Foot Care (Parts I and II COMBINED) Flashcards
2024 - Athlete's Foot, Calluses, Corns, Bunions, Ingrown Toenail, Warts, and Hand Warts. Plantar Warts, Heel Pain, etc., (144 cards)
1
Q
What’s another term for Athlete’s Foot?
A
Tinea Pedis (= “Contagious fungal infection of the foot”)
- Tinea = Contagious fungal infection
- Pedis = “of the foot”
- The type of tinea infection is classified by where it is located on the body, not by the causative organism
2
Q
Lamisil cream or spray can be used to treat some cases of Athlete’s Foot… Lamisil’s active drug ingredient is _____.
A
Terbinafine
3
Q
Which of the following is more susceptible to developing Athlete’s Foot (Tinea Pedis)?
a) Women
b) Teenagers
c) Adults over 40
d) Children under 12
A
b) Teenagers
More common in men AND teenagers.
Children under 12 years of age rarely develop the condition.
4
Q
How is Athlete’s Foot (Tinea pedis) primarily spread from person-to-person?
a) Through respiratory droplets
b) Through contaminated food
c) Through contaminated towels, clothing, or surfaces
d) Through direct skin contact
e) All of the above
A
c) Through contaminated towels, clothing, or surfaces
Athlete’s foot can be spread from person to person through contaminated towels, clothing or surfaces. Tinea dermatophytes proliferate in warm and humid places such as showers, swimming pools and changing rooms. (MedSask, 2024)
5
Q
Where does Athlete’s Foot (tinea pedis) commonly occur on the body?
a) Inside the toenails
b) Instep or sole of the toes and feet
c) On the soles of the feet
d) Between the toes
e) None of the above - equally likely to occur on any parts of the feet and toes/toenails
A
d) Between the toes
Athlete’s foot occurs most commonly between the toes and may spread to the instep or sole. The skin may be cracked or scaly with blisters, inflammation and an itching or burning sensation. It may also cover the soles of the feet and involve the toenails. This is called moccasin-type infection.
Warm, dark, poorly ventilated, moist environments between the toes promote fungal growth and may contribute to the presence of this condition
6
Q
SK Minor Ailment Considerations
When it comes to Athlete’s Foot, when are pharmacists considered to be of value and can assist patients with fungal presentations?
A
When the fungus is at the tip.
- Pharmacists are able to recommend either OTC antifungal agents or prescribe RX topical fungal agents for cases like these.
7
Q
SK Minor Ailment Considerations
When it comes to Athlete’s Foot that involves more than 3 toes or involves different colours, why do we need to refer to an authorized prescriber like an MD?
A
No longer pharmacists’ territory because if it is Athlete’s Foot, would require oral antifungals. OR differential diagnoses need to be ruled out.
- Pharmacists can only prescribed for topical terbinafine NOT oral.
8
Q
Athlete’s Foot
What is the course of treatment for Athlete’s Foot when using: Terbinafine 1% Cream?
A
Massage cream to the affected area ONCE a day for 1 week and re-assess.
9
Q
What is the primary classification method for different types of tinea infections?
a) By the causative organism
b) By the age of the affected person
c) By where it is located on the body
d) By the symptoms and the severity of them
e) If it’s a fungal or non-fungal infection
A
c) By where it is located on the body
10
Q
What are some of the more common symptoms associated w/ Tinea Pedis? (6x)
A
- Area is inflamed, blistered, itchy or painful
- White, cracked or macerated areas between the toes
- Most common between 3rd/4th or 4th/5th toes
- May cover soles of both feet
- Scaling and flaking
- Often comorbid with tinea cruris or tinea unguium (Onychomycosis) & may require treatment
11
Q
What type of rash is often seen in Athlete’s Foot?
a) Raised, red bumps
b) Pustules filled with pus
c) Cracked or scaly skin
d) Hives or welts
A
c) Cracked or scaly skin
12
Q
Which of the following symptoms is NOT commonly associated with Athlete’s Foot?
a) Redness and warmth
b) Dry, cracked skin between the toes
c) Itching and burning sensation
d) Thickened, discolored toenails
A
d) Thickened, discolored toenails is NOT affiliated with Athlete’s Foot… That can be seen in toenail fungal infections.
13
Q
Tinea pedis is often the cause of tinea ______ or tinea _______ from self-inoculation.
A
Tinea Cruris OR Tinea Corporis
- Tinea Cruris = Jock Itch
- Tinea Corporis = Ringworm
Tinea pedis is often the cause of tinea cruris or corporis from self-inoculation (touching affected feet to other areas of the body or scratching feet and not washing hands).
14
Q
How is it possible for tinea pedis to spread to other parts of a person’s body?
A
The infection can be spread to other parts of the body, usually the groin or underarms, by autoinoculation,
- e.g., touching the infected feet then touching other parts of the body.
15
Q
Risk factors for developing Athlete’s Foot include direct contact with infected persons, animals, _______, and conditions of increased _______
A
- FOMITES (i.e., objects or materials that are likely to carry contaminated infections)
- Increased MOISTURE
16
Q
T/F: Children under 12 years of age are commonly affected by Athlete’s Foot
A
False!
- Men & Teenagers are more common to contract this fungal infection.
Children under the age of 12 are unlikely to get Athlete’s Foot.
17
Q
Presentation of: Moccasin-Type [of Athlete’s Foot] Infection
A
Might start with minor irritation, dryness, itching, burning, or scaly skin on the sole and heel of the foot.
Then can progress to thickened, cracked, peeling skin. In severe cases, the toenails become infected
18
Q
What term describes a moccasin-type infection of Athlete’s Foot?
a) Blistered eruption
b) Interdigital rash
c) Vesicular eruption
d) Involvement of the soles of the feet and toenails
A
d) Involvement of the soles of the feet and toenails
19
Q
What might be the cause of the small, raised lesions on the sole of the patient’s foot?
