KONSEP DASAR PENYAKIT CLAVUSA. Pengertian Clavus (klavus) adalah istilah kedokteran, di masyarakat awam biasanya disebut mata ikan. Clavus bukanlah tumor, bukan pula tanda awal kanker, melainkan penebalan dari kulit. Mata ikan adalah kelainan pada kaki berupa kulit yang menebal, tidak merata , tampak seperti kerucut terbalik dengan alasnya ada pada permukaan kulit. Kalau dipegang akan terasa keras, namun kalu dibawa berjalan akan terasa nyeri. Sumber lain mengatakan bahwa clavus ini adalah semacam tumor jinak yang biasanya tumbuh pada kulit permukaan kaki. Bentuk mata ikan itu sendiri biasanya bulat dan berwarna putih persisi seperti mata ikan beneran. Ada juga yang berpendapat clavus merupakan pertumbuhan semacam “kapalan” dimana hanya terlokasi hanya pada satu sisi dan menimbulkan rasa sakit tertekan yaitu pertumbuhan sel-sel tanduk yang tidak normal. Biasanya ditelapak kaki dan pertumbuhannya yang pesat menekan sel-sel sekitarnya termasuk jaringan dibawahnya ataupun sel-sel syaraf. Penyakit seperti ini tidak bisa dibiarkan, disamping mengganggu aktivitas kita, juga akan terus membesar dan melebar. Sehingga menjadi benjolan semacam tumor, bahayakan lambung secara langsung. Bersamaan saat nyeri terjadi akan meningkatkan keasaman dari lambung Berbagai profesi akrab dengan clavus misalnya pemain gitar di jari-jari yang menekan senar pada keher (neck) gitar, sepatu pada jari kaki, penjahit pada jari telunjul, dsb. Lokasi akan menentukan apakah ia akan basah atau kering. Ia akan kering bila terjadi di permukaan kulit dan basah bila terjadi disela jari. Bila terjadi demikian jangan menutup clavus dengan kapas karena tidak menyerap air. Mata ikan biasa berubah menjadi borok terinfeksi. B. Penyebab Ada beberapa pendapat yang menyebutkan penyebab timbulnya mata ikan. Pendapat pertama yaitu mata ikan timbul disebabkan oleh virus yang kemudian masuk diantara kulit dan daging kemudian merusak jaringan bawah kulit, sehingga makin lama, makin mengeras, dan membesar. Pendapat kedua adalah Mata ikan tidak disebabkan oleh kuman, tapi disebabkan oleh gesekan atau tekanan dalam waktu yang lama, sehingga terjadi penebalan kulit. Penyebab terjadinya penebalan dari kulit ini adalah tekanan dan gesekan terus-menerus pada bagian kaki yang terkena. Misalnya, karena pemakaian sepatu yang terlalu sempit atau lama. Oleh karena tekanan terbesar pada telapak kaki, maka biasanya clavus timbul pada telapak kaki. C. Tanda dan Gejala Walaupun merupakan penyakit yang banyak terjadi,munculnya clavus kadang-kadang juga dapat berhubungan dengan penyakit lain. Clavus dapat merupakan adanya gangguan saraf tepi akibat kencing manis, atau pada penderita arthritis rematoid (salah satu jenis rematik) menjadi tanda sudah ada perubahan sendi tulang-tulang kaki. Jika clavus terjadi pada orang diabetes yang sudah mengalami gangguan saraf tepi kaki, biasanya tidak terasa nyeri. Tetapi hal ini malah dapat berbahaya, karena dapat mmeluputkan perhatian akan adanya luka/ borok yang dapat berakibat serius pada penderita diabetes mellitus. D. Pengobatan dan Perawatan Bila tidak mengganggu biarkan saja, bila mengganggu pengobatannya adalah operasi. Hanya clavus akan tumbuh kembali bila faktor tekanannya tidak dihilangkan. Sebenarnya pengangkatan clavus dengan operasi kecil merupakan cara cepat untuk Electric cauter adalah sejenis alat yang cara kerjanya membakar kulit secara electir dan dengan menggunakan metode tertentu sehingga kutil akan terbakar dan lepas dengan sendirinya sampai keakar-akarnya. pembengkakan. Z. stimulasi sirkulasi. Bila hal ini terjadi ada baiknya konsultasi juga dengan dokter spesialis penyakit dalam. Jika perlu . untuk pergi ke dokter. Apakah sudah nyaman atau terlalu sempit. Dibeberapa daerah daun dewa dikenal dengan nama beluntas cina. dan lain-lain. melancarkan sirkulasi darah. menghilangkan panas. (Djoerban.Untuk mengurangi nyeri. dan tenin. Warna permukaan daun dibagian atas hijau tua. atau samsit. dan membersihkan racun. konsultan rematologi. perdarahan. Obat kutil dan mata ikan. dan lain-lain. tulang patah. mungkin dapat dicoba dengan mengoleskan salep keratolik pada mata ikan. Sementara umbinya berkhasiat untuk mengatasi bekuan darah.KK). memberikan obat-obat oles yang dapat menipiskan lapisan kulit yeng menebal yaitu yang mengandung urea.2008) Selain dioperasi clavus dapat diobati dengan cara berikut : 1. Dengan pengobatan ini kutil dapat langsung dihilangkan tanpa mengeluarkan darah. 