What prescription ointment is recommended for treating cracked heels?

Prescription Ointments for Cracked Heels

For cracked heels, urea-based ointments at 20% concentration are the most effective prescription treatment, providing superior hydration and keratolytic effects compared to lower concentrations or standard emollients. 1

First-Line Treatment Options

Urea-Based Preparations

• 20% urea cream is significantly more effective than placebo and 5% urea formulations for increasing skin hydration in the heel area 1
• Urea-based lotions (10%) have shown a 65% reduction in scaling, roughness, redness, and cracking compared to 40% with standard glycerol-based emollients 2
• Higher concentrations of urea (20-40%) provide both moisturizing and keratolytic effects, helping to soften thick, cracked skin 1, 2

Salicylic Acid Preparations

• 6% salicylic acid in a multivesicular cream formulation has demonstrated dramatic improvement in heel hyperkeratosis and painful fissures within 1-2 weeks of twice-daily application 3
• Salicylic acid works as a keratolytic agent that helps remove excess dead skin cells and soften thickened areas 3

Treatment Algorithm Based on Severity

For Mild to Moderate Cracked Heels:

1. Start with 10-20% urea-based prescription cream applied twice daily 1, 2
2. Apply after bathing when skin is slightly damp to enhance absorption 4
3. Continue for 2-4 weeks until improvement is noted 2

For Severe or Recalcitrant Cracked Heels:

1. Consider 6% salicylic acid preparations for more aggressive keratolytic action 3
2. Apply twice daily to affected areas 3
3. If no improvement after 2 weeks, consider combination therapy with both urea and salicylic acid products 2, 3

Special Considerations

For Diabetic Patients

• Careful monitoring is essential as diabetic patients have higher risk for complications from foot conditions 4
• Avoid high concentrations of salicylic acid due to potential for tissue damage in patients with neuropathy 4
• Regular follow-up is recommended to ensure healing and prevent infection 4

For Fungal Involvement

• If fungal infection is suspected (particularly between toes or with nail involvement), consider adding:
  • Ciclopirox olamine cream/gel (0.77%) applied twice daily for 4 weeks 4
  • Terbinafine 1% cream applied daily for 1-2 weeks 4
• These antifungals have shown mycological cure rates of 60-85% for fungal foot infections 4

Prevention of Recurrence

• After successful treatment, maintenance with lower concentration urea creams (5-10%) can help prevent recurrence 1
• Daily application of foot powder after bathing has been shown to reduce rates of fungal infections 4
• Regular use of emollient creams can alleviate pain and dryness and improve the appearance of heels 5
• Patients should be advised to wear appropriate footwear and avoid walking barefoot 4

Common Pitfalls to Avoid

• Failure to distinguish between simple xerosis and fungal infection can lead to treatment failure 4, 6
• Inadequate duration of therapy often results in recurrence; treatment should continue until complete resolution 2
• Neglecting to address underlying conditions like diabetes or obesity that may contribute to heel cracking 4
• Using over-the-counter products with insufficient concentration of active ingredients for severe cases 2