What is the treatment for severe plantar xerosis (dry skin) with heel fissures?

From the Guidelines

For severe dry and cracked heels, the most effective treatment approach is to use moisturizers for dry, scaly skin, as recommended in the 2025 standards of care in diabetes 1. This approach prioritizes the use of moisturizers to soften and hydrate the skin, reducing the risk of further cracking and promoting healing. Key components of this treatment plan include:

• Daily foot inspection to monitor the condition and prevent further complications
• Use of moisturizers, such as urea-based creams, to soften and hydrate the skin
• Avoidance of self-care of ingrown nails and calluses to prevent infection and further damage
• Wearing well-fitted athletic or walking shoes with customized pressure-relieving orthoses to reduce pressure on the heels and promote healing Additionally, individuals with diabetes or those at high risk of foot complications should be referred to a foot care specialist for further evaluation and regular surveillance 1. It is also important to note that preventive foot care measures, such as daily foot monitoring and proper foot care, including nail and skin care, can help prevent the development of severe dry and cracked heels 1. Overall, a comprehensive treatment approach that prioritizes moisturizer use, proper foot care, and regular surveillance can help promote healing and prevent further complications in individuals with severe dry and cracked heels.

From the FDA Drug Label

Indications and Usage For debridement and promotion of normal healing of hyperkeratotic surface lesions, particularly where healing is retarded by local infection, necrotic tissue, fibrinous or purulent debris or eschar. Urea is useful for the treatment of hyperkeratotic conditions such as dry, rough skin, dermatitis, psoriasis, xerosis, ichthyosis, eczema, keratosis pilaris, keratosis palmaris, keratoderma, corns and calluses, as well as damaged, ingrown and devitalized nails. INDICATIONS AND USAGE For Dermatologic Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae, and the various ichthyoses (vulgaris, sex-linked and lamellar), keratosis palmaris and plantaris keratosis pilaris, pityriasis rubra pilaris, and psoriasis (including body, scalp, palms and soles). For Podiatric Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin on dorsal and plantar hyperkeratotic lesions. Topical preparations of 6% salicylic acid have been reported to be useful adjunctive therapy for verrucae plantares.

Treatment options for severe dry and cracked heel include:

• Urea (TOP): useful for the treatment of hyperkeratotic conditions such as dry, rough skin, including keratoderma and calluses 2
• Salicylic acid (TOP): a topical aid in the removal of excessive keratin on dorsal and plantar hyperkeratotic lesions, including keratosis palmaris and plantaris 3 Key considerations: both urea and salicylic acid can be used to treat hyperkeratotic conditions, but the choice of treatment should be based on individual patient needs and medical professional guidance.

From the Research

Treatment Options for Severe Dry and Cracked Heel

• Urea-based products are effective in treating dry and scaly skin conditions, including severe dry and cracked heel 4, 5, 6.
• Urea improves skin barrier function, has antimicrobial properties, and regulates keratinocyte proliferation, making it an ideal ingredient for moisturizers and keratolytic agents 4.
• Topical urea formulations are available in various concentrations, with lower doses (≤10%) acting as a skin moisturizer and higher concentrations (>10%) exerting a keratolytic action 6.
• Urea can be used in combination with other medications, such as anti-inflammatory and anti-fungal drugs, to enhance their penetration and optimize their action 5, 6.
• While there is limited evidence on the specific use of urea for severe dry and cracked heel, its efficacy in treating similar skin conditions, such as xerosis and ichthyosis, suggests its potential benefits for this condition 4, 5, 6.
• Other treatment options, such as salicylic acid, may also be effective in treating severe dry and cracked heel, but urea-based products have been shown to have similar efficacy and safety profiles 7.

Safety and Efficacy

• Urea-based products are generally well-tolerated, with mild irritation being the most common adverse event 4, 5, 6.
• The safety profile of urea is well-established, with no systemic toxicity reported 5.
• Clinical trials have demonstrated the efficacy of urea in improving skin barrier function and reducing symptoms of dry and scaly skin conditions 4, 5, 6.