2. Saat ini ada alat yang dapat menghilangkan kutil dengan cepat. Ekstark ini juga mampu menghambat pertumbuhan sel kanker. mencairkan bekuan darah. gantilah alas kaki selama ini. Jadi jangan ragu. secara laboratoris ekstak etanol daun dewa mampu menghambat pertumbuhan tumor paru pada mencit (tikus putih kecil). Pengobatan tradisional Pengobatan tradisional kutil daun dewa juga dipercaya dapat menyembuhkan kutil. Salep dioleskan pada pagi dan malam hari . mungkin perlu dirontgen untuk melihat kondisi tulang-tulang kaki dan sendi-sendinya. diplester dan dibiarkan meresap. Kedua permukaan daunnya berambut dengan warna putih. Yang penting. Pada beberapa tulisannya menngenai tumbuhan berkhasiat obat Indonesia Prof HM Hembing Wijayakusuma menyampaikan bahwa daun dewa memiliki banyak khasiat. Harus memperhatikan sepatu atau sandal yang dipakai selama ini. sementara dapat ditempelkan plester tebal pada clavus. Disana anda dapat bebas berkonsultasi tentang permasahannya dan tentu saja dokter spesialis itu akan memberikan pengobatan yang terbaik buat kamu. atau gynura pseudochina) cukup lama dikenal sebagai tanaman anti kanker. melancarkan haid. ditutup kapas. sedangkan dibawahnya berwarna hijau muda. Efek farmakologis . 3. Daun dewa (Gynura divaricata. Daun dewa mengandung zat saponin.menghilangkan nyeri yaitu dengan mengeluarkan inti mata ikan atau eksisi total. karena dikhawatirkan sudah terjadi perubahan pada tulang dan sendi. gynura segetum (lour) Meer. Manfaat itu banyak berasal dari daun dan umbinya. Tinggi tumbuhan ini bisa mencapai 50 cm. berwarna kuning berbentuk bonggol. Daun dewa tergolong tumbuhan semak yang subur pada ketinnggian 0-100 meter diatas permukaan laut. semakin awal dalam mengobati penyakit itu semakin baik. flavonoid. yaitu dengan menggunakan salep herbal. menghentikan perdarahan. Daunnya tunggal bertangkai pendek berbentuk bundar telur berujung lancip. pembengkakan payudara. yaitu dengan menggunakan electric cauter. Jika clavus berulang kembali dan anda juga menderita rematik. asam glikolat/malat/salisilat. Bunganya terletak dibagian ujung batang. minyak atsiri. Daunnya berkhasiat untuk mengobati luka terpukul. Efek farmakologis daun dewa adalah anti kuagolan (koagulan=zat yang mempermudah dan mempercepat pembekuan darah). Menurut penelitian dari Fakultas Farmasi UGM dan Badan Tenaga Nuklir Nasional ( BATAN). Pengobatan ini bisa di dapatkan dari dokter spesialis kulit dan kelamin (Sp.Tapi jika ingin mencoba cara tanpa operasi. menghentikan perdarahan. hindari hak tinggi. some of which are listed in the Table below. Jangan dibiasakan berjalan tanpa alas kaki meskipun itu didalam rumah. and callous. Synonyms for clavus include callosity. or plantar corn. Localized callosities of the soles. selalu jaga kebersihan kaki kalau perlu secara rutin dilakukan perawatan yang lebih intensif lagi. corn. callus. karena bisa beresiko kemasukan benda asing. including callosities related to repetitive use of fine jeweler's instruments. The word clavus has many synonyms and innumerable vernacular terms.[1] When callosities occur over 1 or more lateral metatarsals. in certain situations. karena saat itu kaki berada pada bentuk aslinya. A clavus is a thickening of the skin due to intermittent pressure and frictional forces. they are termed intractable plantar keratoses. The extensive thickening of the skin in a clavus may result in chronic pain. cherry pitter's thumb. selal ganti secara rutin kaos kaki.[2] Clinically. firm. 8] Cigarette lighter's thumb[9] Callosity on the forehead From kneeling prayer with the hands on the forehead Hyperkeratosis of the radial aspect of the thumb Caused by excessive cigarette lighter flicking Knuckle pads[10] Hyperkeratosis over the knuckles Caused by boxing training . when pared. central core. in the fourth interdigital web of the foot for heloma molle. heloma molle). keratoma. clinically and histologically. which also may be seen with the use of cherry-pitting tools Weight lifter's callus[6] Callosities over the palmar metacarpophalangeal joints Caused by the friction of weight-lifting apparatus (This also may be seen in athletes who participate in crew. Pencegahan Pencegahan dapat dilakukan dengan sebisa mungkin menghindari kaki dari tekanan yang terus-menerus.