Ck Birla Hospital For Women

A corn (or clavus, plural clavi or clavuses) is a distinctively shaped callus of dead skin that usually occurs on thin or glabrous (hairless and smooth) skin surfaces, especially on the dorsal surface of toes or fingers. They can sometimes occur on the thicker skin of the palms or bottom of the feet.

Corns form when the pressure point against the skin traces an elliptical or semi-elliptical path during the rubbing motion, the center of which is at the point of pressure, gradually widening. If there is constant stimulation of the tissue producing the corns, even after the corn is surgically removed, the skin may continue to grow as a corn.

 Signs and symptoms

The hard part at the center of the corn resembles a barley seed, that is like a funnel with a broad raised top and a pointed bottom. Because of their shape, corns intensify the pressure at the tip and can cause deep tissue damage and ulceration. Hard corns are especially problematic for people with insensitive skin due to damaged nerves (e.g., in people with diabetes mellitus). The scientific name for a corn is heloma(plural helomata). A hard corn is called a heloma durum, while a soft corn is called a heloma molle.

The location of soft corns tends to differ from that of hard corns. Hard corns occur on dry, flat surfaces of skin. Soft corns (frequently found between adjacent toes) stay moist, keeping the surrounding skin soft. The corn's center is not soft, however, but indurated.

Diagnosis

To exclude other differential diagnoses, a skin biopsy may be taken.

Treatment

 A popular method is to use a corn plaster, a felt ring with a core of salicylic acid that relieves pressure and erodes the hard skin. However, if an abnormal pressure source remains, the corn generally returns. If the source of any abnormal pressure is detected, this may be avoided, usually through a change to more comfortable footwear or with various types of shoe inserts or footwear with extra toe space. In extreme cases correcting gait abnormalities may be required. If no other treatment is effective, surgery may be performed.

Depression is a serious mental illness in which feelings of sadness and loss of interest last for weeks and interfere with daily life.

There are numerous factors that can trigger the onset of depression, including:

•  Actions and conditions (like threat, abuse)
•  Illness (such as cancer or chronic pain),
•  Social isolation or loneliness and
• Stressful life events (such as divorce or money problems).
• Depression can cause deep emotional pain both to the person experiencing it and, often, to that person's close family and friends.

There are several different types of medically recognized depression.

• Major depression
• Episodic Depression
• Post Partum Depression
• Pre and marital Depression
• The most common type of depression is called major depression

It occurs when your symptoms interfere with your enjoyment of life or daily functions — including your work, sleep, and eating habits for atleast two weeks straight.

Episodic Depression

Some people experience only one episode of major depression in their life, while others may go through numerous episodes of the illness.

What are ingrown toenails?

1. Ingrown toenails occur when the edges or corners of the nail grow into the skin next to the nail.

2.  Ingrown toenails that are not infected can be treated at home, but you should seek medical treatment if the nail has pierced the skin.

3.   You are at a higher risk of complications from an ingrown toenail if you have diabetes or other conditions that cause poor circulation.

Ingrown toenails occur when the edges or corners of your nails grow into the skin next to the nail. Your big toe is most likely to get an ingrown toenail.

What causes ingrown toenails?

Ingrown toenails occur in both men and women. According to the National Health Services (NHS), ingrown toenails may be more common in people with sweaty feet, such as teenagers. Older people may also be at higher risk because toenails thicken with age.

Many things can cause an ingrown toenail, including:

• Cutting toenails incorrectly (cut straight across, since angling the sides of the nail can encourage the nail to grow into the skin)
• Irregular, curved toenails
• Footwear that places a lot of pressure on the big toes, such as socks and stockings that are too tight or shoes that are too tight, narrow, or flat for your feet
• Toenail injury, including stubbing your toe, dropping something heavy on your foot, or kicking a ball repeatedly
• Poor posture
• Improper foot hygiene, such as not keeping your feet clean or dry
• Genetic predisposition

Using your feet extensively during athletic activities can make you especially prone to getting ingrown toenails. Activities in which you repeatedly kick an object or put pressure on your feet for long periods of time can cause toenail damage and increase your risk of ingrown toenails. They include:

• Ballet
• Football
• Kickboxing
• Soccer

What are the symptoms of ingrown toenails?

Ingrown toenails can be painful, and they usually worsen in stages.

