Skin fissures are cracks in the skin that form due to intense dryness and thickened skin. Fissures can be shallow or deep, and they may bleed or be painful.
In addition to being uncomfortable, fissures can be a precursor to skin ulcers. For this reason, treating skin fissures before they worsen is important.
This article explores what causes skin fissures, how doctors can treat them, and how people can aid the healing process at home.
Skin fissures are cracked areas of skin. They can occur anywhere on the body but most commonly occur:
- on the fingertips
- between the toes or fingers
- on the heels of the feet
- on other areas prone to dryness
The visible signs of skin fissures include:
- breaks in the skin that look similar to cuts or cracks
- thickened or calloused skin around the fissure
- dry skin in the surrounding area
Skin fissures can cause pain because of the cut in the skin. Additionally, irritants can enter the fissure, causing more discomfort.
Skin fissures can be either superficial or deep. Superficial fissures are small cracks that do not penetrate the deeper layers of the skin, while deep fissures do penetrate the deeper layers.
Skin fissures develop as part of a progression of symptoms:
- First, the skin becomes dry.
- It then thickens and may become discolored.
- Tiny cracks form in the skin.
- Without treatment, these cracks can enlarge and become fissures.
A variety of underlying conditions can contribute to this, which include the below.
The body relies on nutrients to maintain healthy skin. Inadequate food intake or nutrient levels can lead to skin disorders, including fissures.
Examples of nutrients that the body needs to maintain healthy skin include:
- fatty acids, such as omega-3 and omega-6
- B vitamins, such as B3, B6, and folate
- vitamins A, C, D, E, and K
- minerals, such as zinc
If a person has nutritional deficiencies, the skin may lose moisture or take longer to heal from wounds.
Dry skin conditions
Skin conditions that cause inflammation, itching, and dryness can also make fissures more likely. These conditions include:
- juvenile plantar dermatosis, where the skin cycles between being excessively moist and dry
- palmoplantar keratoderma, a type of psoriasis that affects the hands and feet
Treating or managing skin conditions can help reduce the risk of fissures. How doctors and patients approach this depends on the type and cause of the condition.
For example, if a person has eczema due to an allergen, avoiding the allergen or taking antihistamines may help. By contrast, treatment for psoriasis may involve medications or phototherapy.
Fungal infections on the skin, such as athlete’s foot, can cause a dry, flaky, or itchy rash. This may increase the risk for skin cracking and fissures.
Those with diabetes are at greater risk for skin fissures on the feet, according to a 2017 study.
People with diabetes are vulnerable to nerve damage in the feet, which is known as autonomic neuropathy. This damage means the nerves are less likely to sense the need for the feet to sweat. The lack of sweating creates a very dry environment that can allow skin fissures to form.
Another potential cause of skin fissures is angiopathy, which refers to damage to blood vessels, including veins and arteries.
Doctors do not know why angiopathy increases the risk for skin fissures. However, if blood cannot reach certain parts of the skin, it may affect skin health and slow wound healing.
In addition to specific medical causes, factors in a person’s lifestyle or daily routine may exacerbate dry skin, leading to fissures. These include:
- Dehydration: If a person often does not get enough water to replace the fluids they lose via sweat and urination, they can develop dry or chapped skin.
- Frequent washing: Frequently washing the skin can also deplete moisture levels. In a 2020 study of more than 526 healthcare workers, an estimated 38.8% reported skin fissures due to excessive hand washing during the COVID-19 pandemic.
- Climate: Living in a dry, arid, or cold climate may also contribute to fissures, particularly for people who are prone to dry skin or have a skin condition such as eczema.
- Profession: In addition to careers that require hand washing, other professions can also cause or worsen dry skin. This includes jobs that involve handling irritating chemicals, such as hand sanitizer, working outdoors, or prolonged standing — this places pressure on the heels.
- Footwear: In cases of cracked heels, open-backed or unsupportive footwear can play a role. These styles of shoes do not cushion the area under the heel, which increases pressure on the surrounding skin.
Treatment for skin fissures can depend on how deep they are.
For superficial skin fissures, doctors may recommend a self-care regimen that encourages fissures to heal and prevents new fissures from forming.
This may involve:
- Checking the feet daily for new fissures and cracking.
- Gently using a pumice stone to remove hard, thickened skin.
- Applying moisturizer to keep the skin flexible and hydrated.
- Using gel or spray bandages to protect the area.
People with athlete’s foot or other fungal infection may also require an antifungal cream, which they can buy over the counter.
While there are open fissures, people should use a suitable moisturizer 2–3 times per day.
A good moisturizer for areas of dry and cracked skin may include a number of active ingredients, such as:
- humectants, which draw moisture into the skin
- salicylic acid or alpha hydroxy acid, which remove dead skin cells
- urea, which hydrates and exfoliates
For deeper skin fissures, doctors may use:
- debridement, which involves a medical professional carefully cutting away dead skin
- prescription-strength skin softeners or debriding agents
- skin glues that hold cracks together while they heal
- strapping, bandaging, or dressings
- antibiotics, which a doctor may prescribe if a fissure contracts an infection
If a person has fissures on their heels, supportive insoles or heel pads may be necessary to reduce pressure on the skin.
If fissures are frequent, recurring, or do not heal on their own, a doctor may investigate whether an underlying health condition could be the cause.
Do not forcibly attempt to remove dry or thick skin at home — only a qualified professional should do this. However, there are several things people can do at home to help fissures heal. These include:
- keeping the skin clean and moisturized
- gently exfoliating areas of callused skin, such as the heels
- protecting the skin from things that exacerbate dryness, such as unnecessary water exposure, heat, friction, or irritants
- for heel fissures, avoiding standing or walking for prolonged periods, and wearing supportive shoes or shoe inserts
- managing underlying conditions, such as diabetes, with medications or lifestyle changes
In general, people can also follow these measures:
- drinking plenty of water every day so that their urine is a pale yellow color
- eating a balanced diet with whole grains, fruits, vegetables, and lean proteins
- wearing clean clothing, socks, and shoes made from breathable materials
- wearing sandals or flipflops in public swimming pools or showers, as this reduces the chances of developing athlete’s foot
- using an air humidifier, if dry air could be contributing to dry skin
A person should seek help from a doctor if their skin fissures worsen or do not respond to home treatments. Early treatment can prevent fissures from turning into a skin ulcer, which is significantly harder to treat.
People should also speak with a doctor if they experience:
- pain while walking or standing
- frequent bleeding
- swelling, pus, or the affected area becomes warm to the touch
Skin fissures are cracks in the skin that typically occur in areas that get dry, thick, or calloused, such as the heels. Many factors can cause them.
It is important to treat skin fissures promptly. Deep fissures can develop infections or lead to ulcers. A doctor can provide dressings, ointments, and moisturizers to help fissures heal.