- Author: Nanette B Silverberg, MD; Chief Editor: William D James, MD more...
Debridement may be enhanced with the use of keratolytic agents, such as ureas, alpha-hydroxy acid (eg, glycolic, malic, or lactic acid), or beta-hydroxy acid (eg, salicylic acid). The use of these agents is not recommended in pregnant women and young children. Most salicylic acid compounds are 10-17%. High concentrations of salicylic acid (eg, 40%) may lead to severe maceration and frank foot ulcerations in patients with diabetes. Self-adhesive pads are most effective for reducing thick lesions, whereas lotions, creams, and medicaments in petrolatum are best for maintenance. Intralesional Kenalog and topical vitamin A acid compounds also may reduce localized hyperkeratosis. Kenalog may be injected during pregnancy because of its limited absorption; however, it can lead to localized hypopigmentation. Topical vitamin A derivatives are not intended for use in women who are pregnant or intending to become pregnant because their safety ranges from category C to category X.
A combination product to be applied by physicians consisting of 1% cantharidin, a vesicant, mixed with 30% salicylic acid and 5% podophyllin has been described as effective for most people after just one session.
These agents cause cornified epithelium to swell, soften, macerate, and then desquamate. Commonly used agents include urea, alpha-hydroxy acids (eg, lactic acid, glycolic acid), and beta-hydroxy acids (eg, salicylic acid).
May loosen the adhesion of the keratinocytes in the stratum corneum, thereby thinning the skin.
May be compounded in petrolatum at any percentage, usually is used at 5-20%, beginning with lower percentage. Can be purchased over the counter as a liquid or pad preparation, ranging from 17-40% (multiple companies make these). Can be irritating or cause blistering.
Promotes the hydration and removal of excess keratin in conditions of hyperkeratosis.
These drugs have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Injectable version of triamcinolone is available in concentrations of 3-40 mg/mL. Generally, this compound is diluted to 1-4% for injection into lesions, such as a clavus.
Corticosteroids cause the skin to thin, and this beneficial side effect can be used to reduce the thickness of a clavus. However, overusage also can lighten the skin and cause atrophy.
Retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes, and they may reduce the potential for malignant degeneration. Retinoids modulate keratinocyte differentiation.
These agents are not specifically approved for use in clavus therapy. Only tretinoin has been shown to be useful for clavus therapy in the topically applied form. These agents cause the skin to peel by loosening of keratinocyte adhesion. Irritation and discomfort are limiting adverse effects.
Inhibits microcomedo formation and eliminates lesions present. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. Available as 0.025%, 0.05%, and 0.1% creams. Also available as 0.01% and 0.025% gels.
Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br. 2000 Aug. 82(6):781-90. [Medline].
Mann RA. Pain in the foot. 1. Evaluation of foot pain and identification of associated problems. Postgrad Med. 1987 Jul. 82(1):154-7, 160-2. [Medline].
Viegas SF, Torres FG. Cherry pitter's thumb. Case report and review of the literature. Orthop Rev. 1989 Mar. 18(3):336-8. [Medline].
Villano PA, Ruocco V, Pisani M. The cameo engraver's corn. Int J Dermatol. 1990 Jul-Aug. 29(6):424-5. [Medline].
Scott MJ Jr, Scott NI, Scott LM. Dermatologic stigmata in sports: weightlifting. Cutis. 1992 Aug. 50(2):141-5. [Medline].
Mishriki YY. Skin commotion from repetitive devotion. Prayer callus. Postgrad Med. 1999 Mar. 105(3):153-4. [Medline].
O'Goshi KI, Aoyama H, Tagami H. Mucin deposition in a prayer nodule on the forehead. Dermatology. 1998. 196(3):364. [Medline].
Maharaj D, Naraynsingh V. Cigarette lighter thumb. Am J Med. 2001 Apr 15. 110(6):506. [Medline].
Kanerva L. Knuckle pads from boxing. Eur J Dermatol. 1998 Jul-Aug. 8(5):359-61. [Medline].
