Calluses with black dots on feet and hands

Calluses are a problem known to most people. They are associated with wearing uncomfortable or poor-quality shoes and clothes, with prolonged walking or standing work, with overly sensitive and thin skin - in general, there are quite a few such reasons. As, incidentally, are the varieties of calluses. A black callus looks especially unaesthetic: it is also often very painful. Therefore, owners of such a problematic growth always try to get rid of it if possible. Indeed, the neoplasm should be treated as early as possible. And how to do this correctly, a medical specialist should tell you during an individual consultation.

Causes black callus

Black calluses are most often formed on areas of the skin that are subject to excessive friction or pressure. The appearance of such a growth is a kind of defense of the body, an attempt to resist possible damage to the skin.

In some cases, a black callus is a consequence of a previously existing wet callus, which is a delamination of the epidermis and accumulation of serous or blood fluid in the resulting cavity. In most people, such neoplasms are found on the palms of the hands, soles, heels, outer sides of the shins, which is due to professional characteristics, wearing uncomfortable or low-quality shoes, as well as certain physiological characteristics. In particular, black calluses never form in places of natural skin thinning: damage to these areas leads to the appearance of wounds or ulcers, but not growths. [ 1 ]

The most common causes of black callus formation are:

• Inappropriate, incorrectly selected, low-quality footwear or clothing. Footwear is the most common provoking factor, caused by direct, prolonged and intense friction of the skin surface against protruding parts or other defects of footwear. Sometimes the pressure of clothing or its elements is distributed unevenly, non-physiologically, which provokes the appearance of a black callus. [ 2 ]
• Excess body weight. Obesity and excess weight contribute to a significant increase in pressure on the lower extremities and skin on the foot.
• Congenital and acquired defects, bone deformations. Curvatures of the musculoskeletal system cause incorrect pressure distribution, leading to zonal thickening and compaction of the skin and the formation of callus growths. Defects can be congenital or acquired as a result of injuries, metabolic disorders, abnormal gait, obesity, wearing shoes that are not the right size, etc.
• Metabolic disorders. Serious metabolic disorders can directly or indirectly affect trophic processes and the condition of the skin. Many such diseases disrupt the blood supply to tissues, worsen nerve innervation, make the skin more susceptible and sensitive to various mechanical damage. Additional problems arise against the background of a decrease in local immune protection: the risk of infection of abrasions and scratches increases significantly, which directly affects the formation of black calluses.
• Diseases of the nervous system, paresis, paresthesia. With a decrease and loss of skin sensitivity, conditions arise under which a black callus forms. Increased growth of connective tissue is caused by weak innervation and incorrect trophic processes.

Risk factors

The prevalence of calluses in the elderly population is estimated to range from 36% to 78%.[ 3 ]

The existing factors for the appearance of black calluses are conventionally divided into general and local.

The most probable factors include the following:

