2. Corns

3. Corns and Calluses Etiology/Pathology
Corns and Calluses: marked hyperkeratosis in the stratum corneum
Normal conditions: mitotic division equal to continual surface cell desquamation= complete replacement of epidermis in approximately 1 month
Friction/pressure: increase mitotic activity
Although corns and calluses are common foot disorders, they should not be ignored
They may indicate a biochemical problem in the feet or lead to serious complications in predisposed patients
Under normal conditions: the cells in the skin’s basal cell layer undergo mitotic division at a rate equal to the continual surface cellular desquamation, leading to complete replacement of the epidermis in approximately 1 month
During corn or callus development: friction and pressure increase mitotic activity of the basal cell layer, leading to the migration of maturing cells through the prickle cell (stratum spinosum) and granular (stratum granulosum) skin layers.
This migration produces a thicker stratum corneum as more cells reach the outer skin surface
Hardening of the skin may signal a biomechanical problem and cause abnormal weight distribution in a particular area of the foot
In this case, a podiatric examination is warranted to determine whether an imbalance is present
When friction or pressure is relieved, mitotic activity returns to normal, causing remission and disappearance of the lesion

4. Corns Corns Signs and Symptoms:
Corn (Clavus): Small, raised, sharply demarcated hyperkeratotic lesion having a central core
yellowish grey color, few mm to 1 cm or more
Base is on the surface and the apex points inwards and presses on the nerve endings in the dermis causing pain
Hard vs. soft

5. Hard corns: on surface of the toes, appear shiny and polished
Soft: whitish thickenings of the skin, usually found on the webs between the 4th and 5th toes.
Hard corns (usually) and soft corns (less frequently) are caused by pressure from underlying bony prominences
Pressure from inappropriate, tight-fitting shoes is the most frequent cause of pain from corns
Hard corns: on surface of the toes, appear shiny and polished
Soft: whitish thickenings of the skin, usually found on the webs between the 4th and 5th toes. Accumulated perspiration macerates the epidermis and gives the corn a soft appearance
Soft corns may occur between any adjacent toes, but are most frequently found between the 4th and 5th toe because the 5th metatarsal is much shorter then the 4th, and the web between these toes is deeper and extends more proximally then the webs between the other toes
As narrow-toed or high-heeled shoes crowd toes into a narrow toe box, the most lateral toe, the 5th, sustains the most pressure and friction and is the usual site of a corn
The resultant pain may be severe and sharp (when downward pressure is applied) or dull and discomforting

6. Soft corn

7. Hard corns
calluses

8. Calluses
Broad-based with a central core with sharply circumscribed margins and diffuse thickening of the skin
Indefinite borders, few mm to several cms
Raised and yellow and have the normal ridges of the skin on its surface
Calluses form on the joints and weight bearing areas, e.g. palms of the hands and the sides and soles of the feet

9. Calluses
Factors: friction (caused by loose-fitting shoes or tight-fitting hosiery), walking barefoot, and structural biomechanical problems contribute to the development of calluses
Structural problems: improper weight distribution, pressure, and development of bunions with age
Can be symptomatic and protective
Some are only painful when pressure is applied (e.g. individuals who suffer from calluses on the sole of the foot often liken their discomfort to that of walking with a pebble in the shoe)
bunion
A swelling or deformity at the head of the first metatarsal of the great toe (big toe).

10. Treatment of Corns and Calluses
Goals: (1) remove lesion (2) prevent recurrence
Ultimate success depends on eliminating the causes, pressure and friction
Careful about the exclusions for self-treatment

11. Exclusions for Self-Treatment
DM, a peripheral circulatory disease or other medical condition that C/I use of foot care products
Lesions bleeding or oozing purulent material
Anatomic defect or fault in body weight distribution
Extensive or painful, debilitating corns/calluses on foot
Proper but unsuccessful self-medication attempt
Hx of RA and complaint of painful metatarsal heads or deviation of great toe
Physical or mental impairment that make following product instructions difficult

12. Nonpharmacologic Therapy

13. Nonpharmacologic Therapy
Soaking in warm (not hot) water throughout treatment for at least 5 minutes to remove dead tissue
Remove dead tissue gently (rough towel, callus file or pumice stone)
Use pressure relieving pads/cushion
Eliminate pressure/friction
surgery

14. Orthotic orthotic devices
Apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body.
Orthotic

15. Pharmacologic Therapy
Only salicylic acid is approved by the FDA
Salicylic acid: The oldest keratolytic agent 0.5%-40% depending on the intended use and dosage form
MOA: 1. Decreases keratinocyte adhesion 2. Increases water binding which leads to a hydration of keratin
Evidence submitted to FDA: presoaking produced no significant positive effects for any efficacy parameter
Because of the latter effect, the presence of moisture was believed to be an important component of salicylic acid’s therapeutic efficacy, and soaking the area in a warm water bath 5 minutes before applying salicylic acid was recommended

17. Salicylic acid Warning/Contraindications: Irritated skin
Any infected or reddened area
Moles, birth marks,
Warts with hair growing from them, genital warts, warts on face or mucous membranes (inside mouth, nose, anus,, genitals or lips)
If diabetic
If poor circulation

18. Treatment is by epidermabrasion or the use of hydrocolloid plasters or keratolytic agents.

19. Epidermabrasion
Epidermabrasion does not involve the use of pharmacological agents but is a physical process that involves removal of the horny skin by the use of a mechanical aid.
Several gently abrasive materials and appliances are available, ranging from emery boards and pumice stones to specially designed files and
synthetic pumice-like blocks

20. Hydrocolloid and hydrogel plasters
Hydrocolloids and hydrogels are complex polymer formulations used in wound management.
They swell in the presence of moisture absorbed from the skin; in corn and callus plasters, the hydrocolloid or hydrogel forms a soft, protective gel-like cushion that rehydrates and softens the hardened tissue.
The plaster is left in situ for about a week; the corn or callused skin should be removed when the plaster is removed.

21. Hydrocolloid and hydrogel plasters

22. Keratolytic agent–salicylic acid

23. Keratolytic agent–salicylic acid
Cautions
As salicylic acid is caustic to normal skin, care should be taken to prevent preparations from spreading beyond affected areas.
True sensitivity to salicylic acid is very rare, but a few patients react to colophony present in collodions and plaster bases.
Preparations containing high concentrations of salicylic acid should be avoided by patients who are sensitive to aspirin

24. Product selection points
Epidermabrasion and hydrocolloid plasters are the safest and most suitable methods for treating corns and calluses.
A wide range of preparations containing salicylic acid is available, all of which should be effective if used properly.
Product recommendations
First-line treatment – epidermabrasion or hydrocolloid plasters.
Second-line treatment – plasters or a liquid application containing salicylic acid.

25. Products in Jordan
Ozone cosmetics 44 with aloe vera and Henna

26. Products in Jordan (students presentation)

27. Products in Jordan

28. Products in Jordan