Identify what this could be…
A
Plantars Wart
20
Q
Wart removal products such as Compound W comes in various kinds of formulations…
Why is it that between these two product lines, we prefer the gel instead of the solution?
A
Less chances of hitting healthy skin cells. AND Gel doesn’t dry out as quickly as the solution!
- Even if we had the solution bottle closed between uses, the solution will dry out faster than the gel version, so gel a good choice
21
Q
Which condition is a yeast infection between the toes?
a) Athlete’s Foot (Tinea Pedis)
b) Onychomycosis
c) Wart (Plantar Wart)
d) Candidiasis
A
d) Candidiasis
22
Q
A 40-year-old man presents to the clinic with complaints of discomfort in his feet, but more so from his toenails and the surrounding areas of the toes.
His toenails have become discolored as they’ve become more yellow, and some of the toenails have gotten thicker, too. Based on these findings, what is likely the diagnosis?
A
Onychomycosis
23
Q
A 40-year-old man presents to the clinic with complaints of discomfort in his feet. He describes itching and burning sensations between his toes and notices some cracking and peeling skin in that area. Based on these findings…
What is the most likely diagnosis for the itching and burning sensations between the patient’s toes?
a) Athlete’s Foot (Tinea Pedis)
b) Onychomycosis
c) Wart (Plantar Wart)
d) Candidiasis
A
a) Athlete’s Foot (Tinea Pedis)
24
Q
Which of the following is NOT a common characteristic of Athlete’s Foot?
a) Cracked or peeling skin
b) Fluid-filled blisters
c) Foul odor
d) Smooth, unblemished skin
A
d) Smooth, unblemished skin is NOT part of Athlete’s Foot characteristics.
Fluid-filled blisters are not always happening but when it does, need to have looked after right away.
25
What condition is often caused by friction or pressure on the foot?
a) Athlete's Foot (Tinea Pedis)
b) Onychomycosis
c) Corns
d) Bunions
c) Corns
26
Plantar Warts are often found on ____ [part of the body].
The plantar surface of the foot
27
Plantar Warts results in the loss of
a) circulation
b) skin rigidity
c) healthy skin cells
d) nails
b) skin rigidity (this is often because of the distruction of skin lines/ridges)
28
_________ in the foot context typically affects the skin folds between the toes, resulting in a moist, red rash with satellite lesions that can sometimes look similar to acne spots filled with pus.
- Infection between the toes - moist, white peeling skin.
Candidiasis (of the foot)
in this case
29
Gout vs. Bunions?
Gout = Buildup of uric acid crystals in the joints.
Bunion = Involve a bony deformity at the base of the big toe and forms bony bumps at the joint.
30
# (To the tune of "Twinkle, Twinkle, Little Star")
Calluses, corns, and bunions too,
All affect the [ BLANK ] on your shoe.
Calluses are thick, and corns are round,
Bunions bulge where toes are bound.
Calluses form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the joint's wrong bend,
Remember these, they're skin's true friend!
Hope this helps make it stick in your mind!
All affect the SKIN on your shoe...
31
# (To the tune of "Twinkle, Twinkle, Little Star")
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are [BLANK], and corns are [BLANK],
Bunions bulge where toes are bound.
Calluses form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the joint's wrong bend,
Remember these, they're skin's true friend!
Hope this helps make it stick in your mind!
Calluses are THICK;
Corns are ROUND;
32
# (To the tune of "Twinkle, Twinkle, Little Star")
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are thick, and corns are round,
Bunions [BLANK] where toes are [BLANK].
Calluses form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the joint's wrong bend,
Remember these, they're skin's true friend!
Hope this helps make it stick in your mind!
Bunions BULGE where toes are BOUND.
33
# (To the tune of "Twinkle, Twinkle, Little Star")
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are thick, and corns are round,
Bunions bulge where toes are bound.
[BLANK] form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the joint's wrong bend,
Remember these, they're skin's true friend!
Hope this helps make it stick in your mind!
CALLUSES form from pressure and wear.
34
# (To the tune of "Twinkle, Twinkle, Little Star")
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are thick, and corns are round,
Bunions bulge where toes are bound.
Calluses form from pressure and wear,
[BLANK] are smaller, but they can [BLANK].
Bunions grow at the joint's wrong bend,
Remember these, they're skin's true friend!
Hope this helps make it stick in your mind!
CORNS are smaller, but they can FLARE.
35
# (To the tune of "Twinkle, Twinkle, Little Star")
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are thick, and corns are round,
Bunions bulge where toes are bound.
Calluses form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the [BLANK]'s wrong [BLANK],
Remember these, they're skin's true friend!
Hope this helps make it stick in your mind!
Bunions grow at the JOINT's wrong BEND.
36
What are three treatment options discussed for bunions?
1) Orthodics/Special Shoes/Orthodic Devices = Podiatry Care
2) Bunion Protective Pads [for cushioning]
3) Surgery
37
What is the problem with the supposed three treatment considerations discussed for Bunions?
- Podiatry Care and Specialty Items
- Bunion Protection Pads
- Surgery
- Podiatry Care and products are pretty **expensive**.
- Bunion Protection Pads are a waste of money as it **doesn't really treat it but only has a cushion** and don't really need it.
- Surgery is a **last-resort and not applicable for all** people.
38
# Define
Calluses
Localized area of thickened skin.
- We need calluses for protective purposes as the skin tries to protect itself against friction or pressure.
39
List the 4 Different Treatment Options Discussed for Treating Calluses.
Change footwear
Pumice Stone/File/Sanding area down.
OTC Callus Removers
--- (cushion + pliable disks 40% s.a.)