• Age. Experts have noticed that patients aged 50-70 most often seek help for the formation of black calluses. This is due to age-related changes in the skin, dehydration of the epidermis, and a decrease in the thickness of the subcutaneous fat layer. In the foot area and, in particular, the sole, the elasticity of the tissues deteriorates over the years. The heel becomes hard, and the mechanical properties of the skin change.
• Gender. Statistics show that women are more susceptible to developing black calluses. The ratio with men is approximately 60:40. This may be due to different initial elasticity of the skin, differences in clothing and footwear preferences (in particular, high-heeled shoes more often lead to the formation of black calluses).
• Excess weight. The frequency of occurrence of problems in the form of black calluses increases significantly in people suffering from obesity. This is due to a significant increase in pressure on the lower extremities, excessive friction of clothing, as well as metabolic disorders and deterioration of the skin in general.
• The degree of physical activity and its features. Black callus often forms in people who are actively involved in sports associated with regular loads on the lower limbs and feet. Such a problem is not uncommon among professional runners, cyclists, biathletes, skiers.
• Incorrect selection of footwear. The development of black calluses can be a consequence of the discrepancy between the shoe model and the shape or size of the foot. In this case, the problem can be caused by both shoes that are too narrow and shoes that are too loose. Unfavorable factors include poor-quality synthetic material, broken or damaged insoles, uncomfortable heels, not wearing socks, a back that is too hard (or lacking one, as in flip-flops), and the presence of additional elements on the shoe (buttons, fasteners, belts, lace knots, etc.). [ 4 ], [ 5 ]
• Features of the foot structure. Some patients have some foot deformities, which during walking leads to changes in kinematics and can be the cause of mechanical overload in certain areas of the lower limb. The problem occurs especially often in people with equinus and equinovarus deformities, decreased or increased height of the longitudinal arch, valgus curvature of the toes. Black calluses are widespread in patients suffering from rheumatoid arthritis, neuropathy, gout, diabetes mellitus. [ 6 ]
• Body hygiene. If body hygiene and, in particular, lower limb hygiene are not observed, the risk of developing black callus increases significantly, and various infectious complications may also appear. Unfavorable trigger factors are: incorrect temperature conditions (both high and low temperature conditions inside shoes and clothes), increased sweating, lack of socks or their excessive contamination, presence of dust and dirt directly on the skin.

Pathogenesis

Calluses are formed as a result of hyperproliferation and incomplete differentiation of epidermal keratinocytes, as well as increased expression of adhesion molecules.[ 7 ]

A black callus usually forms on denser skin that can withstand a fairly large load without being injured. The growth occurs:

• with prolonged resistance of the skin area to damaging effects, with the inclusion of compensatory mechanisms, such as compaction, the appearance of connective tissue thickenings, etc.;
• when the skin area softens under the influence of moisture (in humid conditions the coefficient of friction increases, which ensures faster formation of black calluses);
• when the condition of the skin worsens, which may be associated with a deficiency of vitamins A, E, iron, zinc, as well as with severe dietary restrictions or a poor diet.

Black calluses do not appear on any part of the body. The palmar surface of the upper limbs or the soles of the feet are most susceptible to the formation of growths. In general, black calluses are found in the following places:

• the soles of the feet, which are regularly exposed to the influence of loads caused by body weight, dynamic pressure during walking, friction against various surfaces;
• interdigital spaces that suffer when wearing narrow shoes or when the bone and joint elements are curved;
• palms of the hands interacting with various tools and devices;
• knee areas that suffer from prolonged or repeated standing in a kneeling position;
• elbows, with frequent support on them.

A black callus is closer in formation to a hard callus. There is a limited thickening of the skin with a decrease in sensitivity and smoothing of the skin pattern. Pressing with a finger causes painful sensations due to the impact on the underlying structures (in particular, on the nerve endings). When the keratinized outer layer is removed, a small dark rod or core is found. If the growth cracks, infection is possible.

Symptoms black callus

The first signs of the formation of a black callus may appear as periodic itching or tingling in a certain area. Sometimes a reddening spot appears, but pain is not always present (more often, discomfort is felt when pressing on the affected area).

At an early stage of development, measures to stop the painful process are usually taken extremely rarely: a person does not think about any treatment, since the forming seal practically does not bother and does not cause concern. However, the growth worsens, darkens, and over time begins to cause more pronounced discomfort, for example:

• the black callus becomes inflamed and sometimes swells;
• pain appears not only when pressing, but also when gently probing the affected area of the skin;
• discomfort becomes almost constant during walking and movement, which negatively affects both performance and quality of life.

It is important to understand that a callus with black dots is not always a callus. Quite often, we are talking about a thorn, or plantar wart, which occurs under the influence of the human papillomavirus (HPV). Infection occurs when the skin is damaged, and the pathological process itself begins to develop against the background of weakened immune protection. The main symptoms of a thorn: the appearance of an itchy and painful growth, rough in the center, with black dots. The edges are a kind of ridge of keratinized skin. The localization of such formations is exclusively the palmar and plantar surfaces. The thorn grows mostly deep into the tissues, so the black dots present on it are damaged and clogged capillaries that are in the thickness of the wart. Average external dimensions: 3-10 mm.

