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Clavus Medication

  • Author: Nanette B Silverberg, MD; Chief Editor: William D James, MD  more...
Updated: May 12, 2014

Medication Summary

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.[38]



Class Summary

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).

Ammonium lactate (Lac-Hydrin)


May loosen the adhesion of the keratinocytes in the stratum corneum, thereby thinning the skin.

Salicylic acid topical (Compound W, Panscol, Sal-Plant)


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.

Urea (Ureacin-40, Aquacare)


Promotes the hydration and removal of excess keratin in conditions of hyperkeratosis.


Intralesional corticosteroids

Class Summary

These drugs have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Triamcinolone (Kenalog, Amcort)


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.



Class Summary

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.

Tretinoin topical (Retin-A, Avita)


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.

Contributor Information and Disclosures

Nanette B Silverberg, MD Clinical Professor of Dermatology, Icahn School of Medicine at Mount Sinai; Chief, Pediatric Dermatology, Mt Sinai Health Systems, Mount Sinai St Luke's-Roosevelt Hospital and Mt Sinai Beth Israel Medical Centers

Nanette B Silverberg, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Pediatric Dermatology, Women's Dermatologic Society, European Society for Pediatric Dermatology, Dermatology Foundation, American Association of University Women, Pediatric Dermatology Research Alliance, Vitiligo Support International, American Academy of Pediatrics, American Medical Association, American Medical Womens Association, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


Smeena Khan, MD Private Practice, Adult and Pediatric Dermatology Associates

Smeena Khan, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

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Screwdriver operator's callus (ie, clavus).
Table. Clavus Formation Named for Specific Etiology or Location
Vernacular Term Location Association
Jeweler's callus, cherry pitter's thumb,[4] cameo engraver's corn[5] 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[6] 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[9] Hyperkeratosis of the radial aspect of the thumb Caused by excessive cigarette lighter flicking
Knuckle pads[10] Hyperkeratosis over the knuckles Caused by boxing training
Russell sign[11] 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[12] 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[13] 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[14] Feet Clavus formation due to wearing tight high-heeled shoes
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