Topical treatments

From Pcwiki

Revision as of 21:40, 30 May 2013 by Wikiadmin (Talk | contribs)
Jump to: navigation, search

Although there is no cure-all treatment for PC, patients who deal with PC symptoms on a daily basis have tried a wide variety of products to treat their PC, especially their plantar keratoderma. These products may be over the counter (non-prescription) treatments, prescription treatments, or homeopathic, herbal, or "natural" treatments.


OTC (Over the Counter) Treatments

These are products that are available without a prescription.


Americaine is a family of benzocaine based topical pain relievers. It is a "hospital strength" pain reliever. There are two varieties of Americaine—Americaine First Aid Spray, and Americaine Hemorrhoidal Ointment. They contain the highest level of benzocaine pain relief allowable without a prescription.

K6a patient "During pregnancy, my sores actually changed texture and seemed to have more exposed nerve endings and blood vessels. The pain was constant and agonizing and to even touch a sore would put me through the roof. Because I had so many holes, or open parts in my sores, the things I used helped a lot. So, the best thing I used was Americaine. It's an over the counter hemorrhoidal ointment. I know that sounds funny since I didn't have hemorrhoids, but it has benzocaine in it - a numbing ingredient. So I put this stuff in my open sores and basically it numbed them so I could handle the pain. I went through tubes of the stuff during my last months of pregnancy."

Americaine is available on [].



[Aquaphor Healing Ointment] protects dry, cracked or irritated skin to help enhance the natural healing process and restore smooth, healthy skin.

1. Clinically proven to reduce healing time of minor wounds
2. Creates a protective barrier that seals in moisture
3. Helps heal raw, irritated skin caused by radiation treatments, facial resurfacing procedures and atopic dermatitis
4. Soothes and helps protect extremely dry, chapped or chafed skin and lips caused by winter weather or diabetes
5. Soothes and protects minor burns
6. Fragrance-free, preservative-free, non-irritating

K16 patient "Aquaphor - an ointment that soften dry callouses and smothes dry skin/chapped lips for those of us on an accutane. PCers can get this at their local pharmacy or online."


Bag Balm


Developed in 1899 to soothe the irritated udders of milking cows, the substance with the mild medicinal odor has evolved into a medicine chest must-have, with as many uses as Elmer's glue.

According to Bag Balm lore, the stuff went from barns to bedrooms when dairy farmers' wives noticed how smooth their spouses' fingers were after using it on cows' udders. The wives were jealous.

For over 100 years, Bag Balm® has been a fixture down on the farm. It goes on fast—and stays on! Used for over 100 years on cattle, horses and other domestic animals. It’s loaded with lanolin!

Helps soothe cuts, scratches, skin irritations, small injuries, rash chapping. Softens and moistens skin. It has been used for squeaky bed springs, psoriasis, dry facial skin, cracked fingers, burns, zits, diaper rash, saddle sores, sunburn, pruned trees, rifles, shell casings, bed sores, radiation burns and more.

Patient comments

??? patient "I use Bag Balm to help with my PC"


Callex Creme

[CalleX Ointment] thins and softens hardened skin and exfoliates dry, cracked heels. Its patented, natural enzymes selectively exfoliate only dry, cracked, thickened and scaly skin while its petrolatum base retains natural skin moisture.

K16 patient "I use callex creme that is a mix of urea and salicylic acid."


Heel Balm


Many patients find various creams (including products called 'heel balm') may help to combat dry, cracked and thickened skin on feet and in particular around the heels which may make care and removal easier. Under the 'heel balm' category, there are at least 30 different brands (including Felxitol mentioned below). These products are available at many drugstores as well as online sources.

Patient comments

K6a patient "[a heel balm I use is] made in Australia, but the company may be South African. I used all over my feet to keep them from cracking everywhere - it also seems to make the skin less visually noticeable too. If you have bad cracks you just put the cream on, wrap them up in cling wrap overnight and the next day they are so soft you can walk normal - then do that for a few nights and they go back smooth very quickly. You don't even have to trim the skin down, its very soothing too so it doesn't hurt or sting when used on open cracks. Then, after it has heeled the cracks you can trim the skin easily because its so soft."

??? patient "I find the Flexitol heel balm helps to soften the hard skin on the feet."



Informal comments from physicians on the IPCRR Physician Panel:

Dr. Peter Hull said "It is possible that the abnormal nails could become infected with fungi including non-dermatophytes. Lamisil would only work to get rid of dermatophyte fungi but the nail would remail abnormal if it was affected by PC."