Black dry calluses differ significantly in appearance from normal skin. They have a higher density, rise slightly above the surface. Additional signs such as pain, burning, peeling, itching do not always bother.

The situation may change - for example, if a black callus on a toe is damaged, cracked, injured (for example, during futile attempts to remove it on your own). The clinical picture in this case is supplemented by reddening of the skin, swelling, the appearance of purulent discharge, local and general increase in temperature.

In places of excessive pressure or friction, a callus with black roots often forms. In this case, the "root" is a keratin seal that penetrates deep into the skin and has a pointed or wedge-shaped core. Its formation is associated with external influence on a certain point of the body against the background of strong internal resistance of one of the most protruding areas of the bone. The more intense and prolonged the impact, the deeper in the tissues the callus with a black core will be.

A callus with a black dot inside can have a different structure, localization and external signs. Most often, the pathological growth is found in the following areas:

• near the toes;
• in the area of the joints;
• on the heel;
• in the forefoot.

Calluses, caused by regular or prolonged friction from clothing, can be located almost anywhere on the body.

Complications and consequences

Deeply penetrating black calluses, if left untreated, can cause complications. The core, growing deep into the tissue, compresses the nerve roots. Severe pain appears, the person's gait changes, limping appears, and the ability to work is lost. Against the background of constant pain, insomnia at night and drowsiness during the day begin to bother, irritability, general weakness, and headache occur.

Under certain conditions, the callus may bleed and become purulent. [ 8 ] In such a situation, it is imperative to see a doctor: a worsening condition indicates the development of an infectious and inflammatory process. Its symptoms are usually as follows:

• cracks and ulcers appear in the area of the black callus, from which a bloody, cloudy, yellowish or greenish liquid is released;
• the skin around the growth becomes reddish and swells;
• the pain becomes more pronounced, sometimes pulsating.

You should not try to cure such a pathology on your own: this should be done by a medical specialist.

Diagnostics black callus

In most cases, there is no need for specific diagnostics when a black callus is detected. But the doctor should pay attention not only to the growth itself, but also to the reasons that provoked its appearance. Thus, we can talk about flat feet, arthritis, osteoarthrosis, gout, etc. If there is a suspicion of a particular disease, then additional diagnostics are really necessary. For example, the doctor may prescribe:

• radiography;
• plantography (obtaining a graphic imprint of the sole of the foot);
• podometry (calculation of the podometric index);
• general blood and urine analysis;
• determination of uric acid levels in the blood;
• computed tomography or magnetic resonance imaging.

In some cases, consultation with other specialists is required - for example, an endocrinologist, surgeon, hematologist.

The diagnosis of black callus is usually established after an external examination and assessment of the clinical signs of pathology. Dermatoscopy may be required separately to determine the type of growth and differentiate it from a wart.

In particularly difficult cases – for example, if there are atypical symptoms – a biopsy may be performed, the essence of which is to remove a sample of biomaterial for examination. The procedure is performed using local anesthesia: the surgeon cuts off a small element of tissue (3-7 mm) from the area being examined and sends it for examination.

Differential diagnosis

A black callus most often has to be distinguished from a wart. For an ordinary person, this is quite problematic, due to the lack of necessary experience and knowledge. But a doctor can identify the problem quite quickly.

Warts with black spots appear under the influence of the human papilloma virus. It is easy to become infected with this virus. At the same time, a person will not even suspect the presence of a viral infection, which can manifest itself only under conditions of a sharp decrease in immunity. This happens during strong hormonal fluctuations, after prolonged antibiotic therapy, severe diseases of an acute and chronic nature.

The most similar to black calluses are plantar warts. These are hard, deep-rooted growths that cause severe discomfort when walking and moving. [ 9 ]

In most cases, a black callus appears on the skin in an area of prolonged friction or pressure. To distinguish a callus from a wart, it is better to consult a doctor.

