Many people come into my office beginning in early fall with a chief complaint of dry and cracked skin.  They bring lengthy lists of products — moisturizers, creams and other remedies — that they’ve tried for keeping their skin moist and more importantly, their hands and feet from cracking.  Being unsuccessful, they ask for still other recommendations or products they haven’t used or heard of that might work better. My response always begins with a brief anatomical description of the skin as it relates to moisture and its retention.

A brief account of our outer skin might be summarized by envisioning an ordinary sponge with many nooks and crannies that serve to increase surface area in order to retain more water.  When a sponge is rung out and left to dry it becomes brittle and more susceptible to breakage.
 
I think back to when I was a kid and how I loved to play baseball. I would ride my bike home with my glove on the handlebar and drop both bike and glove in my yard and run inside for dinner.  After many a night left outside, my glove became cracked and dried from nights in the rain followed by sunny summer days. Aside from taking better care, what we were told to do with our gloves was to oil them.
 
So I describe this to my patients and then indicate what most Americans do incorrectly at home each and every. First, particularly in the winter, is to turn up the heat, take hot showers every day, and use lots of the soap.  We get out of the shower and briskly dry ourselves off. We then proceed to moisturize our skin.  So, in review, we dry the heck out of our skin and then proceed to moisturize it. 

So, patients walk into my office with dry soles and cracked heels. The following is what I recommend and why: bathe in tepid water, use very little soap or one with moisturizers, and only pat dry the affected areas.  It is important to thoroughly saturate the dry body part. It is not necessary to bathe every day. A sponge bath or modification thereof can be accomplished by soaking the feet in a basin of water.  If, upon examination, there is cracking or fissuring, apply an oil-base product like Bag Balm, Vaseline or Crisco. In the evening, wrap the foot in a plastic bag or plastic wrap and cover the wrap with a sock, basically forming an occlusive dressing. Remove the wrap and sock in the morning, repeating the process each evening until there is significant improvement in the texture of the area for two days in a row. Then use this method once a week or as needed.

I like to ask people if they use hot or cold water when they wash their dishes. I indicate that if they use cold water, it will be there in the morning still upon the dish.  If they use hot water, the water will evaporate faster and the dishes will be quite dry. This is exactly what happens when we bathe in hot water.
 
It’s important to understand that moisture in the human body most often comes from within, not from without.  A person needs to stay adequately hydrated to protect the outer tissues from dehydrating, which in many cases is self-induced.  Applying moisturizers to skin after a shower or bath will do very little, since moisturizers are water-based and are absorbed rapidly. Vaseline and the like are oil-based, thereby creating a protective barrier between the water content of the tissue and that of your surroundings. 

If you’re still not interested in going to the doctor but have not been successful in healing your own dry and cracked skin, perhaps you need only consider the duck in water.  Or a swimmer crossing the English Channel. That is, they both are well hydrated with an evenly distributed coating of oil that separates them from the outside world.

Dr. Andrew E. Schwartz, D.P.M.
Practice of Medical and Surgical Podiatry

51 Hospital Hill Road
Sharon, CT 06069
860 364 5944

88 Elm Street
Winsted, CT 06098
860 379 3100