Dr. Philip Fleckman said "Terbinafine (Lamisil) is a good drug for dermatophyte infections (but not Candida or other yeast infections) of the skin. Dermatophytes are a group of fungi that live in the top part of the outer, barrier layer of the skin (the stratum corneum of the epidermis). Dermatophytes cause athelete's foot (tinea pedis), jock itch (tinea cruris), and most types of nail fungal infections (onychomycosis). Because the nails in PC are thicker than normal, they are often mistaken for nail fungal infection and treated with terbinafine. Unless the nails or feet are infected, I know of no reason why terbinafine would improve PC."

It is possible for those with PC, to get a secondary fungal infection (such as a nail infection or athlete's foot, etc.) An antifungal treatment will not improve the PC condition; it may work well to treat a secondary infection. Most of these drugs are not designed for long term use; they are designed only to treat an infection.

K16 patient "Me on the other hand have it quite bad, well worst after the kids anyway. Now I am at the point where I don't even have PC in spots it is just raw skin and itches really bad. I also see that I am getting athletes foot or real bad itching on top of toes and between as well." Physician "It is possible she could have athlete's foot on top of her PC and if that is the case it should respond to to Lamisil which is a OTC medicine."

??? patient "I've been using Lamisil about 4 months & doctor asked me to stop taking it because it is not going to be get rid my problem."

K16 patient "While chatting with my brother, he told me his new doctor has been giving him Lamisil for his feet (fungal infection) and cordisone shots!! He just doesn't get it about his own feet....and apparently this new doctor hasn't a clue about what PC is!"

K6a patient "The doctor asked that we pick up an anti-fungal cream. She first thought lamisil, but changed to miconazole. At the store the only Miconazole was a 'vaginal' cream, but the pharmacist said okay to use on feet; they just didn't carry the 'foot care' package, but it would be the same. I started immediately to soak my feet with a capful of bleach and then applied the anti-fungal cream (Miconazole). I did that yesterday evening and today morning, and I would say it's already helping me a lot. Since the last 4 or 5 years my feet started to itches a lot, specially in the heels, and since I started with this medication it is not itching anymore. That's great!"




The product contains 3-4% Salicylic Acid, Keratolytic chemical. The active ingredient is sodium hydroxide, contains no urea

Patient comments

K6b patient: "A child-age patient finds this helpful. They apply the Medi-Heel and cover his feet in ClingFilm for 10 minutes then take the pumice stone and easily remove all the unwanted skin. Nothing is painful for him."

More information on the Medi-Heel website.



Original [NEOSPORIN® First Aid Antibiotic Ointment] provides long-lasting infection protection and may help minimize the appearance of scars. #1 Doctor Recommended Brand for over 25 years. No other triple antibiotic ointment kills more types of bacteria then even the leading prescription based in laboratory results.

NEOSPORIN® + Pain Relief Ointment & Cream

NEOSPORIN® + Pain Relief First Aid Antibiotic/Pain Relieving Ointment and Cream help prevent infection and provides temporary relief of pain or discomfort in minor cuts, scrapes, and burns. From the #1 Doctor Recommended Brand. Soothes painful cuts. Soothes the pain of burns.

K6a patient "Cracks on feet, sore and painful. Sometimes splits are in sores, sometimes extend to regular skin. Trim down callus carefully around split, put ointment like Neosporin into crack to keep soft. If gets dry it will split more and hurt more. Keeping cracks soft and not so deep seems to help them heal faster."


Phytex Paint

Phytex Paint for the treatment of fungal infection. Pain on to the affected areas, morning and evening and after washing.

K6a patient "I prefer hard skin to soggy blisters and soft skin. Phytex Paint which is for athletes foot, this works a treat to soak up the soft skin"

Phytex paint is available [Here]

Topical Ibuprofen

PC Project applied and received IRB approval for a study of topical ibuprofen believing these were approved over-the-counter products. However, the FDA has ordered all companies to stop marketing this product as it has not been approved for safety.

FDA News Release

FDA Warning Letters to each company selling topical ibuprofen

We know that several patients found this very effective. We are disappointed to not be able to go forward with the study at this time. We note that some companies are continuing to sell the product on-line and have included disclaimers regarding non-FDA approval.

Also, at the 2009 Patient Support meeting in Salt Lake City, one of the physicians suggested a similar product Soloraze gel which is by prescription only. Several patients are trying this on their own and will report feedback. We're gathering additional information and will post it when available.

