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Corns and callosities are produced if an area of the skin is subjected to repeated friction as with ill-fitting/tight shoes or with specific occupational activity.A corn/ callosity consists of an area of thickening of the stratum corneum (the most superficial layer of the skin) which is subjected to repeated friction. If the area of thickening is small, it is called a ‘com’, and if the thickening occurs over a larger area it is called a ‘callosity’. Corns on the soles of the feetare commonly caused by the projecting end of a nail in the footwear, while corns on the toes are produced if the front of the shoe is narrow and tight-fitting and causes friction on the toes. Callosities are frequently located on the skin over the bony prominences, especially around the ankle or other joints, and are related to a specificposture. Callosities are also common on the hands, especially the palms of manual labourers.

A com/callosity in fact is a protective reaction of the skin which is subjected to friction from outside. If the friction is severe, it leads to the production of a blister but if the friction is not severe but recurrent, the skin tends to become progressively thicker and thicker. The thickening involves mainly the stratum corneum which leads to the formation of a keratinous plug. With continued pressure, the keratin plug starts pressing upon the underlying skin and causes pain, whenever the area is subjected to pressure. The corn/callosities are always located on areas which are subjected to repeated friction.

Treatment

For treatment, most people try to slice off the thickened keratin mass as this helps to reduce the pressure on the nerve endings and relieve the pain for some time, but since the cause of friction is generally not taken care of, the skin becomes thickened again and the com/callosities recur. For effective treatment therefore, the most important thing to do is to identify the cause of friction and take appropriate measures to prevent it. For corns on the feet one may advise the patient to interpose a layer of soft foam on the instep, especially at the areas where the corn/ callosities are located. One should also look for the projecting ends of the shoenails or areas where the sale of the shoe is hard and is likely to produce friction on the sale of the foot. If the corns are located on the toes, the person should be advised to wear shoes with a broad front or interpose a pad of cotton or foam between the skin and the shoe. Callosities located over the bony projections around the ankle are usually caused by squatting on the floor. A change in the posture or avoiding to squat on hard floor helps to prevent further friction. For the callosities located on the hand, interposition of a soft pad between the hand and the hard object responsible for the friction should help.

Once the cause of friction has been removed the process will reverse itself and the com/callosity would tend to disappear on its own, without any treatment, but this can take several months. To hasten the disappearance of the corn/ callosity one can use certain medicines which help to disintegrate the thickened stratum corneum (keratin plug). Such medicines are preferably applied under an occlusive pad/ dressing. The pad should be applied immediately after the bath and removed only the next day, before the next bath. During bathing the area should be cleaned thoroughly with a soap and the softened portion of the corm/callosity should be rubbed off from the com as much as possible. Continued daily applications of these pads would help in progressive reduction of the thickness of the keratin plug and this can be continued till the skin has attained normal texture. The process of removal of the keratin plug can however, be expedited by surgical removal of the keratin plug. In all such cases however, if the cause of the friction is not removed, the com/callosity will reappear. Therefore, identification of the cause of friction and taking measures to prevent further friction are more important than removal of the keratin plug.

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