Daluiski A, Rahbar B, Meals RA. Russell's sign. Subtle hand changes in patients with bulimia nervosa. Clin Orthop Relat Res. 1997 Oct. 107-9. [Medline].
Koh D, Jeyaratnam J, Aw TC. An occupational mark of screwdriver operators. Contact Dermatitis. 1995 Jan. 32(1):46. [Medline].
Heyl T, Raubenheimer EJ. Sucking pads (sucking calluses) of the lips in neonates: a manifestation of transient leukoedema. Pediatr Dermatol. 1987 Aug. 4(2):123-8. [Medline].
Gibbs RC. "Vamp disease". J Dermatol Surg Oncol. 1979 Feb. 5(2):92-3. [Medline].
Goksugur N, Cakici H. A new computer-associated occupational skin disorder: Mousing callus. J Am Acad Dermatol. 2006 Aug. 55(2):358-9. [Medline].
Cox NH, Finlay AY. Callosities of crossed-leg sitting. Int J Dermatol. 2009 Nov. 48(11):1266-7. [Medline].
Bae JM, Kang H, Kim HO, Park YM. Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy. Br J Dermatol. 2009 Jan. 160(1):220-2. [Medline].
Kurvin L, Volkering C. [Diagnosis and treatment of warts, corns, and clavi]. MMW Fortschr Med. 2007 Mar 8. 149(10):31-3. [Medline].
Erkek E, Kocak M, Bozdogan O, Atasoy P, Birol A. Focal acral hyperkeratosis: a rare cutaneous disorder within the spectrum of Costa acrokeratoelastoidosis. Pediatr Dermatol. 2004 Mar-Apr. 21(2):128-30. [Medline].
Manalo FB, Marks A, Davis HL Jr. Doxorubicin toxicity. Onycholysis, plantar callus formation, and epidermolysis. JAMA. 1975 Jul 7. 233(1):56-7. [Medline].
Oriba HA, Lo JS, Bergfeld WF. Callused feet, thick nails, and white tongue. Pachyonychia congenita. Arch Dermatol. 1991 Jan. 127(1):113-4, 116-7. [Medline].
Wollina U, Mohr F, Schier F. Unilateral hyperhidrosis, callosities, and nail dystrophy in a boy with tethered spinal cord syndrome. Pediatr Dermatol. 1998 Nov-Dec. 15(6):486-7. [Medline].
Robbins JM, Ballew KK, Lowery CR, Husni EA. Asymptomatic occlusive arterial disease. A case report. J Am Podiatr Med Assoc. 1985 Nov. 75(11):616-8. [Medline].
Verbov JL, Monk CJ. Talar callosity--a little-recognized common entity. Clin Exp Dermatol. 1991 Mar. 16(2):118-20. [Medline].
Oztekin HH, Boya H, Nalcakan M, Ozcan O. Second-toe length and forefoot disorders in ballet and folk dancers. J Am Podiatr Med Assoc. 2007 Sep-Oct. 97(5):385-8. [Medline].
Baccouche D, Mokni M, Ben Abdelaziz A, Ben Osman-Dhahri A. [Dermatological problems of musicians: a prospective study in musical students]. Ann Dermatol Venereol. 2007 May. 134(5 Pt 1):445-9. [Medline].
Gambichler T, Uzun A, Boms S, Altmeyer P, Altenmüller E. Skin conditions in instrumental musicians: a self-reported survey. Contact Dermatitis. 2008 Apr. 58(4):217-22. [Medline].
Verma SB, Wollina U. Callosities of cross legged sitting: "yoga sign"--an under-recognized cultural cutaneous presentation. Int J Dermatol. 2008 Nov. 47(11):1212-4. [Medline].
Darvall WA. Flash dancing and spine bumps. Med J Aust. 1984 Apr 28. 140(9):568. [Medline].
Lemont H, Ravick A. Hemorrhage within plantar callus. A cutaneous sign of rheumatoid angiitis. J Am Podiatry Assoc. 1980 Jan. 70(1):22-5. [Medline].