Prescription Treatments


Bactroban is an antibiotic that treats or prevents infection that is caused by bacteria.

K6a patient "When I get feet infections I use Rx Bactroban."

See the PC Wiki section on infections for more information on treating and preventing infections associated with PC symptoms.

Dilantin (antiepileptic)


Phenytoin sodium is a commonly used antiepileptic. Phenytoin acts to dampen the unwanted, runaway brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage gated sodium channels.

Patient comments

K6a patient "Dilantin or Phenytoin. Drug for sufferers of epilepsy. Used for 6 months to a year. Went off it to have unrelated surgery. After two weeks on drug, not one white blister and was able to spend 6 hours on feet. Still pain, but every time upped the dose, could tell a difference. All follicular keratosis on knees, elbows, bum and anywhere clothes rubbed disappeared. When on Dilantin "my head felt 'right'.. felt like I was more balanced in myself...It made me sleep like I have never slept before, I was zonked out before my head even hit the pillow." Downside: If forgot to take a tablet, would get emotional and a little bit unbalanced. When went off it bumps and blisters came back. Just recently went back on it but again off it again because we are deciding what to do about the kid thing (its a category D drug - ie can cause deformities). Apparently it works on the part of the brain that controls the central nervous system and someone i spoke to had a theory that it stops the body over-reacting to the skin build up. The best effect it had was that i had no white blisters and was able to stand for alot longer and walk longer too. Also made every single follicle bump disappear. Ever since I stopped it my feet have got slowly worse but i do wonder if it is related to me just doing more stuff now - or maybe i got used to doing more stuff while i was on it."



"Fluocinonide cream USP 0.05% - Anti-Inflammatory is a prescription topical solution used to relieve symptoms and shorten recovery time of many common skin conditions. Doctors often prescribe the cream for eczema, poison ivy and oak exposure, and several other forms of dermatitis. Fluocinonide is a synthetic corticosteroid that works by stopping the immune system's inflammatory response and preventing further irritation. It is important for patients to follow their doctors' orders carefully when using the cream to achieve the best results and avoid potentially adverse side effects.

It is usually used over a short period of time and there is little or no data on extended use for chronic conditions.

Topical corticosteroids like fluocinonide cream are commonly used in the treatment of skin disorders, though medical researchers are unsure exactly why such drugs have anti-inflammatory properties. When the cream is absorbed into the skin, it constricts nearby blood vessels and halts the distribution of inflammation-inducing chemical signals from the immune system. Fluocinonide cream has proven very effective in relieving itching, redness, dryness, and localized swelling when it is used as directed by a physician.

Most people who use fluocinonide cream as instructed do not experience negative side effects, though it is possible for dryness and itching to actually worsen with frequent use. Some people are allergic to fluocinonide or inactive ingredients, and may experience hives, swelling, and skin irritation that are not limited to the area of skin on which the cream was applied. A severe allergic reaction can cause airway constriction and, in some cases, lead to dizziness and a rapid heart rate. An individual who experiences any adverse reaction should stop using the cream and seek immediate medical care.

Doctors are very careful when prescribing fluocinonide cream for infants and young children due to the possibility of serious health complications. Corticosteroids can cause hormonal imbalances in young patients, leading to delays in growth, weight changes, and high blood pressure. Some children acquire a blood disorder called Cushing's syndrome after taking corticosteroids. Children who are prescribed corticosteroids typically need to receive regular checkups so their pediatricians can make sure they continue to develop normally."What Is Fluocinonide Cream?" WiseGeek. Conjecture, n.d. Web. 14 Sept. 2012. <>."

Patient comments

K6a patient: "I've been on a new medicine from my podiatrist. it's called Fluocinonide Cream USP 0.05%. It's made the calluses on my feet slowly go away and my feet are like new. I still have the thick ones on my heeks but the main flat portion of my feet feel amazing. Best I've felt in 43 years. I use it 2x a day (morning and evening) and can't thank my doctor enough for this."

K6a patient: "Well, I'm on day 3 of using fluocinonide solution (not cream - liquid form, same 0.05%).  I have noticed the calluses are softer (similar results to when I used urea creams)."

More information on Fluocinonide topical cream

Salicylic Acid

Salicylic acid is a key ingredient in many skin-care products for the treatment of acne, psoriasis, calluses, corns, keratosis pilaris, and warts. It works by causing the cells of the epidermis to shed more readily, preventing pores from clogging up, and allowing room for new cell growth. Because of its effect on skin cells, salicylic acid is used in several shampoos used to treat dandruff. Salicylic acid is also used as an active ingredient in gels which remove warts. Use of concentrated solutions of salicylic acid may cause hyperpigmentation on unpretreated skin for those with darker skin types, as well as with the lack of use of a broad spectrum sunblock.

