How do I care for cracked skin?

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How do I care for cracked skin?

Definition  |  Management  |  Cracked skin care  |  Cleansing  |  Conclusion

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Written By Dr. Joshua Townley, BForensSc, PhD.

Updated on March 26, 2024
Cracked feet

Dry skin is a continuum, with symptoms ranging from mild roughness and flaking, all the way up to severe dryness causing deep cracks or fissures in the skin1. While milder forms of dry skin are typically accompanied by itch, cracking associated with moderate or severely dry skin is often painful and can have a significant impact on quality of life. In this article, we’ll discuss how and why skin becomes cracked, and what to do about it.

Definition

What is cracked skin?

Cracked skin occurs when the skin becomes dehydrated and brittle, resulting in the formation of fine lines that develop into cracks. This generally occurs because of a weakened skin barrier, leading to increased water loss through the skin2. Cracks are especially common on weight-bearing areas, like the heels3, or areas of skin that produce less sebum, like the hands, lips and lower legs2. Over time, if not properly managed, these cracks can deepen and become fissures, which are not only painful, but can sometimes bleed, and are an easy target for bacterial infection4. External factors like frequent hand washing or overexposure to harsh environmental conditions can also damage the skin barrier, leading to increased water loss, dryness, and cracking. In some cases, cracked skin can also be linked to underlying health issues like diabetes or nutritional deficiencies5. 

Management

Managing cracked skin

General tips

Use water-free moisturisers – We intuitively (and rightly) reach for moisturisers to combat dry skin, but if the skin is cracked, water-containing products can cause stinging and discomfort. If that’s the case, look for a water-free, occlusive ointment instead, like QV Dermcare Sting-Free Ointment with Ceramides.

Gentle exfoliation – For superficial cracked skin, especially on thickened areas like the heels, gently exfoliating the areas of dry or calloused skin can help promote new cell growth, which can lead to smoother skin6. 

Drinking more water – There is some evidence that increasing your dietary water intake can increase skin hydration, although to exactly what extent this helps, and what amount of water is optimum is still unclear7. 

Beneficial ingredients – Besides occlusive moisturisers, there are other ingredients that can be beneficial for cracked skin. If eczema is an underlying cause, look for products with ceramides, cholesterol and free fatty acids, since these natural skin barrier components can be lacking or out of balance in eczematous skin8. For cracked skin on the heels, alpha-hydroxy acids (AHAs) can provide chemical exfoliation that can significantly improve the appearance and the depth of cracks on the heel. QV Feet Heel Balm, which contains the AHA lactic acid, was found to improve heel cracked appearance by 70%, and crack depth by 74% over 14 days in a small-scale clinical trial9. 

For severe cracking and fissures, especially when there is a risk of infection, or if it’s related to a serious condition like diabetes, it’s best to speak to your doctor about the best options, as it may require more specialised treatment like prescription skin softeners or antibiotics5. 

Cracked Skin Care

Should you use dressings or leave cracked skin open to the air?

Cracked skin, especially in severe cases that experience bleeding, can be considered a wound, and like most types of wounds, requires adequate moisture to heal quickly and effectively10. Covering areas of cracked skin with a bandage or other dressing after applying a suitable ointment can help with moisture retention and promote skin recovery, and may also reduce discomfort caused by rubbing of clothes or by penetration of external irritants11. 

However, it’s important to note that dressings must be clean and properly applied (e.g. not too tight) or there is a risk of introducing infection, or delaying healing, so if you’re unsure it’s best to discuss this first with your healthcare professional.

Cleansing

Skin cleansing with cracked skin

While a hot shower may feel soothing, it can actually do more harm than good for cracked skin. Hot water can strip the skin of its natural oils, leading to further dryness and irritation2. Instead, use lukewarm water, and limit shower or bath time to no more than 10 minutes. It’s also best to avoid harsh soaps and detergents whenever possible, as these can further dry out or irritate the skin2,  making it more prone to cracking and pain. Look for soap-free, gentle cleansers that are also pH balanced and free from common irritants, like fragrance. Afterward, pat skin dry and immediately apply an ointment or moisturiser to lock in moisture.

Conclusions

Cracked skin can be a common symptom when dry skin goes untreated, and is commonly seen in moderate to severe dryness. While strategies like gentle cleansing and exfoliation, use of a water-free, occlusive moisturiser, and covering the area with a suitable dressing can help improve cracked skin, it’s important to speak to your doctor about the best treatment if underlying conditions (like eczema, diabetes, or nutritional deficiency) are involved.

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References

1. Andriessen A. Prevention, recognition and treatment of dry skin conditions. Br J Nurs 2013;22(1):26–30.

2. Augustin M, Wilsmann‐Theis D, Körber A, Kerscher M, Itschert G, Dippel M, et al. Diagnosis and treatment of xerosis cutis – a position paper. J Dtsch Dermatol Ges 2019;17(S7):3–33.

3. Sherkin KJ, Springer A, Andriessen A, Botros M, Cohen D, Guy P, et al. Pathway to dry foot skin. Wound Care Can 2011;9(1):8–27.

4. Specht S, Persaud Y. Asteatotic Eczema [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Mar 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK549807/

5. Nall R. Skin fissure: causes, treatments, and how to heal [Internet]. Medical News Today 2021 [cited 2024 Mar 6]. Available from: https://www.medicalnewstoday.com/articles/skin-fissure

6. Draelos ZD. Revisiting the skin health and beauty pyramid: a clinically based guide to selecting topical skincare products. J Drugs Dermatol 2021;20(6):695–9.

7. Douladiris N, Vakirlis E, Vassilopoulou E. Atopic dermatitis and water: is there an optimum water intake level for improving atopic skin? Children 2023;10(2):273.

8. Mijaljica D, Townley JP, Hondros A, Hewson C, Harrison IP, Spada F. Considering phytosphingosine-based ceramide formulations for atopic skin care. Dermato 2024;4(1):5–22.

9. Ego Pharmaceuticals. Commissioned external study. Average improvement over 14 days using QV Feet Heel Balm vs untreated heel, 2x applications per day. Measurement by visualinspection of digital photographs (appearance) and silicone impressions (crack depth). n=6. 2004.

10. Guillen MRS, Borges EL, Amorim GL, Guedes ACM, Barcelos LS. The use of occlusive dressings: influence on excisional wound healing in animal model. Acta Cir Bras 2022;37(12):e371206.

11. Vachhrajani V, Khakhkhar P. Science of wound healing and dressing materials. Singapore: Springer Singapore; 2020.

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