Article by Dr Manasa S
Skin fissure is the name given to a condition wherein there is dry and cracked skin. It appears as if there are ‘tiny cuts’ in the skin. The skin around the cracks tends to become thickened and calloused.
Common areas of occurrence of skin fissures are
– heels
– fingertips
– in between the toes
The skin fissures occur due to extreme dryness of the skin. This condition is also called xerosis. At the beginning, these cracks start out as small cracks. Later, as the disease progresses they can get deeper and also may be associated with mild to severe pain. After a certain period of time, these cracks get associated with callus formation which looks yellow or dark brown in colour.
Common site of occurrence of skin fissures
Skin fissures occur at places which are under the pressure of physical stress such as heels of the foot. Heels support the weight of the body. Due to constant pressure of body weight over the pads of the feet might expand the skin and cause skin cracks / fissures.
Other areas where fissures occur are – on the fingertips, between toes or fingers, and on other areas of the body which are prone to dryness.
Causes of skin fissures
Skin dryness – Most of the skin fissures are caused due to extreme dryness of the skin. Later, this progresses with formation of callus and thickening, associated with change in colour to yellow or brown colour. If this condition is not treated at this stage, cracks develop on the skin. Further, fissures develop in the skin at and around the cracks.
Environmental causes – Dry and cold climate makes the skin dry. This increases the chances of skin fissures
Improper foot-care – Walking barefoot and wearing open-backed or unsupportive footwear like high heels puts a pressure on the heel and this increases the risk of developing skin fissures.
Overuse of detergents – Continuous and repeated washing of hands and feet with harsh detergents pose greater risk of developing dry skin which might lead to cracks in the overused parts of the body.
Frequent hand washing – People or occupations where frequent washing of hands are required – like healthcare professionals, domestic helps and people who are involved in daily domestic works of washing and cleaning tend to develop dryness over the exposed skin and eventually cracks develop over those areas. A recent report shows that healthcare professionals were found to experience 70% of dry skin conditions and 39% had fissures in the skin due to frequent washing of hands which is a demand of the occupation.
COVID-19 pandemic – This changed the way the people looked at hand hygiene. Healthcare workers around the globe were the bigger group who were much affected due to frequent hand washing during this pandemic. This led to the onset of mild to severe dryness of hands leading to onset or exacerbation of pre-existing eczema. Of a total of 143 doctors surveyed during 2021, the most common symptoms were dryness – 42%, itching – 17.5%, scaling – 21% and redness – 11.2%. These were due to excessive and frequent use of hand sanitizers.
Vitamin deficiencies – can lead to dry and itchy skin which if left untreated might end up in manifestation of skin fissures. A healthy skin needs a good number of proteins and vitamins like Vitamin B, C, A, E, D and K and minerals like zinc and essential fatty acids like omega fatty acids. Deficiency of any of these vital essential elements or micronutrients mentioned above would disturb the normal growth and maintenance of healthy skin.
Other health conditions causing cracks and fissures in the skin
Diabetes Mellitus – Individuals who have been suffering from diabetes for a long time tend to have dry skin and so are they more prone to develop skin fissures. Diabetes is associated with nerve damage in the lower extremities, which is known as autonomic neuropathy. As a result, an individual diagnosed with diabetes is at a higher risk of developing skin cracks with or without pain and bleeding.
Psoriasis – Psoriasis is an autoimmune disorder that is characterized with thick plaques of dead cells over the affected parts. These plaques are at a high risk of developing cracks.
Eczema – This condition causes dry, itchy patches of skin associated with inflammation. These dry and inflamed skin patches have a higher chance of developing cracks and fissures.
Fungal infections – Fungal infections are also one of the reasons for skin fissures. Athlete’s foot (Tinea pedis), a common example of fungal infection which begins at the toes, can spread to the entire foot causing cracks and fissures.
Angiopathy – Angiopathy is a condition which is associated with damage to blood vessels, including veins and arteries. Due to some underlying pathology, the skin doesn’t get enough blood supply which hinders the healthy growth and maintenance of the skin.
Pathogenesis of skin fissure
Dry skin condition is the precursor for most of the skin fissures. When the skin gets thickened and calloused over a period of time, the skin loses its elasticity and small cracks are formed. When these skin fissures are left untreated, the cracks deepen, leading to bleeding and infection.
Types of manifestation of skin fissures
Skin fissures can be either superficial or deep seated.
