Should I Recommend for Severe Dry, Cracking Skin?
in the winter months, many patients will complain of severe
pain and cracking in the skin of the hands and feet. What
practical recommendations might be suggested to ease their
discomfort? Are particular ointments, creams, or special
gloves more effective than others? What about the use of a
topical analgesic to ease the pain?
from Margaret A. Fitzgerald, MS, APRN, BC, NP-C, FAANP, 04/24/2003
skin protects the body from outside substances, chemicals, and
bacteria and contributes to temperature maintenance and other
homeostatic functions. The outermost epidermal layer is only
1/250th of an inch, with the dermis is only 1/50th to 3/25ths
of an inch thick. The skin's protective function can be easily
interrupted through exposure to the elements, such as dry air,
whether accompanied by cold or heat, leading to drying of the
skin and microscopic cracks.
addition, cold changes blood flow at the skin surface and
leads to loss of sensation and increased risk of skin damage
from trauma. Since healthy skin has a slightly acid pH,
exposure to substances with an alkaline pH, such as many
commercial cleansers and hand soaps, also contributes to
interruptions of skin integrity. Once the skin integrity is
disturbed, a homeostatic repair mechanism is stimulated that
causes the rapid repair of barrier function. Continued
exposure to alkaline substances will slow down repair by
inhibiting normal skin acidity when there is continued
exposure to unfavorable environmental factors.
best treatment for severely dry, cracking skin is prevention.
The hands should be protected from any factors that can
interrupt skin integrity. Physical barrier protection, such as
reusable kitchen rubber gloves, is needed whenever the hands
might come in contact with cleansers. Creams that are touted
as forming a protective skin barrier afford significantly less
protection than a physical barrier. Remind patients that most
cleansers are developed to cut through grease and will do this
efficiently, depleting the natural protective oils on the
outdoors, the hands need to be protected with mittens or
gloves adequate for the weather. When hand washing is needed,
a pH-balanced skin cleanser such as Dove or Cetaphil
in small amounts should be used. The use of a hand cream
should always follow hand washing and must also be applied as
often as possible during the day and before bedtime. Most
commercially prepared hand creams contain lipids and
humectants while many contain urea and alpha hydroxy acids.
Lipids help protect the skin from outside influences while
limiting transepidermal water loss. This yields more complete
hydration of the skin and a mild anti-inflammatory effect.
bind water and thus attract water to the skin and temporarily
hold it there. Urea enhances this activity while alpha hydroxy
acids help with exfoliation. Petrolatum (Vaseline) is
an inexpensive option for skin protection but not fully
occlusive as once thought; while usually too messy for daytime
use, petrolatum is well suited for use at bedtime. Bag
Balm, a veterinary product touted to protect cow udders,
has been used for human skin protection and contains
petrolatum, lanolin, and an antiseptic (8-hydroxyquinoline
sulfate 0.3%). While Bag Balm has not been approved for
human use, there are no FDA reports of adverse effects with
dry, cracking skin does occur, a pumice stone after bathing
can be used to gently remove excess callused and dead skin,
followed by a program of skin protection. Covering skin
fissures with an antimicrobial cream and a Band-Aid may
help accelerate healing and relieve pain.
anesthetic creams such as Lanacane are available
over-the-counter and may be helpful for temporary relief of
itch associated with dry skin, but are not of sufficient
strength to relieve pain. Concerns about anesthetic
sensitization with the use of these products is likely
minimal, but remains an area of concern.
deep fissures form, closure with a medical or commercial-grade
glue (Dermabond, Superglue) is helpful in both
controlling pain and accelerating healing. The glue usually
wears off in about 1 week.