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Macerated skin caused by 'corn plasters'

Discussion in 'General Issues and Discussion Forum' started by Ros the Pod, Feb 2, 2010.

  1. Ros the Pod

    Ros the Pod Active Member

    Members do not see these Ads. Sign Up.
    What do you use when a client presents themselves in agony after using corn plasters on a huge corn? What is your best tip to stop the scalpel slipping?
  2. hamish dow

    hamish dow Active Member

    Patience with the patient
  3. A large hammer to stop the patient self tx.

    But If my old Tutor Phil was here he probably say something about the importance of skin tension with your non-scalpel hand.
  4. DaVinci

    DaVinci Well-Known Member

    "I thought I would use the corn plaster to soften the skin to make your job easier"
  5. Problem solve- what do you have at your disposal that might "dry" it out?
  6. Lignocaine 2% and good scalpel technique.
  7. some of these cases may present with sublesional tracking sinus, especially when there is a throbbing pain.
    If you are certain there is no infection, apply Aluminum Chloride (i.e. Drysol sol) o.d or b.d, cover with dry gauze and let the patient come back the next day.
    Antifungal antibiotic clotrimazole solution also works wonders in reducing maceration especially if you need speedy results.
  8. Dido

    Dido Active Member

    I agree with Richard.
    I have seen more than enough cases of appalling tissue damage by this type of self-treatment, some that needed hospitalisation.
    I have found that wiping with IMS, or similar, followed by debridement with good skin tension works well, if the skin is macerated but firm.
    If the macerated skin is hanging off in strips with suspected infection then a dressing and a visit to A & E might be the only answer.

  9. Nat Smith

    Nat Smith Active Member

    Good skin tension and a good stern lecture about never using them again...I tell them that the Salicylic Acid has eaten into the skin...none of them ever seem to read the ingredients...they all seem to understand though when you say "acid"...(sometimes I get a perverse kick out of scaring my patients into submission). Why exactly are these products allowed to be sold OTC?
  10. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Clean the lesion thoroughly with alcohol pre-op antiseptic solution. Give the strong advice to the patient about the foolishness of their self-treatment, and its painful result, while waiting for the alcohol to evaporate and for the corn to "dry". Very careful debridement/ drain pus if present. Offload with an appropriate corn ring or oval, dress and review in 48 hours. Treat as appropriate to encourage continued healing or refer to patient's doctor if situation warrants it. (It never ceases to amaze me that pharmacists continue to sell medicated corn plasters to the public. Surely long-past time that they were banned from otc - "over the counter" - sale.)
  11. At the risk of attracting professional humiliation.....I have to say that when patients present with the above scenario - i.e. painful maccerated HD following self Rx with sal acid plasters - it often makes my job much easier. Sure you can have lots of necrotic tissue and discomfort and infection, but more often than not, it eases debridement and facilitates healing due to the hyperaemia. Digital/infiltrative block and debride fully and heal with inadine dressings or fucidin ointment if infection present. Haven't we used sal acid 60% on a varienty of lesions too???? Of course, I do caution against the use of self medicated plasters - especially in interdigital lesions or where the patient has underlying pathology like ischaemia, neuropathy etc etc....but otherwise, it's a bit like shoes. Give advice and let the patient make their own decisions....

    Banning corn plasters?? Get real! Let's try tobacco products first shall we?
  12. Not right now- just enjoying a Cuban
  13. Dido

    Dido Active Member

    Posted by SS

    Viejo o joven ?

    Como le va?

  14. Me fue dado por un amigo que enseñé hace algunos años. Pues soy siempre un mán muchacho.

    Something like that anyway, I learnt Spanish via Dora the explorer, so it doesn't extend to conversational- that's a google translation above.
  15. hamish dow

    hamish dow Active Member

    So in a nutshell, good technique an a healthy dolop of experience goes a long way. O and of course the ability to adapt to the situation as it requires without being rude to the person who misguidedy made the job more "interesting".
  16. markjohconley

    markjohconley Well-Known Member

    I tend to treat as an ulcer but don't debride till the maceration has been resolved, a habit I've attained after a early, in my career, history of overdebriding of macerated lesions. get them back in a few days.
  17. Ros the Pod

    Ros the Pod Active Member

    I have just discovered something myself - a dab of Friar's Balsam on the macerated tissue works a treat.
  18. Nice. Had you down for a Lebanese aficianado though....:dizzy:
  19. Not these days; I'm smoking baboons, they're milder:
    Have a gorilla.

