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LETTER TO THE EDITOR
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 49-50  

Corns in scleroderma: An underreported entity


Department of Dermatology, Father Muller Medical College and Hospital, Kankanady, Mangalore, Karnataka, India

Date of Web Publication20-Jan-2017

Correspondence Address:
Dr. Namitha Chathra
Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Kankanady, Mangalore - 575 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.198764

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How to cite this article:
Chathra N, Bhat RM. Corns in scleroderma: An underreported entity. Indian Dermatol Online J 2017;8:49-50

How to cite this URL:
Chathra N, Bhat RM. Corns in scleroderma: An underreported entity. Indian Dermatol Online J [serial online] 2017 [cited 2019 Sep 16];8:49-50. Available from: http://www.idoj.in/text.asp?2017/8/1/49/198764

Sir,

Systemic sclerosis (SSc) has been associated with a myriad of foot problems ranging from Raynaud's phenomenon to degenerative changes.[1] However, the occurrence of plantar corns in patients with SSc, as noticed consistently by one of the authors, has remained an unreported entity to the best of our knowledge. Based on this observation, we set out to assess the frequency of corns in scleroderma and the possible pathomechanism behind it.

For this purpose, during a one-year period (March 2011 to February 2012) we studied 18 patients with SSc and 5 patients with mixed connective tissue disease who were diagnosed based on the criteria developed by the American College of Rheumatology and Kasukawa et al., respectively.[2],[3] On examination, all the 18 patients with scleroderma and 3 of 5 MCTD patients were found to have corns on the plantar aspect of their feet. All the lesions had a sharp, discrete border with interrupted dermatoglyphics, thus distinguishing them from callosities [Figure 1]. Also, the lesions did not show any bleeding points following paring, thus negating the possibility of plantar warts. All the patients complained of tenderness, which increased on applying vertical pressure.
Figure 1: Lesion showing central shiny nucleus and absence of dermatoglyphics

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The total number of lesions encountered by us summed up to 60; 20 on the heel area, 24 present lateral to the head of 1st metatarsal, and 15 present between the heads of 4th and 5th metatarsal [Figure 2]. Fifteen patients showed involvement of bilateral feet albeit not necessarily symmetrical. Incidentally, all the 18 patients of SSc had digital pitted scars [Figure 3].
Figure 2: Schematic representation of the distribution of corns

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Figure 3: (a and b) Corns with digital pitted scarring. (c) Corns seen on the heels. Right forefoot amputated secondary to ischemic ulcers

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Corn develops because of an interplay between increase in the pressure on bony prominences and accumulation of the horny layer of the epithelium, thus generating a vicious cycle, which ultimately culminates in the formation of a keratin plug pressing into the dermis.[4] People with SSc also suffer from bone erosions and subcutaneous fat atrophy, consequently increasing plantar foot pressure. Adding to this melee is the prevalent tradition of walking barefoot indoors in this part of the subcontinent, which can increase the wear and tear effect. Furthermore, studies on plantar pressure in scleroderma have demonstrated a particularly high peak pressure in the MTP joint, which substantiates our finding of increased occurrence of corns in the forefoot area.[5] In this study, the all-female population were housewives and had to perform most of their chores standing. This can lead to a further increase in the peak pressure in the MTP joints.

The presence of corns can be considered as a marker for ulceration as the mechanical forces that cause corns and Calluses can also rupture portions of subcutaneous vascular plexus. In healthy patients this may be of minimal significance, but in patients with connective tissue disease it may herald extensive skin ulceration or vasculitis.[5] Thus, corns can be regarded as a sign of the onslaught brought about by the repetitive friction and shear. When the enormity of systemic involvement in SSc is considered, the association of corn may seem trivial. However, knowledge about its occurrence and prompt redressing will go a long way in alleviating the burden of pain and in avoiding more sinister complications such as ulceration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
La Montagna G, Baruffo A, Tirri R, Buono G, Valentini G. Foot involvement in systemic sclerosis: A longitudinal study of 100 patients. Semin Arthritis Rheum 2002;31:248-55.  Back to cited text no. 1
    
2.
Lonzetti LS, Joyal F, Raynauld JP, Roussin A, Goulet JR, Rich E, et al. Updating the American College of Rheumatology preliminary classification criteria for systemic sclerosis: Addition of severe nailfold capillaroscopy abnormalities markedly increases the sensitivity for limited scleroderma. Arthritis Rheum 2001;44:735-6.  Back to cited text no. 2
    
3.
Kasukawa R, Tojo T, Miyawaki S. Preliminary diagnostic criteria for the diagnosis of mixed connective tissue disease. In: Kasukawa R, Sharp GC, editors. Mixed Connective Tissue Diseases and Anti-nuclear Antibodies. Amsterdam: Elsevier; 1987. p. 41-7.  Back to cited text no. 3
    
4.
Singh D, Bentley G, Trevino SG. Callosities, corns, and calluses. BMJ 1996;312:1403-6.  Back to cited text no. 4
    
5.
Alcacer-Pitarch B, Siddle HJ, Dass S, BuchMH, Emery P, Redmond AC. Foot problems in Ssc, a pilot study in investigating foot health status and gait. Ann Rheum Dis 2009;68:748.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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