CALLOSITAS

Synonyms.—Tyioma; Tylosis; Keratoma; Callus; Callosity; Fr., Durillon; Ger.,
Verhärtung.

Definition.—Callositas is a hard, horny, thickened epidermic
patch, due to hyperplasia of the stratum corneum, and occurring for the
most part on the hands and feet.

Symptoms.—Callosities are acquired formations. They consist
of small or large patches of yellowish, grayish, or brownish, hard, horny,
slight or excessive epidermic accumulations, which are generally seen
on parts subjected to pressure or friction. Hardening and slight thick­
ening are also sometimes caused by chemical irritants. The palms,
soles, fingers, and toes are favorite locations. They are somewhat
elevated, are quite thick, especially at the central portion, less so at the
edge, and gradually merging into the sound, unaffected skin; they are
very hard, dry, and horn­like and occasionally brittle. The natural
surface lines of the affected part are obliterated, the patches generally
being smooth. When the thickening is markedly developed, it interferes
with delicacy of touch, and may impair the finer movements somewhat.
As callosities are usually the effort of nature to protect underlying parts
constantly rubbed or pressed upon, they are necessarily very frequently
observed on the hands of mechanics, as tinsmiths, blacksmiths, carpen­
ters, shoemakers, tailors, workers in metals, etc. They are also not in­
frequently seen on the fingers of zither-players, violinists, and harpists.

CALLOSITAS

527

About the soles and sides of the feet they most commonly occur in those
whose occupation requires constant walking or standing, and more
especially if roughly and heavily made or tight shoes are worn. The
ball of the great toe and lateral surface of the little toe and the heel are
favorite locations. They are also obseved in those who go barefooted.
Long-continued pressure kept up by surgical appliances for the correc­
tion of some deformity or the wearing of a truss may bring about callosi­
ties in the parts pressed upon. Callous thickening over the ischial
tuberosities are usually formed in those who sit much upon hard chairs
or benches. They are also thought to arise spontaneously at times, but
such cases are mostly examples of inherited and usually symmetric
callosities—keratosis palmaris et plantaris (q. v.). As a rule, inflam­
matory symptoms do not make their appearance in these growths,
although occasionally, from accidental injury, the subjacent corium may
become inflamed and suppurates, and the thickened mass be cast off.¹
They usually disappear spontaneously when pressure and other external
irritation which may have produced them are removed. A variable
callous condition or horny thickening is, as well known, sometimes
observed in several of the chronic cutaneous diseases, as in some forms
of eczema, in ichthyosis, lichen planus, psoriasis, and a few other maladies,
but in such it is merely a part of the pathologic process; sometimes,
however, the callous development remains after the disease has dis­
appeared. Palmar and plantar keratoses are also not infrequently the
result of prolonged arsenical administration (see dermatitis medicamen-
tosa). Anatomically, the growths consist of thickened upper epidermic
layers; the deeper underlying strata of the epidermis and corium remain,
as a rule, except when involved by accidental inflammatory action,
unaffected.

Treatment.—Quite frequently treatment is not required, as the
accumulation may be a naturally formed protective against the constant
pressure and friction incident to the patient‘s occupation. Occasionally,
however, the formation is excessive and unsightly, and gives rise to dis­
comfort. In such instances and in others in which removal or at least
thinning down is deemed advisable, this object can be accomplished in
several ways. The callus can be softened in hot water containing one-
half to an ounce (16.-32.) of an alkaline carbonate, such as sodium carbo­
nate or bicarbonate, potassium carbonate, or sodium borate, to the gal­
lon. The parts can also be softened by poultices. After a soaking of
some minutes the outer surface is sufficiently softened to be readily
pared down, and this may be repeated until the thickening is sufficiently
reduced. The same result can be obtained by painting on a solution of
caustic potash—in. mild cases, the liquor potassæ, in hard and much
thickened areas a solution several times stronger; care should be exer­
cised with the latter. Several such paintings can be made within a
few minutes of one another, and then the softened part scraped or shaved

¹ Morrison, Jour. Cutan. Dis., 1886, p. 5, reported a curious case in a negro, a fire­
man for ten years on a steamer, in whom the friction of the handle of the shovel and
the exposure to intense heat brought about markedly thickened layered callosities
under which later suppuration, ulceration, and necrosis developed.

528

HYPERTROPHIES

away. According to circumstances it can again be repeated immediately,
or if any irritation has been produced, a day or two later. Lactic acid,
weakened or full strength, will also soften such epidermic accumulations.
Another satisfactory method is by the continuous application of a 10
to 25 per cent, salicylic acid rubber plaster or plaster-mull for several
days or a week; on removal it is followed by hot­ water soaking, and the
mass can, in great part, at least, be rubbed or scraped away. The action
of the plaster may have been sufficient to permit the rubbing or scraping
away of the callus without the supplementary soaking. According to
the degree of thickening this application may need to be repeated once
or several times. The salicylic acid collodion paint, often used in clavus
(q. v.), can be employed in place of the plaster, but is generally not so
efficient, although it is not so inconvenient. In moderate cases envel­
oping the parts at night with a compound salicylated soap-plaster,
advised in some cases of eczema, will usually keep the thickened accumu­
lation from getting stiff, hard, and inelastic.

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