--- (cushion + liquid s.a.)
Protective Materials/Products (e.g., Ball of Foot Cushions)
40
How to treat or care for Hyperkeratotic calluses?
- **MUST** Sand it down (can use 100 grit sandpaper)
- Clean it out
- Use liquid or spray Band-Aid products (or Krazy Glue) to seal it... Regular adhesive bandage will Not stay intact!
41
If a patient came to the pharmacy asking for your recommendation on which OTC Callus Removers should they select, which of the two is considered to be a better formulation? Why?
a) cushion + pliable disks 40% s.a.
b) cushion + liquid s.a.
Cushion + Liquid salicylic acid callus removal products --- this one is more likely to stay intact while wearing socks/shoes for a longer period of time... Plus liquid SA gives us better control and allowing us to place the SA where we want it to be (we don't want it to touch healthy skin)
- The pliable disk options has the risk of sliding around S.A. on healthy skin and the disks are likely to be too small and results in undertreating... Not to mention how 40% is overkill!
42
Is formal counseling really 'a thing' for calluses? Explain.
Not really.
- Calluses are considered to be very low level so formal counselling is not usually happening unless patients has any questions.
43
Which of the following is a primary purpose of calluses?
a) To cause discomfort
b) To protect the skin from friction and pressure
c) To make the skin softer
d) To increase sensitivity in the affected area
b) To protect the skin from friction and pressure
44
Which of the following is NOT a recommended method for treating calluses?
a) Using proper footwear
b) Using over-the-counter callus removers with 40% salicylic acid
c) Using a pumice stone, cheese grater, or similar tool to file down calluses
b) Using over-the-counter callus removers with 40% salicylic acid
- This is overkill... Yet, these are what are in all the OTC products on market right now.
45
Corns
| Hint: Something to do with a kind of localized growth
Hyper-keratotic growth – reaction to local friction/trauma/irritation over a joint
46
Hard Corns
- Small, raised areas of thickened skin with a hard center... usually dry and may appear yellowish or gray in color.
- Typically found on the tops or sides of toes or on the sole of the foot where pressure is applied.
- This type of corn always requires a soak before using any sort of treatment like S.A. or else can make things worse
47
Soft Corns
- Small, raised areas that have a softer texture in comparison to its counterpart. Appear whitish or translucent due to the moisture trapped between the toes.
- Because already macerated (softer), we do not need to soak this corn.
- Found between the toes where the skin is moist and prone to friction.
- It is necessary to COVER these corns when using SA or else will affect the adjacent toe(s)
48
What is the primary difference between calluses and corns?
a) Calluses are caused by fungal infections, while corns are caused by bacteria.
b) Calluses are softer and more moist than corns.
c) Calluses have a diffuse border and are larger in size, while corns have a well-defined core and are smaller.
d) Calluses are typically located between the toes, while corns are found on the palms of the hands.
c) Calluses have a diffuse border and are larger in size, while corns have a well-defined core and are smaller.
49
Which of the following is a characteristic feature of calluses?
a) They have a dense core of dead skin.
b) They are usually yellowish or grayish in color.
c) They commonly develop on or between the toes.
d) They are caused by pressure or friction on weight-bearing areas of the feet.
d) They are caused by pressure or friction on weight-bearing areas of the feet.
50
What distinguishes soft corns from hard corns?
a) Soft corns are larger in size than hard corns.
b) Soft corns have a well-defined core, while hard corns are moist and rubbery.
c) Soft corns are typically located on the palms of the hands.
d) Soft corns are moist and rubbery, while hard corns have a dense core of dead skin.
d) Soft corns are moist and rubbery, while hard corns have a dense core of dead skin.
51
Which corn is usually found between the two and more macerated (i.e., softens when soaked in liquid) and therefore needs to be covered when being treated to prevent it from hitting the toes next to it?
Soft corn
52
Which kind of corn is usually described as being harder/denser, and have less hydration in lesion?
Hard corn
53
What is considered to be *the best* form of treatment for corns?
Removing the cause
54
Protective materials that are available for corns include foam and moleskin:
What is our take on using Moleskin products for things like Corns?
| Moleskin vs. Foam.
It might add more pressure to the area because Moleskin is thicker than foam and therefore cause more irritation because too tight to wear.
- Molefoam products is thicker and might make things tighter when wearing it on our foot as we wear shoes!
## Footnote
Keep in mind that any protective products we try to use needs to still be able to fit inside the shoe as we want to try to prevent irritation.
55
Dr. Scholls **Foam** Ease Corn Cushions (Foam only)...
- How does a person apply this?
- How does this product work?
Goes around the corn (surrounds the corn) and protects it from the irritation from wearing shoe so corn can slowly erode back
## Footnote
We prefer foam over moleskin products usually because foam is thinner and less likely to be as tight to wear with our shoes and therefore less irritation
56
What is the primary cause of a corn, particularly in the case of hammer toes?
a) Genetic predisposition
b) Bacterial infection
c) Local friction, trauma, or irritation over a joint
d) Allergic reaction
c) Local friction, trauma, or irritation over a joint
- Knuckle hitting up against the shoe and then causing a corn (polished skin)
57
What is the purpose of keratin in protecting the toe from irritation?
a) To soften the skin
b) To harden the skin
c) To prevent moisture build-up
d) To provide a cushioning effect
d) To provide a cushioning effect
58
Which type of corn may require covering to prevent it from rubbing against adjacent toes?
a) Hard corn
b) Soft corn
c) Liquid corn
d) Callus
b) Soft corn
59
We discussed about the Dr. Scholl’s® Liquid Corn/Callus Remover as only being more beneficial to one versus another:
When should we recommend this OTC product?
When should we skip this?
Recommended for CORNS
- Contains Salicylic acid 17%
We do **not** recommend for calluses.
