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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_141_библиотеки_им_акад_М_И_Перельмана
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Chemical Burn DuetoGlacial Acetic
https://t.me/med1917
Acid
35
I applied glacial acetic acid to get rid of corns and calluses on my foot (Fig.35.1).
A woman in her 40s, Ms. P, came in complaining of
severe pain after applying glacial acetic acid to corns on her
feet. Upon closer examination, she had chemical burns from
the glacial acetic acid in two places on both feet, with particularly severe damage on the little toe of her right foot. I
have occasionally seen cases where glacial acetic acid was
applied to athlete’s foot or tinea corporis, and many cases
where it was applied to the face or arms to remove moles, but
this is the rst time I’ve seen it applied to remove corns.
Applying such a strong acidic substance to the skin not only
causes chemical burns but also deep tissue necrosis, leaving
permanent scars. It is a dangerous act that should never be
recommended to anyone, including oneself.
Ms. P also informed me that glacial acetic acid is still
being added to food. I thought it was only added to food in
the old days when times were tough, but it’s worrying to
hear that it’s still commonly used in various foods, including cucumber pickles and danmuji (yellow pickled radish).
If you mistakenly apply glacial acetic acid to your skin, do
not attempt to treat it yourself, but go to the hospital immediately. This is the only way to reduce permanent aftereffects (Figs.35.2, 35.3, 35.4, 35.5, 35.6, 35.7, 35.8 and 35.9).
Fig. 35.2 Chemical burns caused by applying glacial acetic acid to
corns and calluses
Fig. 35.1 Damage caused by applying glacial acetic acid to a corn
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_35
Fig. 35.3 Hypertrophic scars and keloids caused by applying glacial
acetic acid at home to remove moles
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Figs. 35.4 and 35.5 Chemical burns caused by mixing glacial acetic acid with our and applying it to remove blemishes and moles
35 Chemical Burn DuetoGlacial Acetic Acid
Figs. 35.6 and 35.7 Chemical burns caused by removing moles with glacial acetic acid
Figs. 35.8 and 35.9 Case of patient who applied glacial acetic acid for the treatment of tinea corporis
Washboard Nails
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36
My child’s nails have many short, shallow horizontal
grooves like a washboard, and the central part is slightly
sunken (Fig.36.1).
“Please x my child’s ngernail!” said the worried mother
of a 13-year-old boy, K.It’s a nail deformity caused by a bad
habit, and I hope the child won’t do it again, but I’m also
worried. I asked, “So, are you biting your thumbnail? Or
pressing it with your other ngernails?” He said, “Like this!”
and he showed it directly (Fig.36.2).
Washboard nails refer to a condition where one or both
thumbnails show deformities similar to a washboard, characterized by numerous short and shallow horizontal grooves in
the central part of the nail, along with a wide depression
extending from the eponychium to the edge of the nail plate.
It was rst described by Samman in 1963. It often occurs due
to habitual actions such as pressing the thumbnail with the
index nger or biting it with the teeth, hence it is also referred
to as habit-tic deformity or traumatic nail dystrophy. Such
habitual actions on the nails can also lead to partial loss of
the nail, reduction in the size of the nail plate, chronic paronychia, secondary bacterial infection, gum damage, and dental problems. Washboard nails typically occur on one or both
thumbnails but can also occur on other nails. Washboard
nails are generally caused by repeated damage to the nail
matrix, usually due to external trauma. This trauma could be
a single blow that causes temporary or permanent damage to
the nail matrix, or repeated minor stimuli that continuously
damage the nail, such as pressing the proximal nail fold,
habitual biting of the nail, or pushing up the cuticle.
Furthermore, it is known that even without such external
trauma, repetitive use of personal portable devices such as
musical instruments, PDAs, and mobile phones can put pressure on the nail matrix of the nger opposite the stimulated
area, potentially causing washboard nails. However, in many
cases, the cause cannot be found, especially in cases where it
Fig. 36.1 Washboard nails on both thumbs Fig. 36.2 One of the habits that create washboard nails
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_36
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Figs. 36.3 and 36.4 Washboard nails showing depressions at frequent pressure points
36 Washboard Nails
Figs. 36.5 and 36.6 Washboard nails on the thumb
occurs on the toenails, the cause is mostly unknown
(Figs. 36.3, 36.4, 36.5, 36.6, 36.7, 36.8, 36.9, 36.10,
36.11–36.18, 36.19, 36.20, 36.21, 36.22, 36.23, 36.24 and
36.25).
The most important thing in treatment is to make patients
aware that changes in the nails can occur due to continuous
nail biting or habitual tics, and to educate them to stop these
habits, then we can usually expect normal nails to grow.
There are reports that nail biting is associated with obsessive-
compulsive disorder, which is treated with serotonin reuptake inhibitors, and there are also reports that washboard
nails caused by nail biting have shown good treatment effects
with serotonin reuptake inhibitors. Intralesional injections of
triamcinolone into the proximal nail fold or topical application of steroids and tacrolimus can help improve the lesions.