Other pathologies that require distinction from black callus:

• Epidermal warty nevus is a neoplasm that rises above the skin surface. Sometimes covered with hair.
• Basalioma is a tumor formation in the form of a nodular ball covered with a crust in the center. It is most often detected in old age.
• Palmar-plantar syphilid is a painless growth that tends to delaminate at the periphery. It is accompanied by a positive reaction to syphilis.
• Keratoderma - keratinized and inflamed areas of skin, without black dots on the surface.
• Birthmarks, moles, pigmented nevi.

Treatment black callus

Black callus can be dry (hard), soft, and core. It is the type of growth that plays the main role in what treatment will be applied. Therefore, it is better to consult a specialist who can correctly determine the type of black callus and prescribe the optimal treatment procedures.

Dry seals can usually be removed at home. It's easy to do:

• the limb with the black callus is placed in very warm water for about 10 minutes (to soften the growth);
• using wet pumice or a special file, carefully remove the rough tissue, making circular movements without applying much pressure;
• After the procedure, the skin in the treated area is thoroughly dried with a towel, any anti-callus agent is applied to soften the compacted area (usually it contains salicylic acid, ammonium lactate or urea).

If the tissue of the black callus is very dense, or the growth is large, and its removal with pumice can cause bleeding, then it is better to contact a specialist who will get rid of the problem surgically. The procedure is usually painless, which is due to the absence of nerve endings in the tissue of the callus.

A soft black callus that develops after a preliminary blister with bloody contents may disappear on its own over time: the dead tissue dries up and peels off, revealing healthy clean skin. You should not try to remove such a growth on your own, as this will slow down the healing process, increase the risk of infection and cicatricial changes. If severe pain and redness appear in the area of the black callus, you should definitely visit a doctor.

Sometimes a black callus has a core, which makes it difficult to remove the neoplasm. In such a situation, only a specialist can help, who will drill out the core using a special device with a thin drill, and place a medicine inside the canal to prevent the problem from reappearing.

Often, to get rid of pathological growths, anti-callus patches are used, soaked in various liquids that help soften the keratinized tissue. You can find a suitable patch at almost any pharmacy. However, it should be remembered that their use is undesirable for people suffering from diabetes and vascular diseases, as well as for those with overly sensitive skin prone to irritation.

In addition to patches, pharmacies offer ointments and creams containing keratolytics - substances that exfoliate dead cells from the surface of the skin. These external agents are suitable only for use by adults. Ointments should not be used if there are signs of inflammation, as well as cracks, wounds in the area of the black callus.

Medicines

The most popular keratolytic agents with a softening anti-callus effect are divided into alkaline and acidic (alpha hydroxy acid) preparations.

Alkaline agents help dissolve keratin fibers, as a result of which the tissue softens, which significantly facilitates its further mechanical removal.

Acidic agents are not able to dissolve the keratin mass, but successfully destroy the connection of skin scales. Such preparations effectively moisturize, and the effect of one application lasts for several days.

The most common keratolytics include salicylic and lactic acids, barium and strontium sulfides, benzoic and boric acids, resorcinol, glycyrrhizic and citric acids, etc.

• Salicylic acid has a pronounced keratolytic and antiseptic ability, and is an active component of many anti-callus agents that are successfully used in dermatological practice. The action of the agent consists of neutralizing the intercellular "connector" that binds epithelial scales, as well as neutralizing the microbial flora.
• Lactic acid is a product of energy metabolism occurring inside tissues during glycolysis. External use of the product allows to supplement and potentiate the activity of salicylic acid.
• Alpha hydroxy acids, or fruit acids, are able to separate necrotic layers, accelerating skin renewal, increasing the number of healthy cellular structures. In addition, fruit acids perfectly moisturize, delivering moisture even to the deep layers of the skin.

