Corns (Clavus) Medication

Updated: Sep 27, 2017
  • Author: Nanette B Silverberg, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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 triamcinolone and topical vitamin A acid compounds also may reduce localized hyperkeratosis. Triamcinolone 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. [68]

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Keratolytic agents

Class Summary

These agents cause the 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).

Salicylic acid topical (Clear Away, Compound W, Dr. Scholl's Corn Removers)

Topical salicylic acid is a keratolytic, bacteriostatic, and fungistatic agent. Its main clinical use is as a keratolytic agent and as an agent that increases the percutaneous absorption of combined drugs by removing the stratum corneum. The keratolytic activity results from solubilization of the intercellular ground substance in the stratum corneum and shedding of the scales, which are bound by it.

Salicylic acid topical can be compounded in petrolatum at any percentage and is usually used at 5-20%, beginning with a lower percentage. It can be purchased over the counter as a liquid or pad preparation, ranging from 17-40% (multiple companies make these). It can be irritating or cause blistering.

Ammonium lactate (AmLactin, Lac-Hydrin, Lactinol)

Ammonium lactate may loosen the adhesion of the keratinocytes in the stratum corneum, thereby thinning the skin. Ammonium lactate provides beneficial effects on dry skin and severe hyperkeratotic conditions. It is indicated for moisturizing and softening dry, scaly skin.

Urea (Aquadrate, Calmurid, Carmol, Nutraplus)

Urea is a a keratolytic, bacteriostatic, bactericidal, and fungistatic agent. It is topical treatment for dry skin and ichthyosis and is also used as a skin moisturizer. Urea promotes the hydration and removal of excess keratin in conditions of hyperkeratosis.

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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 (Aristospan, Kenalog IV, Trivaris)

An 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.

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Retinoids

Class Summary

These agents are not specifically approved for use in corn (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 (Atralin, Avita, Refissa)

Tretinoin topical inhibits microcomedo formation and eliminates lesions. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. It is available as 0.025%, 0.05%, and 0.1% creams and 0.01% and 0.025% gels.

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