Dry, cracked heels are a common complaint and can prove painful and embarrassing. This condition often gets worse during winter, and may be diagnosed as hyperkeratotic xerosis or hyperkeratosis with ichthyosis vulgaris.
While the latter condition is incurable, there are effective treatments to help manage symptoms. These include salicylic acid, glycolic acid, and emollient and humectant moisturising creams to help reduce dryness and scaling for skin that looks healthier and feels happier.
What Causes Dry, Cracked Heels?
If you’re experiencing dry, cracked heels, especially in winter, you may have winter eczema. This could be caused by altered keratin metabolism, and a possible deficiency in filaggrin, a specific protein involved in skin cell growth and hydration. While dry, cracked heels can result from specific insults to the feet, the problem is often related to two skin conditions: hyperkeratosis xerosis and ichthyosis vulgaris.
What is Hyperkeratosis Xerosis?
As the name suggests, hyperkeratosis is a condition characterised by overproduction of keratin. Specifically, hyperkeratosis xerosis involves excessive keratin in the stratum corneum, in addition to altered cell proliferation, surface lipids, pH, and levels of sebum and water. Xerosis can result in dry, red, scaly skin with fissures, and may be painful and unsightly.
What is Ichthyosis Vulgaris?
Ichthyosis vulgaris is an inherited skin condition characterised by a failure of the skin to shed dead skin cells. This is caused by a deficiency in filaggrin breakdown products (i.e. there is an abnormality in the skin’s normal activity where dead skin cells are broken down sufficiently that they can slough off). As a result, the skin becomes dry, with accumulations of dead skin cells that resemble fish scales.
Dry, Cracked Heels – What’s Going on with Your Skin?
Healthy skin relies on a healthy stratum corneum. This part of the skin forms a strong, flexible barrier that helps protect against excessive water loss. Think of it as being rather like a brick wall, with corneocytes (bricks) held together by an intercellular matrix (mortar) of lipids.
A healthy, functional stratum corneum is made up of about 10% water. Maintaining this level of hydration involves proper regulation of sebum, lipids, proteins, and filaggrin, a filament aggregating protein. Filaggrin binds to keratin fibers in the skin and is vital for the proper growth of skin cells.
In recent years, researchers have found that many people suffering with dry, cracked heels have a deficiency in filaggrin. This leads to a loss of hydration in the stratum corneum and abnormal keratinization.
Treatment for Dry, Cracked Heels
There is currently no cure for ichthyosis vulgaris, but it is possible to effectively treat dry, cracked heels. Even better, it’s perfectly possible to treat at home!
Effective treatment for xerosis aims to replace water and natural oils in the skin, and to maintain skin hydration. In addition, treatment helps to control keratin levels and soothe irritated skin.
Topical retinoids and vitamin D are good options for treating dry, cracked heel, as are certain kinds of moisturising creams and lotions. The most effective creams have an emollient effect (creating a lipid-based barrier to reduce evaporation and water loss from the skin), and a humectant effect (helping to draw water into the skin and enhance hydration in the stratum corneum).
Keratolytic agents are also recommended in cases of xerosis. These agents help combat the excessive keratin in skin, including decreasing the degree to which corneocytes stick together, thereby allowing dead skin cells to slough away as intended. Such agents include hydroxy acids (e.g., lactic acid, glycolic acid), salicylic acid, and urea. Indeed, salicylic acid (found in aspirin) and urea have long been used to treat xerosis.
What Does the Evidence Say?
In a paper published in 2004, researchers described two women, one with hyperkeratosis xerosis and one with ichthyosis vulgaris. Both were treated with Salex, a topical multivesicular cream formulation of 6% salicylic acid. The women used the cream on just one heel for 1 or 2 weeks and were re-examined by a physician who didn’t know which heel had received treatment.
The physician could easily tell which heel had been treated by the reduction in dryness, scaling, and hyperkeratosis. Treatment was then extended to both heels and symptoms rapidly improved in both women. They reported less pain and had smoother, softer skin on their heels.
How does salicylic acid help with dry, cracked heels?
Salicylic acid is a keratolytic agent, meaning that it enhances the rate at which scaly skin is shed to reveal smoother, softer skin below. It does this by loosening the bonds between corneocytes, letting dead skin slough away.
Older formulations of salicylic acid could result in a stinging or burning sensation, but new treatments are much improved. Previously, the agents were rapidly absorbed, creating a sudden glut of salicylic acid followed by a rapid decline. Newer treatments carefully control the delivery using multivesicular emulsion technology, essentially creating a time-release effect for salicylic acid.
Salicylic acid treatment for dry, cracked heels is available in both prescription and nonprescription formulations. This includes gels, creams, ointments, lotions, and liquids, as well as patches, wipes, and salicylic acid pads.
Using a moisturising cream that contains salicylic acid can help prevent cracked heels and alleviate existing minor cracks. Use the cream two or three times a day to treat an emerging crack or for dry skin prone to such cracking.
Do not use salicylic acid on normal skin as it can burn and irritated skin and may even lead to infection. You should also avoid using salicylic acid on skin that is already broken, infected, reddened, irritated, or swollen. When using treatments that contain salicylic acid, avoid covering the skin with any kind of dressing or bandage afterwards.
Dry, Cracked Heels – Home remedies!
While it’s always best to have any skin issue assessed by a qualified dermatologist, in a pinch you can cobble together an effective home remedy for dry, cracked heels.
If you happen to have an acne cleanser or acne cleansing pads at home, try using these on your heels. These products often contain salicylic acid, and are formulated for facial skin, so they’re not so strong that they risk burning the skin on your heels.
You can also track down a salicylic acid solution at your local pharmacy and use this to soften dry skin before applying an effective moisturiser. Aim for a 2% salicylic acid solution. Ideally, follow up with a good moisturiser before going to bed (wear cotton socks to prevent messy sheets!).
Glycolic acid can also help with dry, cracked heels and is found naturally in fruit juice. As such, other options for at-home remedies include:
- Glycolic acid facial peels
- Lemon juice mixed with witch hazel
- Pineapple juice (fresh!).
Follow these up with a high quality emollient and humectant moisturising cream to seal in moisture for smooth, soft, happy heels.
Leave a comment below if you have any top tips for treating dry, cracked heels, or if you’ve had success with home remedies.
Joseph Bikowski. (2004). Hyperkeratosis of the Heels: Treatment With Salicylic Acid in a Novel Delivery System. Skinmed, 3(6). https://onlinelibrary.wiley.com/doi/10.1111/j.1540-9740.2004.04056.x