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Pharmacotherapy > Corns, Calluses, Bunions, Ingrown Nails, and Warts > Flashcards

Corns, Calluses, Bunions, Ingrown Nails, and Warts Flashcards

1
Q

Corns and calluses description and other names

A

Calvus or heloma (corn) or tyloma (callus)
- not contagious
seen in all age groups
- when pressed manually or when walking, both may present with pain or burning sensation

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2
Q

Corn and callus pathophysiology

A
  • Are the result of over-keratinization in an attempt to protect the foot from excessive friction or pressure
  • Due to ill-fitting footwear, abnormal gait, weight gain, or foot structure
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3
Q

Corns - Presentation

A

Inspect the foot and footwear

  • Central radix (cone) over bony areas
  • Affected area may be yellowed
  • Skin ridges pass through corns but around plantar warts
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4
Q

Hard corn description

A

On toe joints or soles of feet
- Favor 5th toe joint or on the soles
No bleeding when skin is removed
- May be confused with plantar warts (which can bleed)

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5
Q

Soft corn description

A

Found in between toes
-Favor being in between 4th and 5th toe
Are the result of hard corns absorbing moisture (sweat)
Are often quite painful
- May be confused with athlete’s foot (which is not painful)
- Athletes’ foot is a fungal infection and occurs in populations beyond athletes!
- Athletes foot is pruritic (itchy) and flaky +/-
inflammation

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6
Q

Calluses- Presentation (4)

A
  • Similar in appearance to corns, but better defined
  • No central radix
  • On soles or balls of feet
  • Even thickness
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7
Q

Corns, Calluses, Bunions – Red Flags (6)

A
  1. Doubt in diagnosis
  2. Immunocompromised patients (e.g., diabetes)*
  3. Signs of gangrene
    - Discoloration of skin, necrosis, moderate to severe pain without palpation
  4. Peripheral vascular disease*
  5. Over 65 years old
  6. Malnourished*
    - *Due to impaired wound healing; should see podiatrist /foot care specialist
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8
Q

Corns and Calluses – Goals of Therapy (3)

A
  1. Relieve symptoms
  2. Remove cause of lesion so it may regress
    - Or not progress, as in bunions (…later)
  3. Prevent recurrences
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9
Q

Corns and Calluses – Non-Pharm (3)

A
  1. High-risk (immunocompromised) individuals should
    have their feet examined regularly by a foot care
    specialist
  2. Manage footwear – most common, effective option
    - Change footwear entirely
    - Use orthotic devices to provide arch support and evenly distribute bodyweight
    - Protect affected area with cushioning
  3. Debridement
    - Pumice stones can be used after feet have been soaked for 10 minutes (oils can be applied to further soften these areas)
    - Files / emery boards can be used on dry feet
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10
Q

Corns and Calluses – Pharm (1)

A

Keratolytics – salicylic acid (12 – 40%)

-Overall, little evidence for effectiveness but may speed up the process

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11
Q

Keratolytics details on how to prescribe (corns)

A

Would still recommend if prevention options are not practical or patient is eager to treat
- Be familiar with how to counsel on effective and safe use (Some differences between products (e.g., BID application with liquids vs. q48h with pads), but all for ~14 days.)
- Plasters and pads tend to adhere better than liquid dosage forms, the latter of which can also affect healthy skin
- Always suggest protecting the surrounding skin with occlusive barriers such as petrolatum or donut-bandages for more precise application.
 SE: burning, irritation

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12
Q

Corns and Calluses – Prevention (4)

A
  1. Proper shoe fit (see end of presentation)
  2. Maintain moisture balance / remove dead skin
  3. Moisturizers / hydrating products
    - Should be applied to feet, but not between toes, as this could cause excess moisture, softening, and maceration. e.g., Glaxal Base®, Cetaphil Lotion®
  4. Keratolytic / exfoliating moisturizers
    - Should only be applied to healthy skin. e.g., Uremol 10-20% - contains urea
    - May cause burning or tingling on dry/cracked skin
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13
Q

Monitoring and Follow-Up (corns and calluses)

A
  • Clinical improvement in 10-14 days after initiating salicylic acid treatment.
  • Foot should be inspected at least twice-weekly until healing is complete
  • If normal skin damaged by inappropriate application, suggest discontinuation until irritation resolves / skin is healed.
  • If lesions become more inflamed or purulent, refer to foot care specialist.
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14
Q

Bunions description and proper name

A
  • A.k.a. hallux valgus
  • Deformed big toe (great toe) joint resulting in a bump
  • Are 10X more common in women than men (Likely due to the wearing of narrow, pointed-toe shoes)
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15
Q

Bunion pathophysiology/risk factors (4)

A
  • Bone structure (which may be inherited)
  • Abnormal gait / joint motion
  • Ill-fitting footwear
  • Arthritis
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16
Q

Bunion Presentation

A
  • Joint is angled outward while toe is pointed towards
    other toes
  • Could affect little (5th) toe as well – bunionette!
  • May cause pain, swelling, and redness (bursitis)

refer

17
Q

Bunion Management - Non-Pharm

A

No good treatment options
- Early intervention may stabilize joint and reduce
development of arthritis
- Cushions or foam may slow progression and
provide comfort
Surgical options
- Are based on a variety of factors
- May improve aesthetic concerns, but can be long recovery

18
Q

Bunion Management - Pharm

A
  • Manage pain with ice packs and oral analgesics

- Intra-articular corticosteroids may be considered if pain is severe

19
Q

What to do for a patient with ingrown nails

A
  • Refer patients with ingrown toenails to a foot-care
    specialist (Pain, erythema, abscess may be present)
  • To prevent toenails from becoming ingrown, trim
    them straight across and do not round the corners.
    The corners of nails should project beyond the skin
20
Q

Ingrown nails – Management

A
  • Foam toecaps are useful as protective devices for ingrown toenails
  • Suggest proper footwear
21
Q

What are some footwear tips?