Patient comments

K16 patient "For my calluses, I've been using salicylic acid with good results. The Rx I have is for 6% and I'd like to find something not quite so strong."

MD comment "You asked about finding a cream/lotion/gel that had a milder concentration of salicylic acid (somewhere around 5%). The 6% strength are prescription only (Rx) - so you'll need to have a doctor write a prescription for any of those. I also looked at some of the 3% creams - and found that just doing an on-line Google search will give a number of things that you can get over the counter (OTC). I included one example that I found online that is marketed for psoriasis, but should work just as well on hyperkeratotic calluses found in PC."

K6a patient "I have calluses starting to grow more on my palms. I went to the doctor and the doctor didn't know if salicylic acid would help and I am being referred to someone else. I have started riding a bike and going to the gym to lift weights."

MD comment "I think the PC web page on salicylic acid is very good and explains it well. I also think that the cause is the friction is creating the calluses and no matter what he uses to soften or reduce the thickness of the callus (such as salicylic acid), if he continues to have the friction, the calluses will remain. In fact, it seems to me that once the calluses have formed, it is more difficult to get them to regress by avoidance of friction than it is to prevent it in the first place. I would describe this to him as a balance of life issues type thing - that only he can say whether the enjoyment and health benefits he is getting from the cycling and weight lifting is worth the discomfort that the callusing brings. You could try and find some type of anti-friction gloves to use."

K16 patient "We are using Urea 40 cream and salicylic acid and my husband has worked on his calluses diligently for the last few months and it has made a huge difference."

K16 patient " I use RE Salicylic Acid 6% creme that slows growth."

K16 patient "I do not recommend salicylic acid. I was using it on one hand for a few months and it seemed to be helping but has now stoped using it and it made the calluses on my hand come back 3 times more worse then they were to begin with and I wish that I had not tried it."


Description Urea is an emollient (skin softening agent) which helps to moisturize the skin and is used in topical dermatological products to promote rehydration of the skin. If covered by an occlusive dressing, 40% urea preparations may be used as keratolytic agents (for debridement of nails and removal of calluses.)

Generic Name: Urea Cream, Gel, and Ointment 25%, 30%, 40%, and 50% Brand Name: Examples include Carmol 40 and Keralac

Patient and physician comments

K16 patient "I use Urea Cream (40%) that is a tissue softener."

K17 patient "For thick nails I use a Rx Urea 40% Gel. This comes with an applicator and looks like clear nail polish. I use it twice a day and it dries pretty quickly (less than 5 minutes). I have been using on my two thumb nails for only one week and have noticed one of them is considerably thinner. The other one (right) was thicker to begin with."

K17 patient "Carmol40 (40% Urea) Cream on my calluses off and on since July 2007. It seems to stop the calluses on my feet from growing so fast. I cannot use it daily as was prescribed as it causes my heels/feet to blister. I do use it 2 or 3 times a week, though, and have noticed a change for the good. There is less callusing and less to trim when I do my weekly trimming."

K6a patient "There is also a paste my grandmother has been using daily for many months and her callouses have disappeared totally. She tells me that after having used this paste every night before she went to bed, the callouses started to peel off her feet until one day she could remove what she called "the heart" of the callous, a tiny white thread that she pulled out from the middle. As for the paste, this is something that anyone can buy at the drugstore, there was no doctor involved. It is also cheap. I know that this paste has been out there for many years, the name of the paste is called EXCELSIOR and according to the tube contains: Ácido Salicílico and Excipiente. Again,these are the spanish names/ terma written on the product. The producers are: Laboratorios GRISI."

  • Comment 1 (PC Physician Panel member; Dermatologist) -- "I am not certain what the paste is, but it sounds like it may be urea paste, potentially with some other keratolytics added as well. The urea (if that's what it is), is a substance that reduces the cohesiveness of the calluses and will again, help with the thickness of the calluses, but will not affect the underlying disorder."

