Short-term effect of scalpel debridement of plantar callosities versus treatment with salicylic acid patches: The EMEDESCA randomized controlled trial.

This study compares scalpel debridement versus salicylic acid patches in the treatment of plantar callosities. A randomized clinical trial (ACTRN12614000591651) was performed with 62 patients, divided into two intervention groups. Group A received treatment with salicylic acid patches (Callívoro Marthand® ) and group B underwent scalpel debridement of plantar callosities. Pain was measured on a visual analog scale, and foot pain and disability were evaluated using the Manchester Foot Pain Disability Index (MFPDI) questionnaire (Spanish version). Significant differences were observed in pain measured immediately after treatment (P < 0.001) and at 15 days and 6 weeks after treatment. For some components, the MFPDI questionnaire revealed significantly better outcomes by scalpel debridement at 15 days after treatment. The scalpel debridement of plantar callosities relieves pain more effectively than salicylic acid patches, and patients achieve greater functionality in the initial weeks after debridement.

Analysis of a trial assessing the long-term effectiveness of salicylic acid plasters compared with scalpel debridement in facilitating corn resolution in patients with multiple corns.

This study assesses the effect of salicylic acid plasters on the time to resolution of 324 corns experienced by 201 participants taking part in a randomized controlled trial. While the rate of corn resolution was substantively higher in the treatment group than in the control group, treatment was found to be not significantly related to time to corn recurrence when analyzed over the full 12-month follow-up period. Parametric survival analysis modeling of interval-censored data and incorporating patient-specific frailty terms was utilized, to model correlation of corns within patients (hazard ratio [HR], 1.189; 95% confidence interval [CI], 0.780-1.813; P = 0.422). Median resolution times were 10.0 months for corns in the treatment group and 13.4 months for corns in the control group. Controlling for treatment, corn type was found to be related to resolution time, with dorsal/interdigital (ID) corns showing better resolution than plantar corns (HR, 1.670; 95% CI, 1.061-2.630; P = 0.027). Median resolution times were 5.9 months for dorsal/ID corns and 14.9 months for plantar corns. Secondary measures relating to quality of life (QoL) and foot-related disability, using the EQ-5D questionnaire and the Manchester Foot Pain and Disability Index (MFPDI), were also assessed at the patient level in multivariate models. Treatment was not significantly related to any of these measures over the whole period of analysis. However, a trend analysis revealed a quadratic trend in QoL and MFPDI scores, arising from a substantive initial improvement between baseline and 3 months, followed by a gradual decrease between 3 and 12 months.

Efficacy of intralesional bleomycin for the treatment of plantar hard corns.

BACKGROUND: Intralesional bleomycin is effective for the treatment of various dermatologic conditions. However, the efficacy of intralesional bleomycin for the treatment of corns has not been established. METHODS: A total of 50 patients with plantar corns were recruited and equally divided between groups A and B. Groups A and B were then treated with intralesional bleomycin (1 mg/ml) after paring the hyperkeratotic tissue and simple paring, respectively. The patients visited our clinic at 3-week intervals and were treated for a maximum of 10 sessions. RESULTS: Patients in groups A and B were treated for 35 and 29 corns, respectively. The curative rates of the patients in groups A and B were 37% (13 of 35) and 7% (three of 29), respectively. The proportions of lesions in groups A and B that demonstrated a decrease in size by >50% were 80% (28 of 35) and 38% (11 of 29), respectively. The total number of patients that demonstrated excellent symptomatic improvement in group A was 15 of 22. Excellent responses were achieved within a small number of treatment sessions, ranging from one to four sessions (average: 2.6). Statistical differences in terms of the degree of size reduction and pain relief were noted between the two groups. CONCLUSIONS: This study provides evidence that intralesional bleomycin (1 mg/ml) injection could be one of the ideal treatments for corn. Intralesional bleomycin is particularly useful for reducing lesional pain and size within a short period.

Removal of corns by punch incision: a retrospective analysis of 15 patients.

