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I have been seeing a patient who had an adverse reaction to a 25% urea heel balm.

The 50yo female had never had callous before she went on a holiday late last year, during the holiday she developed a small amount of callous on her heels. A friend told her to use a popular branded heel balm to solve the problem.

On the first application she reported a tingly buring sensation, but thought it was normal. She continued to use the cream for 4 days. After 4 days of use she had developed callous all over her heels and at both the 1st metatarsophalangeal and interphalangeal joints, so much so that every time she took a step the callous would split open and bleed at all areas.

I have seen this patient 3 times and the callous has reduced and is now using sorbolene. She is still developing the callous and it is still splitting but has decreased in severity.

When the splitting occours the only way the patient receives releif is to use a hydrocolloid dressing. She uses about 4 dressings a week

As i said, before this incident she had never had callous before.

Has anyone experienced this problem in their practice? If so what did you do...

YIKES!

 

Hi Katie,

I haven't experienced such a reaction with urea creams but have you considered hyperkeratotic fungal infn. causing the problem?

Is she on any steroid medication?

I agree that it seems unusual to develop callus so rapidly after using the cream & certainly isn't something I would expect to occur. If fissures were already present then the urea cream could induce inflammation but not callosities so quickly.

Is the callus psoriatic in appearance?

Just my thoughts,

Interested to know how she gets on.

Regards,

 

Thanks Twirly,

No she is not on any medication and the callous is normal in appearance.

There were no fissures present before the use of the emollient which is what makes it so strange

 

Katie

Commonly reported reaction to urea containing cream is urticaria Like a nettle rash). In very rare occssions this may predispose to ichtiosis (fish like scale callus). Hyperkeratosis also arises during menapause and it may well be worth referring your patient to her GP for a dermatology consultation.

toeslayer