60
What percentage of salicylic acid is commonly found in over-the-counter callus removers, making them **not** ideal for treatment?
a) 10%
b) 20%
c) 40%
d) 50%
c) 40%
SA 40% is overkill for treatment... Not to mention the fact that will slowly wear the calluses down.
61
What is the characteristic appearance of soft corns?
a) Thickened, yellowish skin with a central core
b) Moist, whitish skin with maceration
c) Small, rough growths with tiny black dots
d) Smooth, dome-shaped papules with a central umbilication
b) Moist, whitish skin with maceration
62
Do we like these two OTC products for Ingrown Toenail(s)? Why (or why not)?
**NO!!! ** We need to get the nail tag out and none of these are going to do it...
- Outgrow contains Benzocaine: It **gives people false hope as it numbs the area while the outgrown nail/skin tag remains there.** Plus, NSAIDs and/or Acetaminophen does better for the pain.
- Dr. Scholl's Toenail Softening Agent only does that (i.e., only soften the nail for easier trimming)... Hard nails are **not** the issue! Again, need to get the nail tag out.
63
Why are over-the-counter callus removers with 40% salicylic acid NOT recommended?
a) They are too expensive
b) They have no effect on calluses
c) They slowly wear down calluses, which can be overkill for treatment
d) They are difficult to find in stores
c) They slowly wear down calluses, which can be overkill for treatment
64
It is always recommended for individuals to be sure to soak things like hard corns and things like hand warts prior to using SA treatments.
What time/part of day in their routines can we suggest to patients to make this step easier?
After a shower... Again, we want to soften the area plus we don't want to apply S.A. on dry skin because it will be tougher to get the product in there plus can make things worse.
65
What would you recommend for treatment for a 55-year-old female patient who has diabetes who calls the pharmacy saying she might have a corn or a wart?
Refer to MD and they should not self-medicate.
- Concerns of diabetic nephropathy, infections, etc.,
66
Viral bump on the skin. Often seen along with warts. Smaller and smoother than other warts… more like a mole. Usually has a soft and central clearing.
Usually MD territory for assessment and cryotherapy might be used to cut it off
Molluscum
67
What is the primary cause of plantar warts (and other warts)?
a) Bacterial infection
b) Fungal infection
c) Human papillomavirus (HPV)
d) Allergic reaction
c) Human papillomavirus (HPV)
68
Which of the following skin conditions is characterized by small, fleshy growths with black dots on the soles of the feet?
a) Soft Corns
b) Skin Tags
c) Plantar Warts
d) Flat Warts
c) Plantar Warts
69
(To the tune of "Mary Had a Little Lamb")
Warts, warts, everywhere,
Different types, but do take care.
Common warts are [BLANK] and [BLANK],
On hands and fingers, they're often praised.
Plantar warts upon your feet,
Cause discomfort when you greet.
Flat warts on the face so small,
Like tiny bumps, they may appall.
Genital warts, a different kind,
Spread through contact, keep in mind.
Filiform warts like tiny threads,
On face and neck, where hair it treads.
Remember these, their types are four,
Warts can be a skin eyesore.
But with care and treatment right,
You can keep them out of sight!
Common warts are ROUGH and RAISED.
70
(To the tune of "Mary Had a Little Lamb")
Warts, warts, everywhere,
Different types, but do take care.
Common warts are rough and raised,
On [BLANK] and [BLANK], they're often praised.
Plantar warts upon your feet,
Cause discomfort when you greet.
Flat warts on the face so small,
Like tiny bumps, they may appall.
Genital warts, a different kind,
Spread through contact, keep in mind.
Filiform warts like tiny threads,
On face and neck, where hair it treads.
Remember these, their types are four,
Warts can be a skin eyesore.
But with care and treatment right,
You can keep them out of sight!
On HANDS and FINGERS, they're often praised.
71
(To the tune of "Mary Had a Little Lamb")
Warts, warts, everywhere,
Different types, but do take care.
Common warts are rough and raised,
On hands and fingers, they're often praised.
Plantar warts upon your feet,
Cause [BLANK] when you greet.
Flat warts on the face so small,
Like tiny bumps, they may appall.
Genital warts, a different kind,
Spread through contact, keep in mind.
Filiform warts like tiny threads,
On face and neck, where hair it treads.
Remember these, their types are four,
Warts can be a skin eyesore.
But with care and treatment right,
You can keep them out of sight!
Plantar warts upon your feet,
Cause DISCOMFORT when you greet.
72
(To the tune of "Mary Had a Little Lamb")
Warts, warts, everywhere,
Different types, but do take care.
Common warts are rough and raised,
On hands and fingers, they're often praised.
Plantar warts upon your feet,
Cause discomfort when you greet.
Flat warts on the [BLANK] so small,
Like tiny bumps, they may appall.
Genital warts, a different kind,
Spread through contact, keep in mind.
Filiform warts like tiny threads,
On face and neck, where hair it treads.
Remember these, their types are four,
Warts can be a skin eyesore.
But with care and treatment right,
You can keep them out of sight!
Flat warts on the FACE so small,
Like tiny bumps, they may appall.
73
T/F: Hard corns possess a core; whereas plantar warts do not.
False.
- Hard corns & plantar warts both possess a core...
| [Hard] Corns have a more polished core (in comparison)
74
Corn vs. Plantar Wart:
Which of the following has a more polished and smoother surface?
Corn
75
Dermatoglyphics are also known as _________ , and they play a role in a plantar wart formation and treatment because affects how wart grows and spreads.
Skin lines or Skin ridges
## Footnote
They play a role in plantar wart formation and treatment because they can affect how the wart grows and spreads.