BACKGROUND: Hard corns are firm, small, dome-shaped papules with translucent central cores, which occur on the palmoplantar region of toes and hands due to repeated trauma. Medical management of hard corns is difficult and sometimes requires surgical excision. Punch incision is a technique which is performed using a circular blade or trephine attached to a pencil-like handle. AIM: We hypothesized that it might serve as an alternative method to surgical excision in the treatment of recalcitrant corns and performed the technique to treat 17 corns in 15 patients. The present study aimed to review these 15 patients retrospectively and evaluate the effectiveness of punch incision. METHOD: A total of 15 patients with recalcitrant corns were treated using punch incision between April 2011 and December 2012 and were evaluated by photographs and patient satisfaction questionnaires. RESULTS: Out of the 17 corns, 3 corns persisted after punch incision and the patients were referred to the orthopedic clinic for further treatment; 2 of the 17 corns partially responded and required additional topical treatment; and 12 of the 17 corns responded completely to punch incision. CONCLUSION: Punch incision is a simple and effective technique for the treatment of small corns on the palms and soles.

New alternative in treatment of callus.

The pathological transformation of the skin into a thick and hard callus due to repetitive trauma or friction is commonly known as corn. Although a variety of medical and operative treatment choices have been proposed, an ideal treatment method is yet to be defined. Effectiveness of tangential excision together with topical cantharidin has been evaluated. We used Canthacur-PS as an adjunct to excision in an outpatient setting. Canthacur-PS is a commercially available topical solution that includes 1% cantharidin, 30% salicylic acid and 5% podophyllin. The treatment has been applied to 72 patients. We found that 65 patients (90.3%) had corn on their feet and seven patients (9.7%) on their hands. Thick, hard and hyperkeratotic skin area was scraped with the help of a no. 15 blade. The solution was applied on and around the periphery (up to 1­2 mm) of the lesion with a cotton swab, and kept closed for 5 days with an antibiotic dressing. All the patients had been followed up for at least 1 year and evaluated by clinical examination and patient satisfaction query. One session of treatment succeeded in 57 (79.2%) corn patients. Two sessions in nine corn patients (12.5%), three sessions in five corn patients (6.9%) and four sessions in one patient (1.4%) were needed. Only one recurrence (1.4%) was seen. No scar formation or other side-effects were seen. Our findings show that this treatment method is a simple, minimally invasive and reliable treatment for calluses.

Managing common foot problems in older adults.

Foot problems related to aging or disease processes such as nail fungus or arthritis often go unrecognized and untreated, and can lead to considerable dysfunction. Multiple contributing factors, such as repetitive stress and structural changes in the foot, further compromise function. Effective topical management approaches for xerosis, fissures, hyperkeratotic lesions, and fungal infections can lessen the severity of symptoms. However, when recalcitrant, such as long-standing onychomycosis, prescription medications may be warranted. These medications are not without serious side effects and should be used with caution in older adults. New methods that pose fewer risks, such as film-forming solutions and photodynamic therapy, are emerging to treat skin and toenail infections. Several nonpharmacological and pharmacological treatment approaches are presented in this article.

Role of tissue-type plasminogen activator in salicylic acid-induced sloughing of human corn tissue.

BACKGROUND: Plasminogen activators (PAs) and their regulatory counterparts, PA inhibitors (PAIs), play a role in normal differentiation processes and various pathophysiologic conditions of the epidermis. Normal desquamation of corneocytes from the skin3s surface may, in part, be regulated by the balanced activities of tissue-type PA (tPA) and PAI-2. Salicylic acid (SA) is commonly used to remove the hyperkeratotic tissue of corns, calluses, and verrucae, and it may disrupt intercellular adhesion structures; however, its exact mechanism of keratolytic action is poorly defined. We sought to determine the effects of SA by comparing the levels of PA and PAI messenger RNA (mRNA) in normal skin, untreated corns, and SA-treated corns. METHODS: Untreated and SA-treated human corn tissue samples were obtained from patients electing surgery to repair bony defects that underlay their lesions. Histopathologic examination of corns was performed by staining the tissue sections with hematoxylin and eosin and by light microscopy. Polymerase chain reaction was used to compare mRNA expression of PAs and PAIs in normal skin, untreated corns, and SA-treated corns. RESULTS: We demonstrated lower tPA and higher PAI-2 mRNA levels in corn tissue compared with normal skin. In corn tissue treated with SA, the expression of tPA mRNA increased and of PAI-2 mRNA decreased to the levels found in normal skin. CONCLUSION: An altered balance in tPA and PAI-2 levels contributes to the induction of hyperkeratotic corn tissue and suggests that the keratolytic action of SA is associated with its ability to stimulate proteinase-meditated desquamation processes.

Milker's callus.

Calluses are a diffuse area of hyperkeratosis occurring as a normal physiological response to chronic, excessive pressure or friction on the skin. They can be distinctive occupational stigmata when they occur on the hands. Herein we report the occurrence of calluses of the thumb in professional milkers as an occupational dermatosis.

