Fissures
During the summer, your skin looks radiant. All of those sunscreens and all that humidity in the air leave your skin moist and supple. But as soon as winter comes, you suffer from flaky, dry skin that often reaches the point of breaking open into painful cracks.
“Fissures, as these linear cracks are commonly referred to, can occur in many parts of the body, such as the corners of the mouth, the opening to the nose, the space between the toes, and the callused areas of the heels and hands,” says Vincent A. DeLeo, M.D., assistant professor of dermatology at Columbia-Presbyterian Medical Center in New York. Once that layer of superficial skin cracks, it exposes living layers of skin, which are extremely sensitive. “The reason they hurt so much when they are on the hands is because you have more nerve endings in that one small area than you have on, say, your knee,” says Denise Kraft, M.D., F.A.A.F.P., a family practitioner in private practice in Bellevue, Washington.
“Fissures most commonly occur in people with an underlying skin disorder that dries out the skin, such as eczema. It’s not thought to be due to any kind of nutritional deficiency,” says Kraft.
“Fissures are caused by uneven expansion of the skin. In the warm weather, the top layer of skin tends to expand with moisture. But in the winter, it loses moisture and shrinks up more than the layers beneath it, which causes it to crack,” explains Neil Schultz, M.D., a dermatologist in private practice in New York. This process is often helped along by nicks and bangs to the skin. “It can happen from your doing nothing or from excessive hand washing or lack of moisturizing,” says Schultz. And it usually occurs in areas where the skin is a little thicker, such as the palms, feet, and fingertips.
The best way to treat a fissure is as follows:
Lock moisture into the area. The best way to do this is to use a petrolatum-based product, says Schultz. “Spread some Vaseline over the crack and then put a bandage over it to lock in the moisture,” he says. The petrolatum, or petroleum jelly, tends to “melt” the skin a little bit, softening it and making it easier for the skin to grow back together, explains Schultz.
Deleo suggests soaking the area in lukewarm water for five to ten minutes before applying the moisturizer. “The moisturizer itself doesn’t add moisture, it simply seals in the moisture from the water,” he explains.
“If the fissure is on the hand, I recommend that my patients put the Vaseline on and then wear a glove at night,” says Kraft. Wear vinyl gloves over the petrolatum, since latex can sensitize, or cause a skin reaction, in some individuals.
Try a petrolatum-based antibiotic ointment. “There are several over-the-counter versions of these, and they provide the double benefit of keeping moisture in while also protecting against infection,” says Schultz.
Fight back with a steroid cream. “You can also use an over-the-counter steroid ointment to cut down on the inflammation and the redness,” advises Kraft. “These ointments won’t help the pain much, but they will help to recreate a barrier that prevents the outside world from getting inside of your body,” she, explains.
Raise the humidity. Using a commercial humidifier or simply keeping a pot of steaming water on the stove or radiator will add moisture to the air in your immediate environment and keep your skin from drying out as much, according to Schultz. “You can even set a pan of unheated water out and get a similar effect,” adds Kraft. “Keeping one in the bedroom is especially good,” she says.
Wear gloves in cold weather. This advice applies to those who have fissures on the hand. “Anything that keeps the area warm and moist is helpful,” says Schultz. Applying moisturizer before putting on your gloves is even better.
Protect your hands from harsh chemicals. Wear vinyl gloves whenever you are using strong solvents or cleaning products. These solutions are extremely drying and should never be used without protecting your skin first. They will not only encourage fissures to develop; they will cause further damage once the problem occurs, according to DeLeo.
Apply an antifungal. If the fissure is in an area prone to fungal infection (such as in the corner of the mouth or between the toes), apply an over-thecounter antifungal agent. “Your pharmacist can identify these ointments for you. They used to be prescription only but are now offered over the counter,” says DeLeo. Do not, however, use these antifungal agents near the rectum.
Tagged under: crack, flaky dry skin, layers of skin, skin cracks, skin disorder, Skin Disorders superficial skin
Filed under: Skin Disorders