Callus

CALLUS (gallus, gallositas, ty-loma, tylositas), an acquired localized thickening of the skin, mainly of the stratum corneum; in most cases it is a so-called skin mark (stigma), arising as a result of more or less prolonged work in a certain profession. Calluses are caused by prolonged repeated external pressure and friction, and they usually develop at those places where the skin directly abuts the bone. The result of repeated pressure is initially anemia, which is then succeeded by arterial hyperemia, which promotes intensified epithelial formation (Neisser, Jadassohn). Histologically, callus is characterized by hyperkeratosis of varying degree; the other layers of the epidermis and the true skin are also somewhat thickened; in the papillary layer there are minimal inflammatory phenomena. The favorite localization of callus is the palm and the sole. Often, from the localization of callus, one can, without questioning, learn the nature of the work, and sometimes even the profession of the person being examined. For example, in those working with a hammer, calluses form on the palms and in the flexures of the finger joints of the right hand. In bakers, due to kneading dough, calluses arise on the fleshy part of the terminal phalanx and on the entire ulnar side of the little finger on both hands. In carpenters, calluses occur on the right hand in the fold between the thumb and index finger and in the middle part of the hand (as a result of planing); in porters, on the shoulders; in typesetters, on the terminal phalanges and the ends of the fingers. In addition, calluses are observed in workers of a number of other professions: tailors, locksmiths, blacksmiths, coopers, hatmakers, wool felters, painters, bag-makers, saddle-makers, bassoonists, stonecutters, engravers, and others. [see separate table (st. 335-336), fig. 1 and 2]. Clinically, calluses represent slightly limited, dense to the touch, flat or slightly convex thickening of the skin of various colors, from whitish to dark brown, on which the skin pattern is partially or completely absent, and sensitivity is significantly weakened or absent altogether. On the surface of calluses, cracks often form, which can serve as portals of entry for secondary infection, the result of which is lymphangitis, abscesses, phlegmons, and others. In many cases, after the cessation of pressure or friction, calluses disappear spontaneously and slowly, leaving no traces, but in some cases calluses remain even after the elimination of the causative factor as a persistent professional mark; this happens when sclerosis of the connective tissue has already developed or a mucous bursa has formed under the callus. Calluses do not form in all workers engaged in exactly identical work, for example, not in all carpenters or bakers. This apparently depends on the presence or absence of the so-called predisposition of the skin to hyperkeratotic processes. In particular, increased sweating is one of the factors conditioning this predisposition. In most cases, calluses do not affect function, except in those cases where fine manual work is required, which becomes impossible for the owner of a callus due to the absence or reduction of sensitivity. In most cases, however, callus, on the contrary, even facilitates the performance of work. A callus (clavus, from the Latin nail) is a variety of callus, developing under the influence of constant mechanical pressure, mainly in tight, uncomfortable shoes, on prominent parts of the toes or on their fleshy elevations. A callus differs from a callus by a more significant thickness of the stratum corneum, penetrating deep into the dermis, due to which the underlying layers of the epidermis and the upper part of the dermis are indented in the form of a funnel, become inflamed and partially atrophy, and the papillae are elongated. The widely held view that a callus has a core is incorrect. Calluses often become places for the formation of blisters, abscesses, and others; when not aseptically cut, lymphangitis and others may arise. Calluses do not disappear after the elimination of the causes that gave rise to them. In the differential-diagnostic respect, one should remember the possibility of the existence of so-called syphilitic calluses (clavi syphilitic!), distinguished by an infiltrative red-brown rim, and in interdigital calluses - by moist syphilitic papules. Plantar warts, in contrast to calluses, consist of thin growths surrounded by a rim. The prevention of professional calluses consists in improving working conditions - in the mechanization of production processes, in workers wearing rational protective clothing (gloves, knee pads, shoulder pads, pads, etc.). The prevention of calluses consists in wearing comfortable, not tight shoes. - TREATMENT of callus consists primarily in eliminating the causes that produce them. Next, agents that soften callous formations are applied: salicylic or lactic acid in the form of 10% salicylic or salicylic-lactic collodion, steaming with heat, and others. When the callus is softened, it is easier to remove it by cutting the horny layers with a knife or razor or by scraping with a sharp spoon followed by cauterization with ferric chloride. Sometimes it is expedient to prescribe callus rings. In callus, one can try compresses of green soap; in severe cases, X-rays and radium are also applied.