A
  • Buy for the intended activity, shop later in the day, ensure all toes fits comfortably in toe-box, walk around to check for tightness, rubbing, or slipping.
  • Desirable features:
     Avoid slip-on shoes as foot may slide inside the shoe
     Made of natural materials for greater breathability
     Lightweight and flexible with good cushioning
     Heels no higher than 1.5 inches
     Wide toe box
22
Q

What are 3 types of warts?

A

Plantar, common and plane

23
Q

Plantar warts description (proper name, contagious? age groups)

A

Benign, contagious tumors – verrucae plantaris
- Can cause embarrassment and pain
- Most common in children and young adults
- Contagious
– Caused by HPV strains infiltrating the skin via cut or micrabrasions transmitted via contact with another lesion or contaminated surfaces
- Although many viruses die within 1–2 years, untreated
plantar warts can easily spread to other sites

24
Q

Plantar wart risk factors (2)

A
  • Immunosuppression (e.g., HIV, transplant patients)
  • Exposure and spread through contact with another lesion or a contaminated surface (e.g., swimming pool deck, gym floors/showers)
25
Q

Plantar wart presentation

A

Found on soles of feet
- This is were micro-abraisions are more likely to allow inoculation
- May occur singly or in clusters
- Generally skin-colored and contain thrombosed capillaries that appear as black dots in the center of the lesion
Often symptomless
- But can have pain with pressure
- Grow inward due to walking

26
Q

Plantar Warts – Red Flags (5)

A
  • Doubt in diagnosis
  • Change in appearance, color, or increasing pain
  • Immunocompromised patients (e.g., diabetes)
  • Peripheral vascular disease
  • Affecting mobility
27
Q

Plantar Warts – Non-Pharm (4)

A

Should be referred to a podiatrist, physician, or dermatologist
1. Cryotherapy with liquid nitrogen (-196ºC)
- Considered first-line; requires multiple treatments
- SE: pain, blistering, and scarring
2. Dimethyl ether and propane (at-home option, -57ºC))
- Also freezes the wart creating a blister
underneath it causing it to fall off
3. CO2 laser therapy / pulsed die laser
- Destroy tissue and vasculature respectively
4. Other
- Hyperthermic therapy – soaking in 44ºC water
- Duct tape – not effective

28
Q

Plantar Warts – Pharm

A

Salicylic acid – 5-40%
- MOA: keratolytic and drying agent. Topical chemicals
trigger inflammatory response and can stimulate the body to attack the virus and destroy infected tissue
- SE: low scarring potential, but can take months to be
effective. Because of location of foot, liquid preparations are preferred over pastes or ointments, as the latter may spread to healthy skin due to pressure of walking
- Cure rates with any method are 60-70%
- Not be used on warts on other parts of the body
(exception hands)
- Not be used on birthmarks and moles

29
Q

How to Apply Topical Products for Plantar Warts?

A

1.Soak foot in warm water for 5-10 minutes
2. Rub away loose tissue with pumice stone or emery
board
3. Apply agent to affected areas only, protecting
surrounding healthy skin with petrolatum
4. Apply product and cover with medical tape
5. Repeat process every ~2 days
(Product dependent)

30
Q

Plantar Warts – Prevention (5)

A 
- Avoid being barefoot
 Recommend pool shoes
- Do not share footwear
- Keep feet clean and dry
- Change socks and shoes regularly
- Cover existing warts with bandages to avoid
transmission
31
Q

Monitoring and Follow-Up (plantar warts)

A
  • Can follow-up with patient every 4 weeks to
    monitor for improvement and encourage continued
    adherence
  • If lesion persists after 12 weeks of self-treatment or
    becomes inflamed or purulent, refer to foot care
    specialist.
32
Q

Common and plane warts description (proper name, contagious? age groups)

A
  • Benign, contagious tumors cause by HPV strains
  • Children and young adults are most commonly affected
  • Same means of transmission and similar incubation as with plantar warts
  • Common Warts:
     Most often seen on the knees, fingers, hands and around the nails
  • Plane Warts:
     Most often seen on face and neck
33
Q

Common and plane warts management - non-pharm

A

Similar to plantar warts

34
Q

Common and plane warts management - pharm (4)

A
  • Salicylic formulations not to be used on the face, neck and genital area. Can recommend for hands.
  • Virucidal Therapy*
  • Antiproliferative Therapy*
  • Immunological therapy*
     Cimetidine has been used in the treatment of warts
     MOA: Increasing cell-mediated immunity by blocking T-suppressor cells on H2 receptors
     Dose: 30-50 mg/kg/ day in 4 divided doses
     Evidence: Mixed results (inconclusive in RCTs)

Pharmacotherapy (14 decks)

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