This is How Skin Cracks

Author: Dr. How Kang Nien Dermatology

Cracked skin is a classic result of dry skin, but can also occur as a due to trauma, an injury, or an infection.

Understanding the Physiology of Cracked Skin

Before getting down to the concept behind cracked skin, we should first understand the concept of skin “brick and mortar”. The “brick” refers to corneocytes (skin cells), while “mortar” refers to the lipid bilayer in between the corneocytes. Healthy and strong skin enables us to stay protected from harsh environmental exposure, such as exposure to soaps, chemicals, preservatives, UV radiations, pollutants and microbiomes. Therefore, should the “brick and mortar” structure of skin be damaged in any way, it will leave our skin vulnerable to adverse effects.

Being vulnerable affects the water retention capability of our skin, leading to dehydration of the corneocytes. This is what causes dry, cracked skin, which results in loss of ability to protect us from environmental agents, subsequently leading to an inflammation of the skin, such as eczema.

So, What Exactly Causes Cracked Skin?

Dry, cracked skin is actually caused by multiple factors, and differs in babies and adults. For babies, dry and cracked skin may be due to a genetic predisposition to atopic diseases (allergic rhinitis, atopic eczema, bronchial asthma, allergic conjunctivitis), or an abnormal response to a commensal organism (i.e Malassezia furfur). It may also be caused by environmental agents such as exposure to harsh cleansers, inadequate moisturising, frequent use of baby wipes, and irritation from faeces and urine due to infrequent nappy changing.

 

Adults, on the other hand, are potentially exposed to a variety of irritants or allergens, as a result of physical involvement in their occupations or hobbies. Thus, patients with childhood eczema who may have been previously stable, may suddenly have a relapse due to exposure to any of these agents. Approximately 40-50% of the elderly may experience some degree of dryness and cracking of the skin, which is likely due to physiological aging, or damage due to an accumulation of lifetime exposure to UV radiations, pollutants and chemicals.

 

Which Parts of Our Bodies are More Prone towards Getting Cracked Skin?

Proneness to suffering from cracked skin depends on its underlying cause, and is different for every individual. For example, areas of the body such as your hands and feet may be more susceptible to developing cracked skin as a result of friction caused by daily activities, or exposure to irritants and allergens.

Additionally, babies who suffer from atopic dermatitis are prone to have dry cracked skin over their cheeks, and extensors of their arms and legs. However, as they grow older, the affected area may be localised to only the forehead, elbows, knees, back of the thigh and buttocks region.

How Do We Prevent Cracked Skin?

Adopting a skin care regimen that focuses on proper cleansing and moisturising is important in the prevention of dry and cracked skin. Therefore, an understanding of cleanser and moisturizer pH levels are extremely important.

Individuals who have sensitive and dry skin will need to cleanse their skin with a mild cleanser which contains minimal preservatives and fragrances. The pH of the cleanser needs to be around 5-7 to maintain the acid mantle of the skin. Cleansers are generally classified into 3 basic types, namely soaps, synthetic detergents and combars.

crack skin

Moisturisers, subsequently, are used to reduce the water loss from skin. A good moisturiser should contain 3 primary ingredients – emollients, occlusive and humectants. Emollient functions as a skin smoother by filling the gaps in between cracked skin.  Occlusive moisturizer, on the other hand, retards water loss from the skin, while humectants attract and bind water from deeper epidermis to the superficial skin.

cracked skin
* Trans epidermal water loss (TEWL), stratum corneum (SC), natural moisturising factor (NMF)

How Do We Treat Cracked Skin?

The management and treatment of dry, cracked skin involves two main steps, namely maintaining the skin barrier function and controlling inflammation. To maintain skin barrier function, proper cleansing and moisturising play a central role. The implementation of these steps should be focused on maintaining the skin barrier function, in which proper cleansing and moisturising plays a central role. If the skin barrier is affected, it will result in inflammation. Therefore, it is recommended to use moisturisers which contain ingredients such as glycyrrhetinic acid, palmitamide MEA, or licochalcone, as these ingredients can aid in reducing inflammation just as effectively as when you use low potency corticosteroids. Alternatively, using topical corticosteroid or calcineurin inhibitors can also help in controlling inflammation.

Apart from the ingredients in a topical preparation, it is important for you to understand the different compositions of topical preparations, which usually consists of water, petrolatum, or a combination of both (refer to figure below). Water on its own is a weak moisturiser, as it tends to evaporate fast. At the other end of the spectrum, petrolatum is a substance which has the ability to prevent 99% of trans-epidermal water loss. Due to its thickness, it becomes a poor medium for bacteria growth, thus reducing the effects of preservatives and chemicals, leading to less irritation. However, due to its oily consistency, certain individuals may not be able to tolerate its application on their skin, which may contribute to hair follicle occlusion that leads to inflammation. 

For that reason, lotions and creams may be better tolerated in hot, humid countries such as Malaysia. However, lotions and creams require the addition of preservatives to ensure its stability, thus causing it to have a higher risk of contact reaction as compared to ointment. Ultimately, no one product is the best, but choosing one that your skin can tolerate, and which you are willing to use it consistently will allow you to maximise its efficacy.

To prevent the flaring up of an underlying skin condition, seek professional advice early as it may help you take the right preventive measures. Additionally, never adopt natural remedies as a form of treatment unless advised by your healthcare provider, as the chances of these unsupervised remedies causing more damage to your skin is actually far greater than leaving it alone.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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Review Date: December 20, 2019 | Last Modified: January 23, 2020

Dr. How Kang Nien Dermatology
Dr. How Kang Nien is affiliated to the Department of Medicine, University Putra Malaysia, where Dr. How Kang Nien is currently working as Lecturer. Dr ...
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Dr. How Kang Nien Dermatology

Dr. How Kang Nien is affiliated to the Department of Medicine, University Putra Malaysia, where Dr. How Kang Nien is currently working as Lecturer. Dr. How Kang Nien has numerous publications within the specialty and published in reputed national and international peer-reviewed journals. Dr. How Kang Nien is actively associated with different national and international societies and academies. Dr. How Kang Nien gain recognition among the honourable subject experts with the contributions made. Dr. How Kang Nien is been appreciated by several reputed awards and funding support. Dr. How Kang Nien major research interest is in studies related to Dermatology.

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