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Hi all,

I've long been interested in the so-called "smoker's corn", which I attach as an example.

Having seen some work by Craig Camasta DPM, I am interested in wether there is any other literature on the subject. These intractable yellow, macerated lesions are quite peculiar.

Many thanks,

Attached Images

IPK smoking 001a.jpg (75.5 KB, 479 views)

There was a little discussion here:

http://www.podiatry-arena.com/podiat...read.php?t=544

But no literature

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LuckyLisfranc

I think what may be confusing the issue is the basic terminology. Describing the presenting skin symptoms there appears to be an indentation in the epidermis which has localised hyperkeratotic hypertrophy. The whiter underling skin which surrounds the yellow mass would be consistent with increased hydration (water trapped in the side salt linkages of the keratin molecules). These kinds of lesion are often long standing and thought to be the result of secondary changes within the dermis where the yellow elastic tissue is replaced by white fibrous bands binding the Stratum Germinitum to the fibrous capsule beneath. These are often referred to in chiropody text as fibrous corns. All too frequently the white maceration is confused with the microscopic white fibrous tissue within the dermis. This would be impossible to see with the naked eye and as the lesion is not a second intension wound, there would be no visible keloids. Daily enucleating the hyperkeratosis followed by paints with an alcoholic base will quickly change the colour from white to yellow. Effectively the whiteness disappears, this would be impossible if the cells were fibrous tissue.

Discoluration similar to the macerated appearance can be found on the skin surfaces after applications of salicylic acids. This is thought to represent a microscopic hydration of the keratin cells and when the cells are physically remove the colour of skin reverts to normal.


The association with smokers

I worked with a chap in NZ and he was convinced smoking could influence chemical deposits in skin cells. He thought smoker's hard skin was darker brown than no smokers. There was some preliminary studies done with a skin light/ colour instrument but the results were inconclusive. It has been shown that chemical deposits have been found in the skin and nails from systemic ingestion e.g. gold and arsenic, so it is not beyond belief nicotine or other tar derivatives may stain skin under certain circumstances. The circumstances have never been proven.

Another plausible explanation is the fibrous lesions are chronic and painful feet in the client group are borne stoically. Often those most severely affected have co moribund complications which might involve compulsive behaviours such smoking and dependency on alcohol and drugs. In the thirties when most of the text concerning this skin lesion classification was made many of the clients described were institutionalised individuals who smoked incessantly.

I think the colour of the hyperkeratosis may become more pigmented in smokers but the association between smoking and localised hyperkeratosis on weighbearing areas is zero.

Cameron
Hey, what do I know?

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Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen

Thanks for your opinion Cameron.

I think this condition is something that is steeped in anecdote - but I really believe it exists as a distinct pathology separate to typical discreet hyperkertotic lesions and IPK.

Certainly since being made aware of these lesions by podiatric surgeons, who refuse to operate on them in the presence of a continued smoking habit, I can almost predict a person has a heavy smoking habit based soley on the clinical appearance of the 'corn'.

Craig Camasta I think had some ?unpublished work on changes in incidence pre/post smoking which was quite interesting.

Although this condition seems universally known about by all podiatric surgeons I speak with, general podiatrist are usually quite astounded at the proposition. :p

Dr. Camasta has made a few presentations on this topic at the Podiatry Institute Seminars - why not check with him directly. I have been a patient of his over the years and he has never failed to answer any questions I had - from the complex to the mundane. He is very approachable and would be pleased to help in any way that he can. His e-mail address is posted on the faculty page of the Podiatry Institute's website ( www.podiatryinstitute.com ).
Becca

I posed a similar question a while ago (maybe May/June)on Podiatry Arena, IPK and smokers. Some interesting info came from that and even though I have made the suggestion to a few people that there may be an association between their smoking and the pain in/on their foot they would still rather ask "isn't there anything else you can do" (besides debriding/ deflective padding than stop lighting their nicotine sticks.
Would be interested to see what comes back from Craig Camasta.