    No thanks... I'm trying to give them up.

    Splendid for you! Now, Neddie, here's the money for moving the piano. There you are: five pounds in fivers.

    Some cut:
    Are you sure you won't have a gorilla?

    No thanks, I've just put one out.

    I see.

    More cut:
    What number?

    7A. Have a gorilla.

    No, they hurt my throat.

    Oh, naughty gorillas.

    Even more cut:
    Here! Have a gorilla.

    Oh! Thanks.

    [Gorilla roaring]

    Oww! Oww! Ooh! Oww! Hey! These gorillas are strong. Here! Have one of my monkeys - they're milder.

    Even, even more cut:
    Inside the air was filled with gorilla smoke.

    Even, even, even more cut:
    Now... have a gorilla.

    No thanks - I only smoke baboons.

    Good show!

    Yes. Babboon show!

    Whole script here: http://www.thegoonshow.net/scripts_show.asp?title=s06e04_napoleons_piano

    One of my all time favourites.
  20. You wouldn't be able to watch that sous l'influence Lebanese. Classic.
  21. Suzannethefoot

    Suzannethefoot Active Member

    I tell them that I can't treat them until the damage that they have done heals, then send them away with a stern lecture. Scare stories so that they will not do it again are always a favourite too. The stories are true, so I don't feel bad about terrifying them.
  22. cornmerchant

    cornmerchant Well-Known Member


    Surely as a professional you are not there to judge? Give advice of course, but to actually tell them off
    for purchasing and using a product that is sold over the counter to treat the problem they have is maybe taking it a little far ? Maybe the stance you take is that of a NHS pod?

    I still treat these patients. there may be an underlying ulceration that needs attention as a result of the plaster, and even reduction of the maceration can speed up healing.

  23. Cameron

    Cameron Well-Known Member


    I agree with cornmerchant it is not our job to judge but inform. Infuriating and frustrating as that might be from time to time. I have a client who will against my advice self medicate he also takes every opportunity to consult with other pods. Feedback indicates the practitoners think less of me because he continues to use medicated plasters.

    The action of the acid (salicylic) is it breaks down the side salt linkages of the keratin molecules and traps water (microscopically). The keratolytic action gives the appearance of a mass of white, rubbery skin. All things considered antisetic astringents as has been previously suggested would assist with dissection with the scalpel. The same macerated tissue is seen in fibrous corns (often confused for white fibrous tissue). In the caseof fibrous corns the macerated tissues will also respond to astringents.

  24. Suzannethefoot

    Suzannethefoot Active Member

    Judging how much skin to remove, when it is macerated by the use of these outdated and downright dangerous corn plasters, is, I have found out to my cost, (and my patients), very hard to do. I do treat the patients, after a few days, when I can see what I'm doing clearly. My judgement, as a chiropodist, is what my patients are paying for. Anything that I can do to stop my patients using them again, is, I believe legitimate, including frightening them into chucking the rest off the packet away.
  25. markjohconley

    markjohconley Well-Known Member

    Yep 100% with you Suzanne!
  26. Cameron

    Cameron Well-Known Member


    The independent evidence to support withdrawal of corn cures based upon clinical critical incidents is scant. Hence the reason they continue to be available. Severe reactions are thought in the main to be the result of misuse by the consumer who has failed to follow manufacturers instructions. Hence the fault does not lie with the product. Apparently the belief of doubling the doze to rid themselves of the irritation in half the time, prevails.

    Corn cures have been around for centuries and corn operators (our ancestors) were masters in their use.

    The irony is of couse centuries later, the corn still masters us.

    What say you?

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