Callus
 | This article needs additional citations for verification. (October 2007) |
| Callus | |
|---|---|
| Specialty | Dermatology  |
A callus (or callosity) is an especially toughened area of skin which has become relatively thick and hard in response to repeated friction, pressure or other irritation. Rubbing that is too frequent or forceful will cause blisters rather than allow calluses to form. Since repeated contact is required, calluses are most often found on feet, for example, people who play steel string guitars often develop calluses due to the frequent friction on the strings. Calluses are generally not harmful, but may sometimes lead to other problems, such as skin ulceration or infection.
In botany, the term is also used to describe a condition of thickened surfaces of leaves or other plant parts.
Development
Although usually found on the foot (where the most pressure and friction are applied), calluses can occur anywhere on the body as a reaction to moderate, constant "grinding" pressure. It is the natural reaction of the palmar or plantar skin. Too much friction occurring too fast for the skin to develop a protective callus will cause blisters instead.
For example players of string instruments will develop calluses on their fingers with frequent play. This actually helps the player as the thicker skin protects the fingertips. Extended play is often painful before the calluses appear. Drummers can also develop a callus on their feet or hands. Calluses on the feet are more common in metal drummers, where double bass drumming is used more often. Use of older sticks will also cause callus on the palms and fingers of a drummer.
People with bunions may find painful calluses behind the second or third toe. These are caused by unequal pressure and rubbing on the smaller toes. Such calluses can be very painful and often do not respond to trimming of the callus, soft materials, or orthotic devices. It is not the callus that causes pain, but rather the severe imbalance in the function of the foot that is taking its toll.
Shoes can produce corns by rubbing against the top of the toes or foot. Continued irritation may cause pain. Stretching out the shoe to reduce rubbing may reduce the contact and alleviate the pain, but the corn may remain. If a toenail or a fingernail rubs against the skin, pinching it between surfaces for a period of time, a corn can form at the edge of the nail. These corns are difficult to treat because the nail is frequently the primary cause.
Sometimes a callus occurs where there is no rubbing or pressure. These hyperkeratoses can have a variety of causes. Some toxins, such as arsenic, can cause thick palms and soles. Some diseases, such as syphilis, can cause thickening of the palms and soles as well as pinpoint hyperkeratoses. There is a benign condition called keratosis palmaris et plantaris, which produces corns in the creases of the fingers and non-weight bearing spaces of the feet. Some of this may be caused by actinic keratosis, which occurs due to overexposure to sun or with age and hormonal shifts. Callus is often found on the ball of your foot but could be located in many other places on your body.
Prevention
Corns and calluses are easier to prevent than to treat. When it is not desirable to form a callus, minimizing rubbing and pressure will prevent callus formation. Footwear should be properly fitted and broken in, gloves may be worn, and protective pads, rings or skin dressings may be used. People with poor circulation or sensation should check their skin often for signs of rubbing and irritation so they can minimize any damage.
Treatment
Calluses and corns may go away by themselves eventually, once the irritation is consistently avoided. They may also be dissolved with keratolytic agents containing salicylic acid, for example, sanded down with a pumice stone, or pared down by a medical professional such as a podiatrist
Corns
A corn (or clavus, plural clavi) is a specially-shaped callus of dead skin that usually occurs on thin or glabrous (hairless and smooth) skin surfaces, especially on the dorsal surface of toes or fingers. They can sometimes occur on the thicker palmar or plantar skin surfaces. Corns form when the pressure point against the skin traces an elliptical or semi-elliptical path during the rubbing motion, the center of which is at the point of pressure, gradually widening. If there is constant stimulation of the tissue producing the corns, even after the corn is surgically removed, the skin may continue to grow as a corn.[citation needed]
The name corn comes from its appearance under the microscope. The hard part at the center of the corn resembles a barley hare, that is, a funnel with a broad raised top and a pointed bottom. Because of their shape, corns intensify the pressure at the tip and can cause deep tissue damage and ulceration. Hard corns are especially problematic for people with insensitive skin due to diabetes, etc. The scientific name for a corn is heloma (plural helomata). A hard corn is called a heloma durum, while a soft corn is called a heloma molle.
The location of soft corns tends to differ from that of hard corns. Hard corns occur on dry, flat surfaces of skin. Soft corns (frequently found between adjacent toes) stay moist, keeping the surrounding skin soft. The corn's center is not soft, however, but indurated.
Diabetes
People with diabetes face special skin challenges. Because diabetes affects the capillaries, the small blood vessels which feed the skin, thickening of the skin with callus increases the difficulty of supplying nutrients to the skin. The stiffness of a callus or corn, coupled with the shear and pressure that caused it, may tear the capillaries or adjoining tissue, causing bleeding within the callus or corn.
Often, bleeding within a callus is an early sign of diabetes, even before elevated blood sugars may be noticed. Although the bleeding can be small, sometimes small pools of blood or hematoma are formed. The blood itself is an irritant, a foreign body within the callus that makes the area burn or itch. If the pool of blood is exposed to the outside, infection may follow. Infection may also lead to ulceration. Luckily, this process can be prevented at several places, but such infections can become life-threatening. Diabetic foot infections are the leading cause of diabetic limb amputation.
See also
References
1. Taber's Cyclopedic Medical Dictionary, 15th Edition, CL Thomas, M.D., M.P.H., editor, F.A. Davis Company, Philadelphia, PA, 1985.
2. The Merck Manual of Medical Information, Home Edition, R Berkow, M.D., et al., editors, Merck Research Laboratories, Whitehouse Station, NJ, 1997.