1. Prepared and presented by Pharmacist Eman Elayeh
Corns and calluses
Prepared and presented by
Pharmacist Eman Elayeh
قال رسول الله صلى الله عليه وسلم : ما من خارج خرج من بيته في طلب العلم إلا وضعت له الملائكة اجنحتها رضا بما يصنع

2. References
Non prescription medicine , forth edition, Alan Nathan , Pharmaceutical Press 2010
Hand book of nonprescription drugs :an interactive approach to self care 16th edition, Rosmari Berardi

3. Causes of corns and calluses
Corns and calluses are localised formations of thick, horny skin (hyperkeratinisation) on the feet
Corns and calluses are caused by pressure or friction on the feet.
Pressure on the nerve endings in these areas gives rise to pain.
Hard corns occur over bony prominences, generally on or around the toes.
Soft corns occur between the toes and have a soft and whitened appearance caused by maceration of the skin by perspiration.
Calluses form on the flatter, weight-bearing and fleshie areas of the foot

4. Corns on feet

5. Calluses on feet

6. Corn:
Small, raised, sharply demarcated region having a central core
yellowish grey color, few mm to 1 cm
Base is on the surface and the apex points inwards
Soft vs. Hard
Calluses:
Broad base with a central core or diffused thickening of the skin
Indefinite borders, few mm to several cms
Raised and yellow and have the normal ridges of the skin

7. Pathophysiology: friction and pressure increase mitotic activity of the basal cell layer leading to migration of maturing cells to the upper layer
Symptoms: pain may be sharp or dull, Calluses are often asymptomatic, causing pain when pressure is applied

8. Treatment goals Provide symptomatic relief Remove corns and calluses
Prevent recurrence by correcting underlying cause

9. Non-pharmacologic therapy

10. Treatment

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

12. Cautions with at-risk patients
Particular care is needed with certain groups of at-risk patients.
Patients with diabetes, for example, often have poor peripheral circulation; they are therefore more likely than healthy people to develop ischaemic foot lesions and will recover less readily from any minor foot damage

13. Cautions with at-risk patients
In addition, peripheral neuropathy may result in a decreased perception of pain so that any injury to the feet may not be noticed
Vision may also be impaired, particularly in elderly patients with diabetes, making it more difficult to see any damage that may have occurred.
Pharmacists should not, therefore, recommend any treatment for foot problems to patients with diabetes and, if asked for advice, should refer the patient to either a chiropodist or the patient’s doctor.
This caution also applies to patients with peripheral vascular disease and to elderly people who, like patients with diabetes, tend to have more foot problems, may have declining peripheral circulatory and sensory nerve function, and often do not have the physical mobility or the dexterity to manage their own treatment properly.

14. 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

15. Epidermabrasion
Careful technique is important for the successful and safe removal of hard skin by epidermabrasion. The following points of advice should be given to patients:
Soak the foot (to soften the skin) in mild soapy water for a few minutes, or apply a moisturising or softening cream.
Rub some soap on to the appliance, and then gently rub the corn or callus for 5 minutes.
Repeat the process nightly for 1 week, and then review.
There is no need to remove the hard skin completely, just enough to relieve pain or irritation.
Do not wear ill-fitting shoes (often the cause of the hyperkeratinisation), to help prevent recurrence of the problem

16. 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.

17. Hydrocolloid and hydrogel plasters

18. Keratolytic agent–salicylic acid

19. Keratolytic agent–salicylic acid
Corn and callus caps and plasters contain high concentrations of salicylic acid (usually 40%) in a semi-solid base spread on to a suitable backing material, contained within a ring that is either self- adhesive or attached to an adhesive plaster.
Such systems provide direct and prolonged contact with the affected area.
They should be applied and changed every 1 or 2 days for about a week, after which time the callosity should lift away easily.
If the callosity cannot be removed after 10–14 days’ treatment, professional help should be sought.
An ointment containing 50% salicylic acid is also available; it should be applied nightly for 4 nights.

20. Keratolytic agent–salicylic acid
Paints and liquids that contain salicylic acid in a concentration of 11–17% are available, often in a collodion- based vehicle.
Collodions contain pyroxylin, a nitrocellulose derivative, dissolved in a volatile solvent such as ether, acetone or alcohol.
On application, the solvent evaporates, leaving on the skin an adherent, flexible, water-repellent film containing the medicament.
This has the advantage of maintaining the salicylic acid at the site of application and also assists maceration of the skin by preventing moisture evaporation.
Liquid preparations are usually applied daily for several days until the corn or callus can be removed easily

21. FDA warning on salicylic acid

22. Keratolytic agent–salicylic acid

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

26. Warts:
Common viral infection of the skin and mucous membranes
Caused by human papilloma viruses
Rough cauliflower appearance, rough nodules that appear alone or grouped
Plantar warts are common on the soles of the feet
Susceptibility:
1. Pappilloma virus must be present
2. There must be an open avenue such an abrasion, through which the virus enters the skin
3. Immune system must be susceptible to the virus. Immuno-deficient persons once infected develop widespread and highly resistant warts.

27. Bunions
Pressue on metatarsal head of the great toe
Asymtomatic, very painful if swollen
Ingrown nails
Incorrect nail trimming