[4] cameo engraver's corn[5] Thumb Digital changes. which. heloma. all these lesions look like hyperkeratotic or thickened skin. these terms describe the related activities that have induced clavus formation. These forces result in hyperkeratosis. and under the metatarsal heads for calluses.[3] Table. heloma durum) or soft (ie. are termed plantar callus. waktu yang tepat untuk memilih alas kaki adalah siang hari. Clavus Formation Named for Specific Etiology or Location (Open Table in a new window) Vernacular Term Location Association Jeweler's callus. this thickening may result in ulcer formation. Plantar helomas tend to have a central keratin plug. Sebaiknya pilih alas kaki yang baik. a hyperkeratotic response to trauma. or a diffusely hyperkeratotic lesion. specifically the dorsolateral aspect of the fifth toe for heloma durum. Memakai alas kaki (sepatu) yang cukup (tidak terlalu sempit) pastikan kaki nyaman memakainya. reveal a clear. particularly in the forefoot.) Prayer callus[7. Maceration and secondary fungal or bacterial infections are a common overlying feature in heloma molle and diabetes.didapatkan dari seluruh tanaman. which do not resolve. E. heloma. or a circumscribed hyperkeratotic lesion that may be hard (ie. The most common sites for clavus formation are the feet. tyloma. including contractures and claw. may contribute to pathogenesis. ulcer formation may result.[15] Callosities can also form from excessive leg crossing. Toe deformity. As clavus formation ensues. as is seen in computer users and text messengers (ie. the bony prominences of the metacarpophalangeal and metatarsophalangeal joints often are shaped in such a way as to induce overlying skin friction. friction against the footwear is likely to perpetuate hyperkeratosis. in which the second toe is longer than the first toe. Bunionettes. in certain situations. an intractable plantar keratosis. Mortality/Morbidity Extensive thickening of the skin may result in chronic pain. hammer. ie. or due to the deformities of rheumatoid arthritis. Morton toe. callosities over the lateral fifth metatarsal head. Specifically.[16] Epidemiology Frequency United States Clavus is a common disorder because of the frequency of usage of occlusive footwear and participation in repetitive activities. "mousing" callus). may be associated neuritic symptoms due to compression of the underlying lateral digital nerves. hand. or foot of a newborn Callus formation at the site of an area of suction on the lip.Russell sign[11] Callosities of the dorsum of the hand over the metacarpophalangeal and interphalangeal joints Caused by the friction involved with self-induced emesis in bulimia nervosa Screwdriver operator's clavus[12] Palmar surface of the hand Occurs at the site of contact with a screwdriver handle Spine bumps Hyperkeratosis over the spinal column Caused by dancing with spinning on one's back Hairdresser's hand First finger on dominant hand Callus formation at the site of friction caused by scissors around the first finger on the dominant hand Sucking calluses[13] Lip. occurs in 25% of the population. Chronic or repetitive motion may also induce clavus formation. Pathophysiology The shape of the hands and feet are important in clavus formation. particularly in the forefoot. or foot of a newborn Vamp disease[14] Feet Clavus formation due to wearing tight high-heeled shoes A clinical image of a screwdriver operator's clavus is below. In the case of neuropathy. and mallet-shaped toes. Furthermore. ie. Clavus may be a sign of underlying neuropathy due to diabetes or neuroborreliosis. this may be one of the most important pathogenic factors in a callus of the common second metatarsal head. clavus). a clavus may hide ulceration or denote abnormal . hand. such as running. Screwdriver operator's callus (ie. activities performed. keratoma. and under the metatarsal heads for calluses. inappropriately shaped or constrictive footwear in the presence of bony prominences (eg. Age Anyone can have a clavus. as opposed to plantar warts. repetitive motion injuries. some . and to look for underlying ulcerations. which do not resolve. Plantar helomas tend to have a central keratin plug. in the fourth interdigital web of the foot for heloma molle. Lesions should be palpated and pared to look for underlying blood vessels (black dots or pinpoint bleeding). A localized callosity of the soles. are termed plantar callus. they are termed intractable plantar keratoses. specifically the dorsolateral aspect of the fifth toe for heloma durum. talar bone prominences[24] ) may exacerbate clavus formation. MRI may delineate diabetic foot problems more clearly. and progressive foot deformities. which. When callosities occur over one or more lateral metatarsals. including neuroborreliosis Tethered spinal cord syndrome[22] Vascular occlusion syndromes[23] Warts (ie. all variants of clavus lesions look like hyperkeratotic or thick skin. which are seen in warts. gait. Race Persons of any race may be affected by clavus. reveal a clear. whereas warts are more painful with lateral pressure. maceration and secondary fungal or bacterial infections are a common overlying feature in heloma molle and diabetes.neurovasculature of the feet. heloma. or plantar corn. occasionally. mucin deposition.[17] Callosities are generally more painful with direct pressure. firm. Examination of patients should include assessment of the types of footwear worn. Causes Conditions associated with clavus formation Advanced patient age Amputation (ie. clavus may enhance the pain of deformed joints. Biopsy of lesions reveals hyperkeratosis and. Paring of callosities or corns.[18] Pedobarographic studies are pressure assessments that may be used to detect an altered distribution of foot pressure. usually of the foot. should reveal normal dermatoglyphics. Sex Clavus is more common in women than in men because of their use of occlusive and poorly fitted footwear. Physical Clinically. but most individuals acquire the risk factors for clavus formation after puberty because of the onset of traumatic footwear use. The most common sites for clavus formation are the feet. central core. Furthermore. when pared. tyloma. verruca vulgaris)[1] Faulty mechanics: Irregular distribution of pressure and repetitive motion injury (especially in athletes) are believed to be the main inciting causes. A clavus forms because of inappropriate distribution of pressure onto a specific site. and current home therapy or previously prescribed therapy. as seen in neurovascular ulcerations (especially in patients with diabetes). stump callosities) Use of a brace or orthopedic stabilizing product Bulimia nervosa[11] Costa acrokeratoelastoidosis[19] Doxorubicin toxicity[20] Keratoderma palmaris et plantaris Obesity Pachyonychia congenita[21] Sensory neuropathies. however. In the case of rheumatoid arthritis. 9%. 90. or beta-hydroxy acid (eg. and in patients with diabetes. especially with helomas.[37] A combination product to be applied by physicians consisting of 1% cantharidin. Most salicylic acid compounds are 1017%.[33] Garlic extracts have also been described as being helpful. Melanocytic Warts. salicylic acid compounds and orthotics may be beneficial. If abnormal dermatoglyphics or pinpoint bleeding is seen. Shoes with extra length are required for toe deformity. Bony prominences and faulty foot mechanics then allow clavus formation to continue. When all else fails. Relief of symptoms may be achieved by thinning and cushioning of the involved lesions. 27. attempts at pressure redistribution should be made. 40%) may lead to severe maceration. Pads or permanent insoles.[38] Reduced friction may be accomplished with the use of silicone-lined sleeves on the toes. Shoes should be soft inside without seams that rub or press. 28. a vesicant. in select cases. 