    K16 patient "I am a older women with PC, who visits my podiatrist once a month. He keeps the callus' cut down on my feet. As I've been aging (and gaining weight) the cracks in the callus' have gotten worse (and multiplied) to the point where it's painful to walk. This has been for YEARS, and at night, especially I'd be walking on the balls of my feet to keep pressure off the cracks. Over the years my podiatrist has given trial size creams, etc., just to try to see if anything helped. About 3 months ago he gave me samples of "Kerol Emulsion 50% Urea", which I started using in the AM, and PM. Once I used the samples up I requested a prescription, which I got and have been using faithfully. Within 1 month most cracks were healed, and new growth slowed down. Within 6 weeks virtually all cracks have healed and I can actually walk flat footed from morning to night. It's not a cure, but boy, the relief is the next best thing."

  • Comment 1 (PC Physician Panel member; Dermatologist) -- "As we discussed Urea has been used for a long time to soften and smooth thick skin - we often used 20-40% urea on palms and soles in patients with keratodermas. Also used for ichthyosis etc. I think you could post this on the web as it doesn't have significant toxicity and it might provoke some discussion of others who have used urea products. The 50% emulsion is a new formulation and also contains lactic acid which has keratolytic properties. With the thick callouses of PC I would be surprised that it would be very effective unless used under occlusion (i.e. plastic wrap) and if too much thinning it might increase the pain. As the patient noted it may help to heal fissures on the feet."

  • Comment 2 (PC Physician Panel member; Dermatologist) -- "50% is really a high percentage -- we used to use 40% under occlusion (i.e. plastic wrap) to thin nails and it will soften just about anything at that percentage. I am not familiar with the Kerol emulsion formulation (though I see on the web it is in a zinc and lactic acid containing vehicle), so can't comment on that. I wonder how thick the calluses were to begin with. It would be interesting to find out more about this particular formulation and to see if some other patients might be willing to give it a try systematically. A prescription is required. I think if you had 5-10 people willing give it a try over 6 weeks you would get a pretty good idea about whether it was something you wanted to pursue through a more rigorous trial (or not)."

    Other treatments (herbal, homeopathic, miscellaneous)

    Formula 303


    A All Natural Homeopathic Formula used for Relief of Muscle Spasm, Pulled & Tight Muscles, Tension and Stress.

    Patient comments

    ??? patient "I take natural relaxant supplement called Formula 303. The main ingredient is Valerian Root. Sometimes when I'm having a really hard time and getting off of my feet is not an option for me I will take 1 200 mg ibuprofen along w/the Formula 303 (which is not addictive)."

    Gentian Violet


    Gentian violet has antibacterial, antifungal, and anthelmintic properties. It is commonly used for:

    Marking the skin for surgery preparation and allergy testing

    Tinea; e.g. Athlete's foot, jock itch, and ringworm

    Candida albicans and related infections; e.g. thrush, yeast infections

    Mouth ulcers

    Impetigo, used primarily before the advent of antibiotics, but still useful to persons who may be allergic to penicillin, as it cleans the open sores and prevents spread of the contagion

    Abrasion; It has also one of the best agents for "scabbing" up an abrasion or "strawberry" type of weeping wound where the flesh is abraded away. It will prevent infection in almost any wound or burn and quickly help the epithelium form a scab. It does not burn when applied and temporary skin discoloration is a minor side effect.

    Use in PC

    Gentian violet may have some benefits with PC infections and needs further exploration and testing.

    Olive Oil

    K6a patient "Rub olive oil on feet, let it soak deep into skin, the scrub off oil with dish detergent. Recommended by patient's dermatologist. Took away burning feeling."


    Rose Hip Seed Oil

    Rose hip seed oil is a pressed seed oil, extracted from the seeds of a rose bush which grows wild in the southern Andes. It is unique among vegetable oils in containing retinol (Vitamin A). Rose hip seed oil is high in the essential fatty acids - linoleic acid or omega-3, and linolenic acid or omega-6. It is commonly used in skin care products. It is used for a variety of skin conditions, including dermatitis, acne and eczema, for mature and sun burnt skin as well as brittle nails. Rose hip oil is also frequently used to heal scarring and diminish photo aging.

    K6a patient "Dry skin around and on thick skin is itchy and painful. Blisters may crack. Skin care product based on Rose Hip Oil. Find it helps on very dry skin, especially on heels which would get very cracked in summer.


    Tiger Balm

    Description from the Tiger Balm Website

    Tiger Balm - a brand that millions use worldwide for quick, effective relief of their body aches and pains.

    Patient comments

    K6a patient "Tiger Balm - found in Thailand (for gnat bites). I rub it into the veins around the ankle and it relaxes the whole foot, relieving pain."


  • Personal tools