Are cracked heels just dryness? They may also be related to these diseases

Are cracked heels just caused by dryness?

I wonder if you have the same problem. When winter comes and the weather gets cold and the north wind blows, your hands and feet feel unusually dry and painful. Some people even have cracked heels and bleeding. This has often become a common and unspeakable problem. Many people think that applying moisturizer can solve the problem. So are cracked heels just caused by dryness?

Cracked heels refer to dry and thickened heel skin. Cracks of varying depths and lengths appear on the thickened skin along the direction of the skin texture. Medically, this is often called "cracks". When the cracks deepen, varying degrees of pain may occur, bleeding may occur in the cracks, and even suppuration and infection may occur. Age and temperature drop may increase the degree of cracked heels. In some cases, several cracks occur at the same time, and the cracks may be deep enough to reach the dermis or subcutaneous tissue. There is often pain and even bleeding during activities. If pathogens invade, suppurative infection may occur, affecting production and daily activities.

Are cracked heels just caused by dryness?

In addition to physiological factors such as dry skin, cold environment, and some unhealthy lifestyles such as excessive washing and excessive use of detergents, cracked heels may also be caused by pathological factors. As people age, their skin becomes thicker and less elastic, and their feet secrete less sebum, which leads to dry and cracked skin. Fungal infection of the feet leads to excessive keratinization of the heels. Diseases such as diabetes lead to systemic dryness, and hereditary or acquired palmoplantar keratosis can all cause cracked heels.

What diseases may be related to cracked heels?

Are cracked heels just caused by dryness?

I wonder if you have the same problem. When winter comes and the weather gets cold and the north wind blows, your hands and feet feel unusually dry and painful. Some people even have cracked heels and bleeding. This has often become a common and unspeakable problem. Many people think that applying moisturizer can solve the problem. So are cracked heels just caused by dryness?

Cracked heels refer to dry and thickened heel skin. Cracks of varying depths and lengths appear on the thickened skin along the direction of the skin texture. Medically, this is often called "cracks". When the cracks deepen, varying degrees of pain may occur, bleeding may occur in the cracks, and even suppuration and infection may occur. Age and temperature drop may increase the degree of cracked heels. In some cases, several cracks occur at the same time, and the cracks may be deep enough to reach the dermis or subcutaneous tissue. There is often pain and even bleeding during activities. If pathogens invade, suppurative infection may occur, affecting production and daily activities.

Are cracked heels just caused by dryness?

In addition to physiological factors such as dry skin, cold environment, and some unhealthy lifestyles such as excessive washing and excessive use of detergents, cracked heels may also be caused by pathological factors. As people age, their skin becomes thicker and less elastic, and their feet secrete less sebum, which leads to dry and cracked skin. Fungal infection of the feet leads to excessive keratinization of the heels. Diseases such as diabetes lead to systemic dryness, and hereditary or acquired palmoplantar keratosis can all cause cracked heels.

What diseases may be related to cracked heels?

1. Dry skin

A common skin disease that can occur on the heels, characterized by dry, rough, and fine-lined skin on the heels, but without itching or inflammation.

2. Diabetic foot

About 50% of diabetic patients will experience dry skin on the lower limbs. Due to autonomic neuropathy, reduced foot sweating, and peripheral vascular disease, some patients will experience dry and cracked heel skin and diabetic foot. [1]

3. Tinea pedis

It is caused by fungal infection of the foot, and is usually bilateral. Among them, hyperkeratotic tinea pedis can cause the keratin of the heels to become thickened, dry, and flaky, and in winter, there are cracks and bleeding.

4. Hereditary palmoplantar keratoderma

This disease is relatively rare. It usually develops in infancy and lasts a lifetime, with some symptoms resolving after puberty. It can also develop after puberty. It presents as yellowish, hard, keratinized plaques on the palms and soles, which are usually asymptomatic but sometimes accompanied by itching, pain, and cracking, and are particularly severe in winter. [2]

5. Acquired palmoplantar keratoderma

Most are caused by systemic diseases, such as Sjögren's syndrome, systemic sclerosis, and diabetes, while a few are caused by unknown causes. There is no family history and the disease develops in adulthood. [3]

6. Ichthyosis vulgaris

Patients often experience symptoms such as cracking, dryness, and desquamation. Heel cracks are often accompanied by pain. It is a chromosomal dominant genetic disease, often caused by retention of the stratum corneum, and may be related to factors such as desquamation damage. [4]

1. Drug treatment

Cracked heels may be a manifestation of xerosis, chapped hands and feet, etc. Generally, topical medications are prescribed by the dermatology department, which can relieve the symptoms of skin dehydration after local application; however, cracked heels can also be a skin manifestation of diabetes or other systemic diseases. If cracked heels are accompanied by itching, pain, weight loss and other problems, you need to actively seek medical treatment and conduct standardized treatment after finding out the cause. Due to the large individual differences, there is no absolute best, fastest, and most effective medication. In addition to commonly used over-the-counter drugs, you should choose the most appropriate medication under the guidance of a doctor and fully combine your personal situation.