12. or lactic acid).2%. whereas lotions. Orthotics can be placed in the shoe for patients with abnormalities of the foot. Bleeding into callosities in patients with rheumatoid arthritis may be a sign of rheumatoid angiitis. 29] Rheumatoid arthritis[30] : About 17% of patients with rheumatoid arthritis present with intractable foot pain. Chronic arthritis leads to foot deformities and consequent callus formation. In a study looking at 72 patients. malic. padding. surgery may be performed. Obsessive-compulsive disorder (pseudo-knuckle pads) Ectopic nail Acanthosis Nigricans Acrokeratoelastoidosis Arsenical Keratosis Atypical Fibroxanthoma Atypical Mole (Dysplastic Nevus) Nevi. respectively. Once the etiology of the foot pressure irregularity is determined. and medicaments in petrolatum are best for maintenance. 2.[34] Self-adhesive pads are most effective for reducing thick lesions. such as cavovarus. Paring of the lesions immediately reduces pain. salicylic acid). glycolic.[36] A carbon dioxide laser can be used to pare deep lesions. chronic callosities in the presence of neurovascular deterioration may lead to ulcerations and superinfections. relieve stress on the region. Reduction of heel height may be helpful for patients with metacarpal head callosities. High concentrations of salicylic acid (eg. Debridement may be enhanced with the use of keratolytic agents. Lesions may be maintained in this state if the patient uses short soaks and pumice stone debridement at home. such as ureas. and 4 sessions. wart therapy is initiated.[40] . 3.4% after 1. it may lead to frank foot ulcerations. 6. with only one recurrence at 1 year follow-up. Insoles may be made of silicone or soft plastics.[25. mixed with 30% salicylic acid and 5% podophyllin has been described as effective for most people after just one session. and 1. 26. which place pressure proximal to the metatarsal head. Diabetes mellitus with associated peripheral neuropathy[31] : In patients with diabetes. Nongenital Warty Dyskeratoma Medical Care Treatment of a clavus should be aimed at reducing symptoms such as pain and discomfort with walking. Orthotics can be created by using insoles made to correct deformities noted on dynamic pressure molds. If normal dermatoglyphics are noted. Lamb's wool may be beneficial in interdigital corns. alpha-hydroxy acid (eg. creams. and.5%.disorders may alter the shape or sensation of the soles of the feet. Paring of the lesions immediately relieves pain. Triamcinolone can lead to localized hypopigmentation.3% with callosities on the feet demonstrated that application of this agent after paring with a 15 blade effected clearance in 79.[35] Intralesional triamcinolone and topical vitamin A acid compounds also may reduce localized hyperkeratosis. and shoes with extra width are required for lateral toe callosities. The use of orthotics and conservative footwear with extra toe space are often beneficial. silicone[39] or collagen injections[3] over the bony prominence in question. [45] Consultations An orthopedist and a podiatrist can be helpful in adjusting abnormalities of gait or pressure distribution. Topical vitamin A derivatives are not intended for use in women who are pregnant or intending to become pregnant because their safety ranges from category C to category X. Dermatologists are best consulted to assess for the possibility of other disorders in the differential diagnosis. and beta-hydroxy acids (eg. Kenalog may be injected during pregnancy because of its limited absorption. mixed with 30% salicylic acid and 5% podophyllin has been described as effective for most people after just one session. alphahydroxy acid (eg. a vesicant. Diet No special diet is required. Activity Adjustment of the footwear and the use of special insoles aid in the maintenance of full mobility and eliminate the need for activity limitation. Metatarsal condylectomy or chevron osteotomy may be performed to relieve metatarsal head pressure. The use of these agents is not recommended in pregnant women and young children. however. injectable silicone can be used on the soles underneath the callosities and corns to reduce pressure related callous formation. lactic acid. weight loss relieves some of the foot pressures involved. 