Murray HJ, Young MJ, Hollis S, Boulton AJ. The association between callus formation, high pressures and neuropathy in diabetic foot ulceration. Diabet Med. 1996 Nov. 13(11):979-82. [Medline].
Dainichi T, Honma Y, Hashimoto T, Furue M. Clavus detected incidentally by positron emission tomography with computed tomography. J Dermatol. 2008 Apr. 35(4):242-3. [Medline].
Thomas JR 3rd, Doyle JA. The therapeutic uses of topical vitamin A acid. J Am Acad Dermatol. 1981 May. 4(5):505-13. [Medline].
Dehghani F, Merat A, Panjehshahin MR, Handjani F. Healing effect of garlic extract on warts and corns. Int J Dermatol. 2005 Jul. 44(7):612-5. [Medline].
Foster A, Edmonds ME, Das AK, Watkins PJ. Corn cures can damage your feet: an important lesson for diabetic patients. Diabet Med. 1989 Dec. 6(9):818-9. [Medline].
George WM. Linear lymphatic hypopigmentation after intralesional corticosteroid injection: report of two cases. Cutis. 1999 Jul. 64(1):61-4. [Medline].
McDowell BA. Carbon dioxide laser excision of benign pedal lesions. Clin Podiatr Med Surg. 1992 Jul. 9(3):617-32. [Medline].
Akdemir O, Bilkay U, Tiftikcioglu YO, Ozek C, Yan H, Zhang F, et al. New alternative in treatment of callus. J Dermatol. 2/2011. 38:146-50.
Balkin SW. Injectable silicone and the foot: a 41-year clinical and histologic history. Dermatol Surg. 2005 Nov. 31(11 Pt 2):1555-9; discussion 1560. [Medline].
Richards RN. Calluses, corns, and shoes. Semin Dermatol. 1991 Jun. 10(2):112-4. [Medline].
Nagel A, Rosenbaum D. Vacuum cushioned removable cast walkers reduce foot loading in patients with diabetes mellitus. Gait Posture. 2009 Jul. 30(1):11-5. [Medline].
Lee KB, Park JK, Park YH, Seo HY, Kim MS. Prognosis of painful plantar callosity after hallux valgus correction without lesser metatarsal osteotomy. Foot Ankle Int. 2009 Nov. 30(11):1048-52. [Medline].
Atlan M, Naouri M, Lorette G, Estève E, Zakine G. [Original treatment of constitutional painful callosities by surgical excision,collagen/elastin matrix (MatriDerm(®)) and split thickness skin graft secured by negative wound therapy]. Ann Chir Plast Esthet. April 2011. 56:163-9.
|Jeweler's callus, cherry pitter's thumb, cameo engraver's corn||Thumb||Digital changes, including callosities related to repetitive use of fine jeweler's instruments, which also may be seen with the use of cherry-pitting tools|
|Weight lifter's callus||Callosities over the palmar metacarpophalangeal joints||Caused by the friction of weight-lifting apparatus (This also may be seen in athletes who participate in crew.)|
|Prayer callus[7, 8]||Callosity on the forehead||From kneeling prayer with the hands on the forehead|
|Cigarette lighter's thumb||Hyperkeratosis of the radial aspect of the thumb||Caused by excessive cigarette lighter flicking|
|Knuckle pads||Hyperkeratosis over the knuckles||Caused by boxing training|
|Russell sign||Callosities of the dorsum of the hand over the metacarpophalangeal and interphalangeal joints||Caused by the friction involved with self-induced emesis in bulimia nervosa|
|Screwdriver operator's clavus||Palmar surface of the hand||Occurs at the site of contact with a screwdriver handle|
|Spine bumps||Hyperkeratosis over the spinal column||Caused by dancing with spinning on one's back|
|Hairdresser's hand||First finger on dominant hand||Callus formation at the site of friction caused by scissors around the first finger on the dominant hand|
|Sucking calluses||Lip, hand, or foot of a newborn||Callus formation at the site of an area of suction on the lip, hand, or foot of a newborn|
|Vamp disease||Feet||Clavus formation due to wearing tight high-heeled shoes|