From the Guidelines
Debridement of corns, either through manual debridement or paring of hyperkeratosis by a podiatrist, is the most effective treatment approach, with the use of emollients and nonadherent dressings post-debridement to protect the skin. This method is supported by a study published in the British Journal of Dermatology in 2020 1, which recommends debridement as a procedure performed regularly by podiatrists, with the option for self-management using an emery board or nailfile for less severe cases. When considering treatment options, it's essential to prioritize assessment and correction of weight distribution, with cushioning to reduce hyperkeratosis build-up, as this can help alleviate pressure on the skin and prevent further corn formation 1. Some key points to consider when treating corns include:
- Debridement should be performed carefully, especially in patients with sensitive skin or underlying conditions, to avoid overdebridement and potential complications 1
- The use of EB-specific assessment tools, such as pressure assessment platforms, can help evaluate the distribution of pressure on the skin and guide management decisions 1
- Emollients and nonadherent dressings should be used post-debridement to protect the skin and promote healing 1
- Patients with persistent or painful corns, or those with underlying conditions such as diabetes or poor circulation, should consult a podiatrist for professional care, as they may require more intensive treatment or surgical removal in severe cases.
From the FDA Drug Label
Indications and Usage For debridement and promotion of normal healing of hyperkeratotic surface lesions, particularly where healing is retarded by local infection, necrotic tissue, fibrinous or purulent debris or eschar. Urea is useful for the treatment of hyperkeratotic conditions such as dry, rough skin, dermatitis, psoriasis, xerosis, ichthyosis, eczema, keratosis pilaris, keratosis palmaris, keratoderma, corns and calluses, as well as damaged, ingrown and devitalized nails.
- The treatment for corns is urea (TOP) as it is useful for the treatment of hyperkeratotic conditions including corns 2.
From the Research
Treatment Options for Corns
- Salicylic acid plasters: Studies have shown that salicylic acid plasters are an effective treatment for corns, with a higher proportion of resolved corns and a prolonged time to corn recurrence compared to scalpel debridement 3, 4.
- Scalpel debridement: This is a common treatment method for corns, but studies have shown that it may not be as effective as salicylic acid plasters in the long term 3, 5.
- Split-thickness sole skin graft (STSSG): This is a surgical method that involves harvesting a skin graft from the arch of the sole and using it to reconstruct the wound after corn excision. Studies have shown that STSSG can be a reliable alternative treatment for recurrent palmoplantar hyperkeratosis 6.
- Conservative modalities: Using a shoe insert and properly fitting shoes can help to reduce pressure on the corn and promote healing 6.
Mechanism of Action
- Salicylic acid: The exact mechanism of keratolytic action of salicylic acid is poorly defined, but studies have shown that it may disrupt intercellular adhesion structures and stimulate proteinase-mediated desquamation processes 7.
- Tissue-type plasminogen activator (tPA): Studies have shown that tPA plays a role in the keratolytic action of salicylic acid, and that an altered balance in tPA and PAI-2 levels contributes to the induction of hyperkeratotic corn tissue 7.
Effectiveness of Treatment
- Salicylic acid plasters: Studies have shown that salicylic acid plasters are effective in facilitating corn resolution, with a median resolution time of 10.0 months 4.
- Scalpel debridement: Studies have shown that scalpel debridement can relieve pain more effectively than salicylic acid patches in the short term, but may not be as effective in the long term 5.
- Quality of life: Studies have shown that treatment with salicylic acid plasters or scalpel debridement can improve quality of life and reduce foot-related disability, but the effect may decrease over time 4, 5.