76
Which of the following statements best describes the relationship between skin ridges/lines and corns & plantar warts?
a) Both corns and plantar warts typically have intact skin ridges/lines.
b) Corns tend to have disrupted skin ridges/lines, while plantar warts usually have intact skin ridges/lines.
c) Corns usually have intact skin ridges/lines, while plantar warts tend to have disrupted skin ridges/lines.
d) Neither corns nor plantar warts have any correlation with the disruption of skin ridges/lines
e) Both corns and plantar warts typically have skin ridges/lines disrupted
c) Corns usually have INTACT skin ridges/lines; while Plantar Warts tend to have DISRUPTED skin ridges/lines.
| Disruption is associated with how wart thrives and spreads.
77
T/F: Both hard corns and plantar warts both possess a core that causes irritation. When it comes to treatment, the ultimate goal of each situation is for Complete Elimination of the Cores.
| Statement saying we are focused on eliminating the core for both.
False!
- Core Elimination is the main goal of therapy for Plantar Wart because trying to kill the root (not for hard corns)
78
# Plantar Warts
Why are we concerned when blood vessel are formed in the core of the plantar warts?
The presence of blood vessels in the core of plantar warts is significant because **it helps them to thrive and grow**.
- Blood vessels provide nutrients and oxygen to the wart tissue, **allowing it to persist and potentially spread**.
79
# Plantar Wart: Treatment
Regardless of the formulation of salicylic acid used for treatment (e.g., liquid/paste/gel), what is the dosing frequency and schedule when using these kinds of agents for plantar warts?
Once daily **OR** once Every 2 days
(for 12 weeks)
## Footnote
Remember, warts require longer duration of treatment!
80
# Plantar Wart
When trying to treat something like a Plantar Wart, how "deep" do we need to go for treatments?
We need to get to the core therefore, would need to go below the skin surface (because we need to get to the core)...
81
# Treatment
Dr. Scholl's Wart Remover (40% salicylic acid) can be used for both Corns and Warts.
How long [duration] would one use this product if treating for a CORN?
2 weeks
## Footnote
Corn takes a shorter amount of time for therapy in comparison to warts. Keep that in mind...
82
# Treatment
Dr. Scholl's Wart Remover (40% salicylic acid) can be used for both Corns and Warts.
How long [duration] would one use this product if treating for a WART?
12 weeks
83
What is the name of the RX agent that can be used as a wart treatment?
Canthacur
| (a derivative of cantharidin)
84
How does Canthacur (Cantharidin) work in Wart Treatment?
Irritates the virus on the wart as much as it can and tries to kill off the entire thing.
85
Once Canthacur (Cantharidin) is applied to the affected wart PLUS 1-3 mm margin around the wart, we let it dry before we place a non-pourous adhesive tape over top of it.
This tape is to be left on for how many days before can remove the tape and debride?
One week.
86
After first round of using Canthacur (Cantharidin) and have done debridement one week after and notice any visible wart tissue remaining, **what is the next step in the process of treatment? **
Re-apply a small amount of the Canthacur (Cantharidin) and repeat the process of bandaging and debridement process as the first time again until the core of the wart is gone.
87
With Canthacur (Cantharidin) to treat warts, how will a person know destruction of the wart is successful? (3)
With Canthacur (Cantharidin), you will know destruction of wart is complete as:
- The site has healed,
- Affected area has a smooth texture to the skin
- Normal skin lines/ridges are present again.
88
T/F: Individuals who use Canthacur (Cantharidin) for wart removal purposes may require 3+ treatments for larger lesions.
True.
89
# Treatments for Hand Warts
What are the two products discussed in class for treatment of hand warts?
1) Duofilm Liquid (S.A. & Lactic Acid) x 8-12 weeks
2) Compound-W x 8 weeks
90
# Treatments for Hand Warts
What are the steps or procedures when using Duofilm Liquid? (5 points)
1. ALWAYS! Soak the wart first.
2. Rub off the dead skin
3. Vaseline at the base (optional for TLC... can also put a bandage on top as an alternative, too)
4. Apply the drops [Duofilm]
5. Cover it... And Continue to use for 8-12 weeks
91
# Treatment for Hand Warts
Alternative to Duofilm, what else could someone use [OTC] for hand warts? For how long?
Compound-W
- Use for 8 weeks
92
# Treatments for Hand Warts
Which salicylic acid prep can be used to treat hand warts and contains both salicylic acid and lactic acid?
Duofilm liquid
93
Can we use Duofilm for corns, too? Explain.
Yes.
- Follow the same steps to apply the agent on the affected area as would with hand wart except **only use for 10 days**
94
# Corns: Treatment
Salicylic Acid Preps for Corn Treatment can include the Dr. Scholl's Corn Remover Product that contains Cushions and 40% S.A. disks...
How do I use this product?
If treating a hard corn, always be sure to soak it first....
1) Place sticky side of disc directly over center of the corn.
2) Cover the disc with a cushion (or place the cushion over top of the disc) and smooth it out.
95
Salicylic Acid Preps for Corn Treatment can include the Dr. Scholl's Corn Remover Product that contains Cushions and 40% S.A. disks...
How often should people use this when treating a corn?
Once daily or EOD.
Treatment Period: ~10 days
96
# Hand Warts
Approximately ___% of cases of hand warts will "spontaneously" regress.
25%
97
Is Duofilm liquid better/worse/equal to Compound W when treating for things like hand warts? Explain.
Both products are equally fine to use.
- There is **no evidence** to suggest that Duofilm is a superior agent than Compound W just because it has an extra ingredient.
98
# Hand Warts
What are the two options to use as treatment for Hand Warts for Children?
- Salicylic Acid
- OTC Cryotherapy
## Footnote
Cryotherapy can be rough on children's skin and packaging indicates to not use for <4 yo.