Superficial fissures are minor cracks that do not penetrate into the deeper skin layers. On the other hand, deep fissures penetrate into deep layers of skin and are associated with more severe complications like bleeding with or without pain.
Symptoms of skin fissure
Appears as ‘cuts or cracks’ in the skin
Affected skin most commonly looks yellow or dark brown in colour
Skin is thickened and calloused
Early signs of skin fissures include dry skin, scaly and redness
Skin fissures on the foot makes it difficult to walk and stand for long time, it can also be painful
Itching, pain and bleeding are the advanced signs of skin fissure
When skin fissures are not treated promptly, they might get infected and might turn into wounds and then finally to ulcers
Care of skin fissures at home
There are certain measures that can be adopted as both preventive and therapeutic measures.
General measures include –
Hydration – keeping the hydration proper by drinking enough water
Balanced foods – consumption of balanced food which contain whole grains, fruits, vegetables and lean proteins
Clothing – wearing clean clothing, socks and shoes which allow proper aeration
Sandals – Choosing sandals or flip-flops to wear in public swimming pools or showers so as to prevent getting affected with athlete’s foot
Air humidifier – One should use air humidifier, if the dry air is a reason for dryness in the skin
Regular use of lotions, moisturizers and emollients –
– Lotions which contain glycerine and urea help to shed dead cells off the skin and thus get deeper into the skin layers. This helps to heal the cracked skin surfaces.
– Lotions which contain beeswax and certain mineral oils help to increase the water content of the skin by preventing the loss of water by evaporation.
– Lanolin and propylene glycol acts as emollients to fill in the fissures of the skin. These lubricants help in proper hydration of the skin and thus give the smoothness to the affected part.
Pumice stones – Removing or exfoliating dead cells on the feet with the help of pumice stone keeps the skin healthy. But care should be taken when there is already a crack or fissures on the skin associated with or without infection or pain or bleeding.
Use of oils – Certain oils and other substances which can be used as massage oils to prevent and manage fissures in their early stages include:
– Coconut oil – Use of coconut oil has been found to be very effective for dry skin conditions. It moisturizes the skin along with improvisation of the normal functions of the skin.
– Almond oil – It helps to heal the fissures of the skin by improving the functions of the skin barrier. It also helps in preventing water loss in the skin.
– Avocado oil – Applying the avocado oil directly to the fissured skin increases collagen production and aids in speeding up the healing of wounds.
– Oat oil – Application of the oat oil adds up the moisture content and reduces inflammation, thereby prompts proper wound healing.
Honey – Honey when used acts as a natural moisturizer, helps in healing of the cracked skin. Honey also possesses some antibacterial properties, which might help in prevention of skin infections.
Aloe vera – Aloe vera is a popular and effective herb which finds a good place because of its antioxidant properties and soothing effect on the skin. When applied to the fissured skin it helps in increase of the collagen production and thus aids in wound healing and when applied regularly might prevent the formation of fissures by improving the elasticity of the skin because of its antioxidant property.
When to consult a skin specialist?
– One should consult a skin specialist in the below mentioned conditions –
– When there is no improvement even after applying moisturizers or taking care of fissures at home
– If the skin fissure is infected and associated with or without bleeding and the fissures are deeply situated
– If the fissures are associated with inflammation and soreness with or without discharge of foul-smelling liquids
– If the fissures are associated with athlete’s foot, a common fungal infection of the toes
– When the fissures are deep rooted with complications such as discharge of pus and bleeding with extreme pain, it might need a skin specialist to remove the damaged skin and clean the wounds or to close the fissures with skin glue or bandages to keep them closed.
– People who are already suffering from chronic diabetes, psoriasis, eczema or any other chronic skin disorders or any medical condition need to visit the skin specialist to get a comprehensive approach towards the skin fissures.
Ayurveda perspective
In Ayurveda we have a condition mentioned amongst Vata Nanatmaja Rogas i.e. ‘specific disorders caused by only aggravation of vata’ named ‘Vipadika’. A similar condition has been explained in the context of ‘Kshudra Kushta’ – minor skin disorders wherein it is called ‘Vaipadika’. Vaipadika is defined as fissuring and cracks in hands and feet with severe pain.
Skin fissures explained in this article pertaining to ‘hands and feet’ can be compared to Vipadika. It can be treated on the lines of ‘Vata Roga Chikitsa’ or ‘Kushta Chikitsa’.
Related Reading – Vipadika