40%) may lead to severe maceration and frank foot ulcerations in patients with diabetes. whereas lotions. View full drug information . A combination product to be applied by physicians consisting of 1% cantharidin. malic. and then desquamate. salicylic acid). glycolic acid). such as ureas. Medication Summary Debridement may be enhanced with the use of keratolytic agents. High concentrations of salicylic acid (eg. it can lead to localized hypopigmentation. macerate.[41] Surgical corrections for claw. soften. Most salicylic acid compounds are 10-17%. Intralesional Kenalog and topical vitamin A acid compounds also may reduce localized hyperkeratosis. alpha-hydroxy acids (eg. however. hammer. Shaving of prominent condyles of bony prominences may be beneficial particularly on the fifth digit.[45] When thinning of the plantar fat pads is contributory to the formations of callosities.[38] Keratolytics Class Summary These agents cause cornified epithelium to swell. or beta-hydroxy acid (eg. glycolic. Chronic foot pain despite conservative therapy is the number one indication for surgery. and mallet toes are simple procedures. Description of excision followed by either grafting. Vacuum orthoses have been described to aid in lesional clearance for diabetic patients with plantar callosities. This combination results in 95% clearance. and medicaments in petrolatum are best for maintenance. creams. or grafting using split-thickness graft with or without a collagen/elastin matrix graft has been described as effective in a single resistant case. salicylic acid). or lactic acid). use of flaps.[41] Surgical Care Surgical options for clavus should be used when only conservative measures fail.[42] Mann and DuVries described the use of a combination of arthroplasty and condylectomy. Commonly used agents include urea. with only a 13% occurrence of transfer lesions. Self-adhesive pads are most effective for reducing thick lesions. especially warts and keratoderma. Hallux valgus correction may aid in reduction of painful callosities over the long term. Arthroplasty of the fifth toe interphalangeal joint also may be performed. Aquacare) Promotes the hydration and removal of excess keratin in conditions of hyperkeratosis. such as a clavus. this compound is diluted to 1-4% for injection into lesions. However. Panscol. Corticosteroids modify the body's immune response to diverse stimuli. overusage also can lighten the skin and cause atrophy. Corticosteroids cause the skin to thin. Intralesional corticosteroids Class Summary These drugs have anti-inflammatory properties and cause profound and varied metabolic effects. Irritation and discomfort are limiting adverse effects. thereby thinning the skin.1% creams. usually is used at 5-20%. These agents cause the skin to peel by loosening of keratinocyte adhesion. Amcort) Injectable version of triamcinolone is available in concentrations of 3-40 mg/mL. Sal-Plant) May be compounded in petrolatum at any percentage. View full drug information Salicylic acid topical (Compound W. Also available as 0. Only tretinoin has been shown to be useful for clavus therapy in the topically applied form. View full drug information Triamcinolone (Kenalog. Can be irritating or cause blistering. and this beneficial side effect can be used to reduce the thickness of a clavus.Ammonium lactate (Lac-Hydrin) May loosen the adhesion of the keratinocytes in the stratum corneum. and they may reduce the potential for malignant degeneration.025%. . Retinoids Class Summary Retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes. Available as 0.025% gels. Avita) Inhibits microcomedo formation and eliminates lesions present.01% and 0. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. and 0. ranging from 17-40% (multiple companies make these). Retinoids modulate keratinocyte differentiation. View full drug information Urea (Ureacin-40. Generally. beginning with lower percentage. These agents are not specifically approved for use in clavus therapy.05%. View full drug information Tretinoin topical (Retin-A. 0. Can be purchased over the counter as a liquid or pad preparation.