling a tennis racquet

Cont… Calluses on the feet generally form on the ball of the foot, the heel, and the underside of the big toe. They often form where the foot and the beginning of the toe meet (under the end of the metatarsal bone).

What is the differences between corns and calluses? corns generally found where the toes rub together or with shoes. corns have an inner core that can be soft or hard. corns are deeper, more facal ,and frequently painful. a soft corn is found between toes and hard corn is often found over a bony part of a toe( uasually fifth toe).

Cont… sometimes corns have a dry, waxy, or translucent appearance. while calluses refers to a more diffused flattened superficial area of thick skin and have undefined borders. calluses located in the weight bearing areas such as the palms of the hands and soles of the feets. usually asymptomatic, but if the friction is extreme, may become irritated, causing mild burning discomfort.

The Goal of treatment Remove the pressure or the friction that cause the corns or callus . Removal of the hard skin.

Product Recommendation First line treatment (no pharmacological): epidermabrasion or hydrocolloid plasters. Second line treatment (pharmacological) : plasters and liquids applications containing salicylic acid .

Home Treatment 1. Epidermabrasion: is physical process that involves removal of the horny skin by the use of a mechanical aid and does not involve the use of pharmacological agents. Several gently abrasive materials and appliances are available such as emery boards and pumice stones.

1. Epidermabrasion Emery boards Pumice stones

1. Epidermabrasion The following points of advice should be given to patients: Soften the skin in mild soapy water or a moisturising cream. Rub the pumice stone on the wet callus or corn with light to medium pressure for 2 to 3 minutes. This will remove the dead skin. The process should be repeated nightly for 1 week, and then review.

Caution Be careful when using a pumice stone. If you take off too much skin and go too deep, it can result in bleeding and infection. If you have diabetes, peripheral arterial disease, peripheral neuropathy, or other conditions that cause circulatory problems or numbness, consult your health professional before trying any treatment for calluses or corns.

Home Treatment 2. Wear shoes that fit well and are roomy, with wide and deep toe boxes, low heel and made of material that is stretch to relief pressure on hard corns.

Home treatment 3. Wear socks that fit. Loose socks can bunch up and cause pressure. 4. Use protective padding such as moleskin or orthotic shoe inserts to cushion the callus or corn.

moleskin Moleskin is a soft fabric with a thin layer of felt attached to a sticky backing. It is used to protect the skin from rubbing against itself or footwear. Moleskins can protect blisters when they are cut in a ring shape that encircles the blister. The adhesive should not be stuck to broken or raised skin.

Home treatment 5. Take care of the feet by Washing them regularly, and using lotion to keep them from drying out. Dry skin makes it easier for a callus to crack and bleed. 6. Usage of metatarsal bar inserts for your shoes, to distribute your weight more evenly over the ball of your foot.

B. Hydrocolloid and hydrogel plasters Hydrocolloids and hydrogels : are complex polymer formulations that swell in the presence of moisture absorbed from the skin. The plaster is left in situ for about a week; the corn or callused skin should be removed when the plaster is removed.

B. Hydrocolloid and hydrogel plasters MOA: In corn and callus plasters, the hydrocolloid or hydrogel forms a soft, protective gel-like cushion that rehydrates and softens the hardened tissue.

C. Keratolytic agents_salicylic acid The concentration of salicylic acid in products used for this purpose ranges from about 11% to 50%, depending on the type of formulation such as: 1. caps and plasters : contain high concentrations of salicylic acid (usually 40%) in a semi-solid base spread on to a suitable backing material, contained within a ring that is self-adhesive .

Keratolytic agents 1. caps and plasters : they should be applied and changed every 1 or 2 days for about a week, after which time the callosity should lift away easily.

Side effects Occasionally local irritation or dermatitis (skin rash) may occurs .. If it happens remove the plaster and clean and dry the area … don’t repeat the treatment …. DON’T USE: near inflamed or broken skin. CI: ingredient allergy. diabetic patients .

Keratolytic agents 2. ointment: containing 50% salicylic acid is also available; it should be applied nightly for 4 nights. 3. Paints and liquids: contain salicylic acid in a concentration of 11–17% are available, often in a collodion-based vehicle.

Keratolytic agents Collodions : contain pyroxylin dissolved in a volatile solvent such as ether, acetone or alcohol. On application, the solvent evaporates, leaving on the skin an adherent, flexible, water-repellent film. Liquid preparations are usually applied daily for several days until the corn or callus can be removed easily.

Collodions This has the advantage of maintaining the medication at the site of application and prevent maceration of the skin.

Caution Salicylic acid is caustic to the skin , care should be taken to prevent the spread of the medication beyond to the affected area to prevent skin maceration. Caution should be taken in case of hypersensitivity to salicylic acid (rare conditions ).

Last line treatment Surgery is rarely used to treat calluses or corns but use if : 1. A bone structure (such as a hammer toe) is causing a callus or corn, surgery can be used to change or remove the bone structure. 2. This is used only if other treatment has failed. If treatment for soft corns does not work.

When to refer the patient?? Self medication gives no results after two weeks. Patients with diabetes mellitus, peripheral circulatory problems (poor circulation). Lesion are oozing purulent material. 5. corns and calluses indicates anatomic defect or fault in body weight distribution. 6. patient has physical or mental conditions that make applying medications difficult .