99
Salicylic Acid and OTC Cryotherapy are two therapeutic options for children who have hand warts... Which one is more effective?
They are EQUALLY effective. They just have different side effects, treatment regimen, and duration of therapy.
- Let the parent decide this based on what they think their child can handle and things like age.
## Footnote
SA used QD for 2-3 months... Cryotherapy Q2W for approx 1 month (but can be harsher on skin and can be uncomfortable)
100
This is a hand wart. The bump has flattened but still as a hardened white core on the plane of the skin [as pictured].
Is it okay to stop therapy? Explain.
NO! Not yet!
Despite it being flat and on the plane of the skin, it is important to continue treatment because the HPV [virus] is still intact at the root underneath the surface!
- With Canthacur (Cantharidin), you will know destruction of wart is complete as the site has healed, smooth textured skin and see normal skin lines again.
| Picture is of a foot but same idea!!
101
# Wart Removers
What are the differences between:
- Dr. Scholl's Dual Action Freeze Away
- Dr. Scholl's Freeze Away
Dr. Scholl's Dual Action:
- Salicylic Acid + Cryotherapy
- Would first freeze the area before applying SA
- Every 2 weeks, do a cryotherapy treatment... But you would apply SA once daily for 14 days
- Repeat cycle 4x
Dr. Scholl's Freeze Away: Just cryotherapy (no SA)
- Use every 3 weeks x 4
102
# Wart Removers
How do we feel about using something like Dr. Scholl's Dual Action Freeze Away for wart removal?
We don't mind it.
It's considered a good move to use the Dual Action product as the products has multiple mechanisms that can be beneficial.
103
What is the difference in Cryotherapy treatment via OTC [Dr. Scholl's] vs. MD's office?
Temperature!
OTC [Dr. Scholl's]: -70°C
**vs.**
MD's Office: -190 °C
104
What is the purpose of using cryotherapy/freezing products for things like hand warts and plantar warts?
Destroying the abnormal skin cells, including the HPV-infected cells and can hopefully help clear the viral infection a bit better.
105
When using cryotherapy/freezing therapy, application times can vary based on the location of the affected area.
If I were to be treating the heel and ball of the foot, how should I be applying the freezing agent for?
20 seconds x 2 applications = 40 seconds total
## Footnote
OTC instructions might say 20 seconds but likely to be more effective to do another 20 seconds as the first 20 seconds likely to warm back up fairly quickly and want some kind of kill.
106
Why is it that we require longer contact time with cryotherapy for balls of the feet for example, versus when treating places like the hand?
There's keratotic skin on the balls of the feet so need more contact time to get proper penetration.
107
Cryotherapy OTC freezing products available has different widths for their tips [where the medication is delivered out of]... Does it matter which one we get?
We prefer the pointy tip applicator over the wide tip.
- Pointy tip = More precision in application
- Wider tip = Less precision = Might affect surrounding tissue when we don't want to
108
When using cryotherapy/freezing therapy, application times can vary based on the location of the affected area.
If I were to be treating the arch or the toes, how should I be applying the freezing agent?
Depending on the size of the wart, freezing/contact time can vary from 10-20 seconds.
109
We usually prefer using salicylic acid GEL agents (if had to pick a specific formulation) since the gel is more likely to allow us to get it exactly where you want it to go and not breach to healthy skin cells when not needed.
**With that being said, after applying S.A. gel to the affected wart(s), what is a MUST step following this application?**
Use a liquid bandage following the application of S.A. gel!
- We want to seal it and prevent the contents of S.A. from breaching surrounding areas when not needed.
110
What's our take on Duct Tape for Warts?
I mean... Sure. It is likely doing the same thing as Compound W but there are few things to note if using Duct tape...
- Hard to cut the perfect shape or size - we still don't want to cover healthy cells
- Irritation is likely with the glue/adhesive used
- Use daily for 2 months
111
What is the relevance of using oral forms of Zinc OR Cimetidine (an H2-Blocker typically used for stomach acid) for wart treatment?
Typically considered when products like Compound W and/or Cryotherapy options are ineffective and warts are not going away.
- GP/MD territory on this... Not pharmacist involved asde from dispensing and showing them where to find the Zinc on the shelf for example.
- Effective? Likely not.
112
What is the proper dosage to use for Zinc (PO) and Cimetidine for wart removal purposes?
Not confident about the dosing of either products for wart removal purposes.
- This is MD territory and to be prescribed by MDs (not pharmacists)
113
How can we treat Flat Warts?
- Can technically use cantharidin and S.A. BUT know that there is no permanent cure to flat warts and they are likely to come back a few months after finishing treatment. Worse case scenario, can also try cryotherapy and/or surgery
Should still clean or wash the affected areas with disinfectant then sock for 15-20 minutes then let the wart dry... Then repeat process BID for a few weeks until the wart is dissolved and under control.
**Flat Warts are not pharmacist territory! MD Referral needed**
114
What are 2 possible causes of Ingrown Toenail(s)?
- Wearing shoes that are too tight/crowd the toenails
- Cutting the toenails too short and/or not cutting them straight across.
115
What are 3 possible treatment options for ingrown toenails?
- Try to put a cotton underneath the nail
- File off the edges of the nail
- Using a foam cap
116
Which demographic or population are we concerned about ingrown toenails?
Diabetics
- Risks of infection and possible amputation
117
What are the impacts of using Epsom Salts and a foot bath for ingrown toenails?
Not effective in draining the infection from the feet. These are more or less means of TLC.
118
What are the 2 possible causes of Bunions?
- Structural defects (genetic predispositions)
- Footwear can also make it worse.
119
What skin condition is caused by a fungal infection and presents with itching, burning, and peeling skin between the toes?
a) Plantar Warts
b) Ingrown Toenails
c) Athlete's Foot
d) Bunions
c) Athlete's Foot
120
Warts are a form of which kind of virus?