1. Moisturizer: Moisturizer ingredients mainly include urea, lactic acid, glycolic acid, glycerin and propylene glycol, etc. Among them, heparin-like moisturizers use polysulfonated mucopolysaccharide as an active ingredient, which can increase hydration by stimulating the synthesis of endogenous hyaluronic acid, increase the hydration capacity and elasticity of the skin, and are especially effective for elderly patients with dry skin.

Compound lactic acid ointment is used to treat ichthyosis vulgaris and chapped hands and feet[5], which can inhibit epidermal hyperplasia, enhance the hydration of the stratum corneum, moisturize the skin, and relieve itching and pain.

2. Keratin softeners: such as 20% urea cream, 0.1%~0.2% vitamin A acid, 15% salicylic acid ointment, etc. for topical use. Mainly used for those with severe heel hyperkeratosis.

3. Vitamin E lotion : Vitamin E, as a good antioxidant, can prevent skin keratinization and can be applied to the affected area to relieve chapped hands and feet.

4. Antifungal drugs : For tinea pedis, antifungal drugs can be used systemically, such as itraconazole, terbinafine, etc. for oral administration. If secondary bacterial infection occurs, antibiotics should be used in combination.

5. Oral hypoglycemic drugs and insulin injections: Diabetic patients can take oral hypoglycemic drugs, such as biguanides, insulin secretagogues, thiazolidinediones, α-glucosidase inhibitors, etc. Diabetic patients can inject insulin to effectively control postprandial blood sugar.

6. Vitamin A and retinoic acid drugs : Oral administration of these drugs has a certain effect on patients with ichthyosis vulgaris, while topical retinoic acid moisturizers can help improve dry skin. [6]

2. Surgical treatment

Blood supply reconstruction: Some diabetic foot cracks are related to ischemia, so re-establishing blood supply to the feet through surgery will have a certain effect on those with severe heel cracks. It may also reduce the incidence of late amputation in diabetic patients.

1. Pay attention to keeping warm and protecting your skin. The skin is relatively dry in winter, so you should apply some clam oil, lard, vaseline or glycerin (mixed with half water) to moisturize the skin.

2. Use less alkaline soap to wash your face and hands to avoid excessive fat removal, which may cause dry and rough skin.

3. When the human body lacks vitamin A, it is more likely to experience systemic dryness, which is more likely to occur on the outer thigh, the back of the upper arm, the neck, shoulders and buttocks. This is reflected in the heel cracking of the feet, but the feet are not the most common part. If it is found to be lacking in vitamin A, you should ensure a comprehensive intake of nutrition and, if necessary, supplement vitamin A under the guidance of a doctor.

4. When the heels are cracked, doctors will first conduct a physical examination and ask about the patient's medical history to determine the extent of the skin cracking. If a fungal infection is suspected, fungal microscopy and fungal culture, skin dryness test, and laboratory examination may be required. If the patient is suspected of having diabetes, urine sugar determination, blood sugar determination, and oral glucose tolerance test are also required. If there are chronic skin diseases such as tinea pedis, tinea pedis, and ichthyosis, timely treatment is required.

References

[1] Yan Zhencheng. Advances in diagnosis and treatment of diabetic foot[J]. Journal of Chongqing Medical University, 2017, 42(03): 263-267.

[2] Liu Lixia, Li Gang, Ma Guoan. A pedigree with hereditary palmoplantar keratoderma[J]. Chinese Journal of Dermatology, 2006(10): 611.

[3] Li Huizhu. Palmoplantar keratosis and related syndromes[J]. Foreign Medical Journal. Dermatology and Venereology, 1996(04): 228-230.

[4] Ou Yingmei, Li Changxing, Li Guozhou. Related factors and nursing intervention for skin itching and pain in patients with ichthyosis vulgaris[J]. Chinese Journal of Clinical Nursing, 2017, 9(02): 144-147.

[5] Zhu Bin, Sun Qiyuan. Clinical efficacy of compound lactic acid ointment in the treatment of ichthyosis vulgaris and chapped hands and feet[J]. Chinese Journal of Health Standard Management, 2014, 5(20): 112-114.

[6] Feng Suying, Lin Lin, Jin Peiying. Clinical application, adverse reactions and countermeasures of retinoic acid drugs[J]. Chinese Journal of Dermatology, 2003(07): 59-61.

Author: Yu Hong, Deputy Director and Pharmacist of the Pharmacy Department of Dalian Women and Children's Medical Center (Group), Sports New City Campus

Reviewer: Li Ling, Chief Pharmacist of the Pharmacy Department of Dalian Women and Children's Medical Center (Group), Sports New City Campus