The above list of keratolytic agents also includes several other drugs whose effects have not yet been fully studied, although experts say they are completely safe for health. These substances include urea, perhydrol, sulfur, benzoyl peroxide, and thioglycolic acid.

In particular, urea, which is most often used in dermatological practice, has quite intense keratolytic and moisturizing activity. It helps dissolve and soften keratin fibers, but for this action to occur, a certain concentration of the substance is required: in ointments, it is usually 20-30%. In its pure 100% form, urea does not have such a keratolytic property.

Medicines for removing black calluses are available in the form of liquid solutions, ointments, and gels. The following are the most well-known remedies that are prescribed by doctors to patients with calluses:

• Diprosalik is an ointment with keratolytic and anti-inflammatory properties, which is due to the action of the components included in the composition: salicylic acid and betamethasone dipropionate. The ointment softens the skin, facilitates exfoliation, relieves swelling. It can be used for black calluses, as well as for psoriasis and eczema. Features of use: apply twice a day to the affected area of the skin, rubbing gently until the desired result is achieved.
• Syntomycin ointment 10% contains chloramphenicol, castor oil, sorbic acid. Suitable for the treatment of damaged, infected black calluses. It is not a keratolytic, but has pronounced antibacterial and healing activity. The ointment is applied externally, daily or every other day, for 3-5 days. Longer use is undesirable, as it can cause contact sensitization.
• Doctor Foot is a special paste for softening rough skin and facilitating the removal of dead tissue. The composition of the preparation is represented by urea, allantoin, celandine and D-panthenol. The peculiarity of the product: it eliminates even old dry black calluses. Application: apply the paste to the callus area, stick a plaster on top and keep it for 8-10 hours (no more than 12 hours). Then remove the plaster, steam the skin with a hot bath and remove the callus using a pumice stone or brush. If necessary, the procedure can be repeated after a while. Contraindications: individual hypersensitivity to the components.
• Urgo Coricide (Urgocor) corn plaster – contains salicylic acid and a number of auxiliary components. Effectively removes dry and hard black corns and calluses in adult patients. After a hot bath, dry the skin in the area of application and stick the plaster so that the salicylic paste gets directly on the corn area. Do not allow the active component to get on healthy skin. The plasters are changed daily, and the duration of treatment depends on achieving the desired effect. Sometimes after gluing the plaster, short-term itching may occur, which goes away on its own. Rarely, an allergy may develop.
• Uretop 12% ointment is an external preparation based on urea, gently exfoliates rough skin, moisturizes and softens well. To achieve the effect, it is enough to apply the ointment 1-2 times a day, intensively rubbing it into clean skin. As a rule, the course of treatment is 1-2 weeks. Side effects in the form of redness, tingling, itching are rarely detected.

Herbal treatment

Experts say that when a black callus appears, patients in most cases are in no hurry to seek medical help, trying to get rid of the problem on their own. The first thing people resort to is traditional medicine recipes, time-tested and generational. Most often, they use raw potatoes, which are applied at night under a bandage, lemon peels, fish oil, garlic or onion juice, propolis, as well as some medicinal plants:

• Milky dandelion juice is good for getting rid of dry black calluses, as it softens even very rough skin. You just need to cut the stem and apply the protruding "milk" to the problem area. This should be repeated several times until the result is achieved.
• Pine resin is another natural and effective remedy. It is applied to steamed and towel-dried skin, a bandage or gauze is tied on top and warm socks are put on. After 24 hours, the compress is removed, the skin is steamed again and resin is applied. This is repeated until the callus softens to the required state, after which it is carefully removed with pumice.
• Wash the aloe leaves and cut them lengthwise. Apply the cut side to the black callus, after steaming it. Fix it with a bandage. Perform the procedure at night, and remove the compress in the morning. Repeat until the desired effect is achieved.

Important: if signs of inflammation or other suspicious symptoms appear in the area of the growth, you should definitely consult a doctor.