HPV family
121
T/F: The presence of blood vessels in the core of plantar warts helps them to thrive and grow.
True.
- Blood vessels provide essential nutrients and oxygen to the wart tissue, allowing it to persist and potentially spread.
122
What is the characteristic appearance of hand warts?
a) Soft, whitish lesions with pinpoint bleeding
b) Small, rough growths with tiny black dots
c) Smooth, dome-shaped papules with a central umbilication
d) Pedunculated or sessile growths with a smooth surface
b) Small, rough growths with tiny black dots (sometimes)
123
# Diagnosis Case Studies:
A 45-year-old construction worker presents with thickened, hardened skin on the soles of his feet. He complains of discomfort when walking long distances.
- Symptoms: Thickened, rough skin; may be yellowish or gray in color; may cause discomfort or pain.
- Signs: Localized areas of thickened skin, often on weight-bearing areas of the feet or hands.
Presentation: Well-defined, round or oval-shaped patches of thickened skin, often with a central core of hardened tissue.
**What is the likely diagnosis for this patient?**
**Calluses**
- Localized thickened skin on weight-bearing areas is consistent to calluses usually along with having a central core of hardened tissue.
Could also be **Hard Corns** as well as they describe round patches of hardened skin with a central core FYI... Hmmmmmm
124
# Diagnosis: Case Study
A 64-year-old man complains of a painful, hardened lesion on the top of his toe. He reports discomfort while wearing shoes.
Symptoms: Painful, hardened area of skin; may have a central core.
Signs: Thickened, yellowish skin; often with a central core of keratin.
Presentation: Well-defined, round or oval-shaped lesion, usually on weight-bearing areas of the feet, such as the tops of toes or soles.
**Hard Corns**
- Located on the tops of the toes as well as the weight-bearing areas of the feet and experiences pain/discomfort
- Hardened area of skin with a Central core of keratin -- distinguishing feature between this and calluses plus the oval-shape
125
# Diagnosis: Case Studies
A 10-year-old child complains of a painful growth on the bottom of their foot. Upon examination, a small, cauliflower-like lesion is noted.
Symptoms: Pain or tenderness with pressure; small, fleshy growths with black dots (thrombosed capillaries) on the soles of the feet.
Signs: Small, rough growths with tiny black dots; may have a cauliflower-like appearance.
Presentation: Solitary or clustered lesions on weight-bearing areas of the feet, often with pinpoint bleeding when pared down.
**What is the likely diagnosis for this 10-year-old child?**
** Plantar Wart **
- The fleshy black dots are little blood vessels that have grown up into the wart. This is a distinguishing feature of plantar's warts along with their califlower-like appearance.
- Pain and its location is also a good pinpoint of this diagnosis
126
# Diagnosis: Case Studies
A 37-year-old woman presents with small, soft growths on her neck and underarms. She reports no pain but finds them cosmetically bothersome.
Symptoms: Soft, flesh-colored growths hanging from the skin; typically painless.
Signs: Pedunculated or sessile growths with a smooth surface; may be wrinkled or folded.
Presentation: Small, soft protrusions of skin, often in areas of friction or folds, such as the neck, underarms, or groin.
**What is the likely diagnosis?**
**Skin Tags **
- Symptoms, including the painless and more cosmetically bothersome effects
127
# Diagnosis: Case Study
A 25-year-old man presents with complaints of foul-smelling feet despite practicing good hygiene.
He reports wearing closed shoes for prolonged periods.
Symptoms: Strong, unpleasant odor emanating from the feet; may be embarrassing or socially distressing.
Signs: Foul odor associated with sweat and bacterial growth on the feet; may have moist, sweaty skin.
Presentation: Persistent foot odor due to bacterial breakdown of sweat and skin cells, often worsened by wearing closed shoes or poor hygiene practices.
Bromidosis (Foot Odor)
| Smelly Feet
128
Who are SilverSocks targetting?
What is the logic behind the use of this product?
Is it effective?
Diabetics.
Silver and Copper can both serve to be antibacterial... But it is not likely to do much good in terms of acting on all the bacteria that might be causing Smelly Feet. If anything, it could maybe decrease the smell a bit.
Theoretically, it can make some sense... But not likely to be as effective as one would hope for.
129
# Diagnosis: Case Study
A 43-year-old man complains of itchy, burning, and peeling skin between his toes. He reports frequent use of communal showers at the gym.
Symptoms: Itching, burning, and peeling skin between the toes; may have redness and blisters.
Signs: Cracked, scaly skin with redness and inflammation; may have small fluid-filled blisters.
Presentation: Fungal infection of the skin, typically between the toes but can spread to other areas of the foot, causing itching, burning, and discomfort.
**What is the likely diagnosis? **
Athlete's Foot
130
# Diagnosis: Case Study
A 22-year-old office worker notices small, raised bumps on their fingers. They report mild itching and occasional pain.
Symptoms: Small, grainy, raised bumps on the fingers or hands; may be itchy or painful. They are rough to touch.
Signs: Flesh-colored or slightly darker papules with a rough surface; may have black dots (thrombosed capillaries).
Presentation: Single or multiple papules on the fingers or hands, often with a rough texture resembling a cauliflower.
Hand Warts
- Location (hands and fingers)
131
# Diagnosis: Case Study
A 19-year-old woman presents with pain and redness along the edge of her toenail. She reports difficulty wearing shoes and notices pus drainage.
Symptoms: Pain, redness, and swelling along the edge of the toenail; may have pus drainage or infection.
Signs: Nail tag is digging into the surrounding skin; may be swollen, tender, and infected.
