From the Guidelines
The best treatment for dry cracked heels involves a combination of moisturizing, exfoliation, and protection, with a focus on using urea-based moisturizers, protecting the area, and promoting cell turnover, as recommended by recent guidelines 1. To manage dry cracked heels, start by applying a thick, urea-based moisturizer like Eucerin Advanced Repair Cream (10% urea) or CeraVe SA Cream twice daily, focusing on affected areas.
- Before bed, apply a thicker ointment such as petroleum jelly or Aquaphor and wear cotton socks overnight to enhance absorption.
- Weekly exfoliation using a foot file or pumice stone after soaking feet in warm water helps remove dead skin.
- For deeper cracks, consider using liquid bandage products or hydrocolloid bandages to protect the area while healing.
- Severe cases may benefit from over-the-counter products containing salicylic acid (2-3%) or lactic acid (5-10%) to help break down thickened skin. These treatments work by restoring the skin barrier, increasing hydration, and promoting cell turnover, as supported by recent guidelines on foot care 1. Consistency is key - most people see improvement within 1-2 weeks of regular treatment, though deeper cracks may take longer to heal completely. It is also essential to educate patients on proper foot self-care, including washing feet daily, using emollients to moisturize dry skin, and cutting toenails straight across, as recommended by guidelines on the prevention of foot ulcers in persons with diabetes 1.
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. Dosage and Administration Apply Urea 40% to affected skin twice per day, or as directed by your physician. Rub in until completely absorbed. Apply to diseased or damaged nail(s) twice per day, or as directed by a physician.
The best treatment for dry cracked heels is Urea 40% applied to the affected skin twice per day 2 2.
- Key points:
- Apply to affected skin
- Rub in until completely absorbed
- Follow physician's directions for use.
From the Research
Treatment Options for Dry Cracked Heels
- Urea is a potent emollient and keratolytic agent, making it an effective monotherapy for conditions associated with dry and scaly skin, including dry cracked heels 3, 4.
- Urea-containing formulations are available in diverse formulations and concentrations, and multiple clinical trials have shown significant clinical improvement in many dermatological conditions presenting with scaly and dry skin 3, 4.
- Urea can increase skin penetration and optimize the action of topical drugs, and urea-based products are well tolerated with mild side effects 3, 4.
Mechanism of Action
- Urea improves skin barrier function, including antimicrobial defense, by regulating gene expression in keratinocytes relevant for their differentiation and antimicrobial peptide production 4.
- Urea plays a fundamental role in regulating keratinocyte proliferation and has been used to treat various dermatological conditions, including ichthyosis, xerosis, atopic dermatitis, and psoriasis 3, 4.
Comparison with Other Treatments
- Topical antibiotics, steroids, anesthetics, and antifungals can cause allergic contact dermatitis, and patch testing is necessary to identify common sensitizers 5.
- Clotrimazole, nystatin, and miconazole are effective topical treatments for cutaneous candidiasis, with similar efficacy and mild adverse effects 6.
- Urea has been shown to reduce epidermal hyperproliferation and induce differentiation in psoriasis, making it a potential treatment option for dry cracked heels 7.