The best way to describe these little critters is to imagine having small "dot" calluses on the bottoms of your feet. Those of you who pick at them, are able to remove a central core of this callous, which temporarily provides relief until it builds up again. We know how painful these can become! Of our patients described them as having a sensation of stepping on tiny pebbles all the time. Ouch!

There are quite a few variants of porokeratosis. The ones that usually affect the feet are known as "punctuate" Porokeratosis. This is typically a hereditary condition which causes chronic keratinization (formation of callous) in tiny circular, slightly elevated mounds. These types of porokeratosis can be found anywhere along the bottom of the feet, and depending on their location, can become very painful. Most people find themselves picking at these to try and remove the center part of these lesions which is the hardest part of the callous. When they realize that these little guys keep coming back is when they visit us!

How do we make them go away? Well, it is not that simple. Because this is a hereditary condition, they usually do not go away. They can however, with tender loving care, be kept under control. The best way to initially treat symptomatic porokeratosis, is to have the lesion sharply excised (carved out with a scalpel) by a podiatrist. We have found that after doing this, immediate relief is achieved.

But we are looking for long-term relief! Depending on the size and the location of the lesion, sometimes the use of Cryotherapy, or freezing the central core, with the application of Salinicaine under occlusion, can give relief for up to six months or longer!

Relief can be prolonged with what you can do at home. Porokeratosis can be effectively kept under control at home with the use of a urea based cream, which is a powerful ingredient that will significantly soften callous formation with little if any effect on the healthy surrounding skin. This cream in effective concentrations can only be obtained through prescription or sometimes at your podiatrist's office! We will even sometimes instruct our patients to use this urea-based cream under occlusion for a more powerful effect.

So the porokeratosis is softened, but now what? The second step to this process is just as important as the first. If you do nothing but soften this lesion, you end up with a soft painful callus! It absolutely needs to be removed. The way to do this at home is through the use of a pumice stone. The best time to use the pumice stone is after you have showered when your feet are moist. Wet the pumice stone, and in a light circular motion, increasing pressure as tolerated, you can work off what the cream has softened. Anyone that is diabetic or has neuropathy involving their feet should not do this without the approval and under the guidance of their podiatrist!

We are sure many of you are thinking "Why can't you take me to the OR and surgically just cut these darned things out?" As a matter of fact, we can cut them out but, again, is not as easy as it sounds. These porokeratosis extends beyond the superficial layer of skin and end the fat pad cushioning the bottom of your foot. With surgically excising these, we would have to use a plastic surgery-based skin flap to cover the large hole that would be left after removing these down beyond their core. Remember any cut anywhere on the body produces scar tissue. In healing this type of surgery, many patients have complained of ending the up with a scar larger and more painful than the original lesion! This is not a risk we suggest you take unless you have been honestly consistently treating these with minimal improvement and the porokeratosis is causing discomfort significant enough that it interferes with your daily activities.

There are many people we see in our practice with this condition. All in all, it is an extremely rare situation, where the patient chooses the surgical option. We find most people, with good at- home maintenance, rarely, if ever need to return to us to have them "carved out". We like this kind of success and we can make this happen for you too!