Early-stage symptoms include:

• Skin next to the nail becoming tender, swollen, or hard
• Pain when pressure is placed on the toe
• Fluid building up around the toe

If your toe becomes infected, symptoms may include:

• Red, swollen skin
• Pain
• Bleeding
• Oozing pus
• Overgrowth of skin around the toe

How are ingrown toenails diagnosed?

Your doctor will most likely be able to diagnose your toe with a physical exam. 

What are the treatment options for ingrown toenails?

Ingrown toenails that aren’t infected can normally be treated at home. However, if your toenail has pierced the skin, or there is any sign of infection, seek medical treatment. Signs of infection include:

• Warmth
• Pus
• Redness and swelling

Home treatment

To treat your ingrown toenail at home, try:

• Soaking your feet in warm water for about 15 to 20 minutes three to four times a day
• Pushing skin away from the toenail edge with a cotton ball soaked in olive oil
• Using over-the-counter medicines, like calpol, for the pain
• Applying a topical antibiotic, such as t-bact, to prevent infection

• If the toenail does not respond to home treatments or an infection occurs, you may need surgery. In cases of infection, stop all home treatments and see your doctor.

  Surgical treatment

  Total nail removal may be used if your ingrown nail is caused by thickening. The doctor will give you a local pain injection and then remove the entire nail.

•  According to the NHS, nail removal is 98 percent effective for preventing future ingrown toenails.

  After surgery

  Your doctor will send you home with your toe bandaged. You will probably need to keep your foot raised for the next one to two days and wear special footwear to allow your toe to heal properly.

  Avoid movement as much as possible. Your bandage is usually removed two days after surgery. Your doctor will advise you to wear open-toed shoes and to do daily salt water soaks until your toe heals. You will also be prescribed pain relief medication and antibiotics to prevent infection.

  Your toenail will likely grow back a few months after a partial nail removal surgery. If the entire nail is removed down to the base, the nail matrix under your skin, a toenail can take over a year to fully grow back.

  Complications of ingrown toenails

  If left untreated, an ingrown toenail infection can cause an infection in the bone in your toe. A toenail infection can also lead to foot ulcers, or open sores, and a loss of blood flow to the infected area. 

  A foot infection can be more serious if you have diabetes. 

  Preventing ingrown toenails

  Trim your toenails straight across and make sure that the edges do not curve in.

• Avoid cutting toenails too short.
• Wear proper fitting shoes, socks, and tights.
• Wear steel-toed boots if you work in hazardous conditions.

• If your toenails are abnormally curved or thick, surgery may be necessary to prevent ingrown nails. 

Paronychia is a soft tissue infection around a fingernail that begins as cellulitis but that may progress to a definite abscess. The 2 types of paronychia are as follows :

• Acute paronychia - Painful and purulent condition; most frequently caused by staphylococci.

• Chronic paronychia - Usually caused by a fungal infection

The image below depicts paronychia.

Classic presentation of paronychia, with erythema and pus surrounding the nail bed.

Signs and symptoms

Physical findings in acute paronychia include the following:

• The affected area often appears erythematous and swollen

• In more advanced cases, pus may collect under the skin of the lateral fold

• If untreated, the infection can extend into the eponychium, in which case it is called eponychia

Further extension of the infection can lead to the involvement of both lateral folds as it tracks under the nail sulcus; this progression is called a runaround infection.

Physical findings in chronic paronychia include the following:

• Swollen, erythematous, and tender nail folds without fluctuance are characteristic of chronic paronychia

• Eventually, the nail plates become thickened and discolored, with pronounced transverse ridges

• The cuticles and nail folds may separate from the nail plate, forming a space for the invasion of various microorganisms

Diagnosis

The diagnosis of paronychia is based primarily on patient history and physical examination. Some laboratory studies, however, can be useful. These include the following:

• Gram staining and/or culture - To help identify a bacterial cause of fluctuant paronychia.

• Potassium hydroxide (KOH) 5% smears - To help diagnose fluctuant paronychia caused by a candidal infection

Management

Treatment strategies for paronychia include the following:

• If soft tissue swelling is present without fluctuance, the infection may resolve with warm soaks 3-4 times daily

• Patients with extensive surrounding cellulitis or with a history of diabetes, peripheral vascular disease, or an immunocompromised state may benefit from a short course of antibiotics

• If an abscess has developed, incision and drainage must be performed.