I sincerely hope that K will also give up these habits, diligently apply the treatment ointment, and succeed like other
children who have been cured.
36 Washboard Nails
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Figs. 36.7 and 36.8 Washboard nails on the thumb
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Figs. 36.9 and 36.10 Washboard nails on the thumb—10× magnication
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36 Washboard Nails
Figs. 36.11–36.18 Nail deformities resembling a washboard observed on nails other than the thumb—10× magnication gures
36 Washboard Nails
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Figs. 36.19 and 36.20 Washboard nails on the big toe—10× magnication
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Fig. 36.21 Washboard nails on the thumb—10× magnication photo
Fig. 36.22 Washboard nails and periungual warts
Fig. 36.23 Nail biting, washboard nails, and paronychia
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Figs. 36.24 and 36.25 Washboard nail-shaped lesions—10× magnication
36 Washboard Nails
Warts, Plantar Warts, Verruca Plantaris
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After examining the patient, I told her that the thing on
her foot was a wart, and she said it was a corn even if she
died (Fig.37.1).
Ms. K in her 30s came in saying she had a corn near her
big toe, but upon closer examination, it was a wart, so I said,
“You have a wart on your foot.” She replied, “Am I a child?
A wart? I swear it’s a corn!”
When patients come in saying they have a corn on the sole of
their foot or under their toes, it should be differentiated from
plantar warts (verruca plantaris). The differentiation of the
two conditions is possible by scraping off the surface keratin
with a scalpel. Despite Ms. K’s strong assertion that it was a
corn, when we scraped it off a bit, the black dots characteristic of plantar warts appeared (Figs.37.2 and 37.3).
37
Fig. 37.1 Wart lesion observed on the big toe
Figs. 37.2 and 37.3 When the lesion is scraped with a scalpel to the height of the surrounding skin, black dots are visible
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_37
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37 Warts, Plantar Warts, Verruca Plantaris
Warts are a disease in which benign proliferation of the
skin and mucous membranes occurs due to infection with the
human papillomavirus (HPV). They mainly occur on exposed
areas such as hands, feet, legs, and face, but in cases of sexual contact, they can also occur on the genitals. Warts have
characteristic clinical ndings, so there is not much difculty
in diagnosis, but histological ndings can be helpful when it
is not clear. In particular, the expanded blood vessels in the
dermal papillae represent the numerous black dots present
on the protuberant surface of the lesion, and when the hard
keratin layer on the surface is scraped off, thrombosed capillaries are present. They are an important differential point
with other diseases such as corns and calluses. Unlike warts
that occur in other parts, plantar warts cannot protrude to the
skin surface due to weight pressure and often dig into the
skin like corns. Therefore, plantar warts form plaques rather
than papules and nodules, cause pain when walking, so they
are mistaken for corns and go to the hospital, but when
examining patients who actually come to the hospital with
corns, there are far more cases of plantar warts than corns.
Especially in the case of children, almost 99% are warts, not
corns. It is necessary to distinguish between the three common keratotic lesions found on the soles of the feet, plantar
warts, corns, and calluses, and plantar warts are more painful
when caught than when pressed, and if you shave off the
hard keratin layer on the surface, the center is not hard and
black dots are found due to thrombosed capillary loops, and
sometimes bleeding is observed from the center of the lesion.
Also, warts on the soles of the feet often occur regardless of
the area where the shoes touch or the weight is applied, and
there is a tendency for multiple lesions to gather (Figs.37.4,
37.5, 37.6, 37.7, 37.8, 37.9, 37.10, 37.11 and 37.12).
The incidence of warts in childhood or adolescence is
reported to reach 10%, and although warts have a high prevalence, generally warts do not interfere with life and often do
not cause signicant functional disabilities, and most patients
cannot accurately distinguish between warts, corns, and calluses. They have the wrong knowledge that all warts will
naturally disappear over time, so they only go to the hospital
after the number of lesions has increased and the range has
widened considerably. It is possible. However, the treatment
of warts, which has been considered insignicant, mostly
involves physical and painful methods such as cryotherapy,
laser surgery, and intralesional bleomycin injections. Since
most cases do not heal with a single treatment, the time and
cost of treatment, as well as the discomfort caused by low
satisfaction with the treatment, can be burdensome for both
patients and medical staff. Therefore, it is thought that systematic and accurate information about warts should be provided to patients, and efforts should be made to improve the
quality of life of wart patients.
Warts are mostly benign diseases, with lesions naturally
disappearing within 2years in 2/3 of cases. However, the number or size of lesions can increase if they persist for a long
Fig. 37.4 Black dots commonly found in wart lesions
Figs. 37.5 and 37.6 Plantar warts—10×, 60× magnied photos
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