Linear lymphatic hypopigmentation after intralesional corticosteroid injection: report of two cases.

Perilesional and linear hypopigmentation, extending cephalad along the lymphatics, occurred in one patient following intralesional injection of corticosteroid suspension for treatment of a hypertrophic scar, and in a second patient following sub-lesional injection of a soft toe-web corn. Atrophy did not occur. Repigmentation in both patients was complete without specific treatment. Review of the literature and evaluation of these patients suggest that the linear hypopigmentation in these two cases was caused by lymphogenous uptake of the corticosteroid crystals.

Corn cures can damage your feet: an important lesson for diabetic patients.

Seven diabetic patients rapidly developed severe foot ulceration and sepsis after application of corn cures. Four patients needed forefoot surgery. Corn cures should not be used by diabetic patients.

Callosidades dolorosas constitucionales: tratamiento con etritinato / Constitutional painful callosities: treatment with etretinate

Se describe un caso de queratodermia palmoplantar circunscripta, bilateral, con paquioniquia e hiperhidrosis, en una paciente de sexo femenino, de 32 años de edad, sin antecedentes heredofamiliares de la afección. Se la trató con etretinato durante 3 meses , obteniéndose la remisión de las lesiones y su sintomalogía hasta la actualidad. Proponemos, de acuerdo a la revisión realizada, la clasificación de los cuadros de callosidades dolorosas en constitucionales o hereditarias. Nuestro caso constituye la segunda observación en la bibliografía de callosidades dolorosas constitucionales (CDC). (AU)

Callosidades dolorosas constitucionales: tratamiento con etritinato / Constitutional painful callosities: treatment with etretinate

Se describe un caso de queratodermia palmoplantar circunscripta, bilateral, con paquioniquia e hiperhidrosis, en una paciente de sexo femenino, de 32 años de edad, sin antecedentes heredofamiliares de la afección. Se la trató con etretinato durante 3 meses , obteniéndose la remisión de las lesiones y su sintomalogía hasta la actualidad. Proponemos, de acuerdo a la revisión realizada, la clasificación de los cuadros de callosidades dolorosas en constitucionales o hereditarias. Nuestro caso constituye la segunda observación en la bibliografía de callosidades dolorosas constitucionales (CDC).

Hereditary callosities with blisters. Report of a family and review.

A family with calluses of the soles associated with blistering is described. Electron microscopic study of a bulla showed an intraepidermal blister with cytolysis of keratinocytes and clumping of tonofilaments. Review of the literature and our own experience with keratoderma palmaris et plantaris revealed no similar patients with this combination of findings. The appearance of the soles is similar to pachyonychia congenita, but the lack of nail and mucous membrane changes is not consistent with that disorder. Treatment with isotretinoin caused reduction in the size of the calluses but exacerbated the blistering.

[Constitutional painful callosities. Analgesic efficacy of etretinate]. / callosités douloureuses constitutionnelles. Efficacité antalgique de l'étrétinate.

We have recently evaluated eight patients with an unusual genetic dermatosis that was characterized by the development of painful callosities at pressure points of soles, with tender yellowish-brown hyperkeratosis. These lesions are very painful: walking produced pain that was severe. The patients performing manual labor, in addition, had multiple callosities on the palms. Hyperhidrosis of the soles and palms was frequently present. Skin lesions were first noted in adolescence. There was no similar family history. There was no personal nor family history of hair, nail or dental disease. A biopsy was performed in one case and showed a simple hyperkeratosis similar to these observed in callosities. Classification of our cases is difficult. They are not similar to the entity named "hereditary painful callosities" by Roth et al. Review of the literature did not show similar cases. The patients received Etretinate (1 mg/day/kg). In all 8 cases, a dramatic improvement was obtained within seven days; the pain disappeared entirely and the patients were able to walk again without any pain. Then, the per-day dose was diminished without reappearance of the pain.

The therapeutic uses of topical vitamin A acid.

Topical vitamin A acid (VAA) has various mechanisms of action which may be responsible for its therapeutic success in many different disorders. Although the absorption, metabolism, and excretion of VAA are not completely understood, VAA appears to remain mainly on the skin surface. The question of carcinogenicity is unresolved, and more research is needed to clarify this problem. This article reviews the literature regarding the therapeutic uses of VAA and summarizes various investigators' experiences with VAA.