Presentation: Nail growing into the skin along the edge of the toenail, often causing pain, inflammation, and infection
Ingrown Toenail(s)
132
A 55-year-old man presents with sudden onset severe pain and swelling in his big toe joint. He reports a history of high purine diet and occasional alcohol consumption.
Symptoms: Sudden onset severe pain, swelling, redness, and warmth in one or more joints, often in the big toe joint.
Signs: Swollen, tender joint with overlying redness and warmth; may have limited range of motion.
Presentation: Acute attacks of inflammatory arthritis, commonly affecting the big toe joint (podagra), but can also affect other joints such as the ankles, knees, and wrists.
**What is the likely diagnosis? **
Gout
133
# Diagnosis: Case Studies
A 70-year-old woman notices a soft, whitish lesion between her toes. She experiences discomfort and occasional burning sensations.
Symptoms: Soft, whitish lesion; may be painful or tender.
Signs: Moist, whitish skin; often found between the toes or in areas of moisture and friction.
Presentation: Soft, macerated lesion, often found between the toes or in areas where two toes rub against each other.
**What is the likely diagnosis?**
**Soft Corns **
- Between the toes (and areas of moisture and friction
- Presentation: soft (macerated), white lesions, discomfort
134
# Diagnosis: Case Studies
A 59-year-old female presents with a toe that is bent downward at the middle joint. She reports discomfort while wearing shoes.
Symptoms: Toe bent downward at the middle joint; may cause pain or discomfort.
Signs: Deformity of the toe, usually with the proximal interphalangeal joint flexed downward and the distal joint extended.
Presentation: Abnormal positioning of the toe, often resembling a _____, with the tip of the toe pointing downward.
**What is the likely diagnosis?**
**Hammer Toe**
- A toe that is bent downward at the middle of the joint and has discomfort when wearing shoes
- Toe deformity and the pain and discomfort
135
# Diagnosis: Case Studies
A 46-year-old male notices a painful, swollen bump on the side of his big toe. He reports difficulty fitting into shoes. He indicates his father also suffered from the same thing.
Symptoms: Painful, swollen bump on the side of the big toe; may cause redness or inflammation.
Signs: Enlargement of the first metatarsophalangeal joint; deviation of the big toe toward the other toes.
Presentation: Bony bump on the side of the foot, usually at the base of the big toe, accompanied by misalignment of the toe.
**Bunions **
- Genetic predisposition
- Misalignment of the toe - the big toe will lean on the smaller toes.
- Usually affects the big toe and will cause them to lean towards the other toes around them.
136
# Diagnosis: Case Studies
A 6-year-old child presents with multiple small, raised lesions on their knees and elbows. The lesions are painless but concerning to the parents.
Symptoms: Small, raised bumps on the skin; usually painless. They are are smaller than other warts and, unlike other warts, these bumps are smooth on top.
Signs: Flesh-colored or slightly lighter or darker papules with a smooth surface.
Presentation: Multiple, small papules on areas of friction or trauma that can affect any area of the body such as the face, legs, elbows, or hands. Usually common among children and young adults.
**Juvenile Warts **
- Painless, smaller bumps than other warts.
- Typically found in children and young adults and in areas of the skin where there's friction or trauma usually.
- Can be flesh-colored, or lighter or darker than the skin that surrounds them
137
Why are blood vessels in the core of plantar warts significant?
a) They help in diagnosing the type of wart
b) They provide nutrients and oxygen for wart growth
c) They cause pain and discomfort
d) They facilitate immune response against the wart
b) They provide nutrients and oxygen for wart growth
## Footnote
When warts have blood vessels at its core = Concern because of this!
138
How do plantar warts typically affect the skin lines or ridges of the foot?
a) They have no effect on skin lines
b) They align with skin lines, enhancing their appearance
c) They disrupt the natural pattern of skin lines
d) They cause skin lines to become more pronounced
c) They disrupt the natural pattern of skin lines
- Dermatoglyphics play a role in plantar wart formation and treatment because it influences the growth and spread patterns of the wart/virus.
## Footnote
Skin lines or ridges, also known as dermatoglyphics, play a role in plantar wart formation and treatment because they can affect how the wart grows and spreads. Plantar warts often disrupt the natural pattern of skin lines, causing them to appear interrupted or distorted. Additionally, the friction and pressure from walking or standing can cause the wart to grow inward, following the lines of pressure on the foot
139
Plantar Fasciitis
Over-stretching of the plantar fascia where can either get Inflammation, irritation and/or become swollen, which is the tissue in the foot used during walking and foot movement...
- Not associated with trauma
- As we age, we have less fat on the heel
- Can be extremely painful
140
What can pharmacists do to help people with Plantar Fasciitis?
Refer to MD.
141
Despite the fact that Plantar Fasciitis is immediate referral for MD, what percentage of cases are able to find ressolution with OTC and home remedies within 6 months of starting treatment?
Approx. 80%
## Footnote
... But can still be quite painful for individuals during this process of treatment and finding something that might work.
142
What are some options to consider to help treat or care for the Plantar Fasciitis?
Cold Packs
Strassburg Socks
Plantar Fasciitis sleeves
143
Strassburg Socks
- What are their indications?
- How does it work? When to use?
- Is it effective?
* Indication: Plantar Fasciitis
* Keeps the feet and heels stretched out instead of curving inward or flopping overnight (looks like as though we are stepping on the gas pedal) and tries to keep the tendons stretched out... This prevents the tendons from shrinking and hope to prevent them from re-ripping.
* Yes, it is effective. But very expensive.
144
# Diabetic Foot Care and Sick Day Management
Why is it important for diabetics to check their feet regularly - even once daily?
Diabetics lose nerve sensations.
- If a diabetic is using S.A. they are likely not to feel anything because of this.
- Need to be careful with or without use of S.A. as this can lead to ulcers.