Surgical treatment

At the initial stage of the formation of a black callus, conservative treatment methods are successfully used, including the correct selection of shoes and clothing, the use of special inserts, bandages and insoles, etc. It is appropriate to use medications that soften the callus growth - in particular, keratolytic ointments and pastes.

If conservative treatment does not lead to a positive result, the growth regularly recurs, or the root is too deep, the doctor may recommend surgical removal of the black callus. It is performed mainly using one of the following methods:

• Standard excision of callus tissue with a scalpel or treatment with a punch incision, [ 10 ] enucleation. [ 11 ] The procedure is quite traumatic, but sometimes a black callus can be removed only in this way. The operation does not require preliminary preparation and hospitalization of the patient, it is easily tolerated, but has some features of postoperative care, which the doctor will tell you about. [ 12 ]
• Cryodestruction method. The method of freezing with liquid nitrogen, known to many, is quite effective: frozen tissues are rejected within a few days after the procedure, revealing healthy skin.
• Laser removal method. Compared to cryodestruction, laser removal does not involve freezing, but rather high-temperature exposure. As a result of the procedure, the keratinized structures are heated and evaporated. Healthy skin does not suffer. This technique is considered the most optimal.
• Radio wave method. Black callus is removed by exposure to radio wave energy.

If during the consultation the doctor discovers that the black callus has become complicated by an infectious and inflammatory process, then the surgical intervention is postponed. The corresponding therapeutic measures aimed at eliminating the inflammation and neutralizing the infectious agent are prescribed. Therapy may include the use of anti-inflammatory drugs and antibiotics. After completing the conservative treatment course, the doctor again considers the possibility of surgical removal of the black callus.

Prevention

Preventive rules for preventing the formation of black calluses are quite simple. They must be remembered and followed to avoid the occurrence of such problems.

• Both clothes and shoes should be comfortable, high-quality, and appropriate in size and width.
• Too high heels on shoes are undesirable. If you still have to wear “high” shoes, you should put special anti-slip insoles or silicone inserts in them, which are usually sold in shoe stores, pharmacies or online stores.
• When playing sports or doing gardening work, you should wear suitable protective gloves and special shoes.
• It is important to carefully follow sanitary and hygienic recommendations, take a shower daily, use moisturizers (for both hands and feet), and change underwear and socks in a timely manner.
• If you have problems with your joints (including your toes), you should see a doctor before they get worse. A specialist will help you adjust your foot position, prescribe treatment, and select the best orthopedic insoles or shoes to prevent the appearance of black calluses.
• It is necessary to maintain nails in an adequate condition, not allowing excessive growth of nail plates and their ingrown. If possible, it is recommended to regularly perform pedicure procedures, remove rough skin.

For preventive purposes and at an early stage of black callus formation, it is recommended to use:

• protective patches that prevent the appearance of growths in areas of regular friction of the skin;
• special cosmetic products that provide care for rough skin;
• special anti-slip shoe inserts and insoles;
• insoles, bandages, retaining inserts, correctors for toe and foot deformities (must be selected by an orthopedic specialist).

If a growth in the form of a black callus does appear, the best solution would be to seek help from specialists: orthopedists, podiatrists, dermatologists. A medical consultation will help to make a correct diagnosis and determine the treatment. This is important, first of all, because the treatment measures for black calluses and warts are very different. In order not to harm your health and quickly get rid of the problem, you need to consult a doctor.

Forecast

In most cases, a black callus does not cause complications and has a favorable prognosis if you do not neglect the treatment of the disorder. However, there are cases when, in the absence of treatment, the growth increases, pain appears, and work capacity is limited. There is also a risk of tissue infection: when an infection gets in, an inflammatory reaction is triggered. The black callus swells, the pain increases, and there is a risk of suppuration.

For patients with diabetes or peripheral circulatory disorders, the prognosis is somewhat less favorable. There is a high risk of complications, and the treatment process can be significantly delayed.

If you take timely measures and seek treatment from a specialist, the black callus will disappear fairly quickly and without complications.