What is the treatment for cracked fingers?

Treatment for Cracked Fingers

The cornerstone of treating cracked fingers is frequent application of moisturizers (at least twice daily) combined with identification and avoidance of irritants, with topical corticosteroids reserved for cases that fail conservative management. 1

Immediate Management Approach

Moisturizer Application

• Apply moisturizer after every hand washing and before wearing gloves to restore and maintain the skin barrier 1
• Use the "two fingertip unit" rule: apply an amount of moisturizer equivalent to two fingertip units to both hands after each washing 1
• Moisturizers containing humectants (such as those with 2% colloidal oatmeal) and natural oils (like 7% sweet almond oil) are effective for moderate to severe hand dermatitis 2
• Apply moisturizer at least twice daily, even when hands appear normal, to prevent recurrence 3

Hand Washing Technique Modifications

• Use lukewarm or cold water instead of hot water (avoid temperatures above 40°C), as hot water disrupts the stratum corneum lipid structure and increases skin permeability 1
• Wash hands for at least 15-20 seconds, covering all surfaces 1
• Dry hands thoroughly with a disposable towel before applying moisturizer 1
• Avoid washing hands immediately before or after using alcohol-based sanitizers, as this increases dermatitis risk 1

Identifying the Type of Hand Dermatitis

Irritant Contact Dermatitis (ICD)

• Most common cause of cracked fingers from frequent hand washing, wet work, or exposure to detergents and surfactants 1
• Identify and avoid irritants: dish detergent, bleach, very hot/cold water, disinfectant wipes used directly on skin 1
• Switch to less-irritating soap products 1
• Consider using barrier creams (restorative creams with humectants), though their effectiveness is equivalent to regular moisturizers 1

Allergic Contact Dermatitis (ACD)

• Suspect if dermatitis persists despite avoiding obvious irritants 1
• Common allergens include: topical antibiotics (neomycin, bacitracin), benzalkonium chloride in adhesive bandages, fragrances in soaps 1
• Patients with suspected ACD should undergo patch testing to identify specific allergens 1

Topical Corticosteroid Therapy

When to Use

• Apply topical corticosteroids only if conservative measures (moisturizers and irritant avoidance) fail 1
• Can be used to mitigate acute flares of dermatitis 1

Specific Recommendations

• Clobetasol propionate 0.05% foam probably improves symptom control compared to vehicle when assessed after 15 days of treatment (moderate-certainty evidence) 4
• Mometasone furoate cream applied three times weekly may maintain remission better than twice weekly application 4
• Be cautious of potential topical steroid-induced damage to the skin barrier with prolonged use 1
• Monitor for mild atrophy, particularly with extended use 4

Protective Measures

Glove Use

• Apply moisturizer before wearing gloves to prevent occlusion-related irritation 1
• Use rubber-free gloves (neoprene or nitrile) if latex sensitivity is suspected 1
• Consider cotton glove liners or loose plastic gloves for additional protection 1
• Avoid applying gloves when hands are still wet from washing or sanitizer use 1
• Do not occlude hands with self-adherent wraps, as this worsens dermatitis 1

When to Escalate Treatment

Dermatology Referral Indications

• Recalcitrant hand dermatitis that does not respond to topical corticosteroids and conservative measures 1
• Consider for patch testing to evaluate for clinically relevant allergens 1
• May require phototherapy, systemic therapy, or occupational modification 1

Advanced Treatment Options (for Severe Cases)

• Oral cyclosporin 3 mg/kg/day probably improves symptom control compared to topical betamethasone after six weeks (moderate-certainty evidence) 4
• Alitretinoin 30 mg daily significantly improves both investigator-rated and participant-rated symptom control compared to placebo (high-certainty evidence), though headache risk increases 4
• Topical calcineurin inhibitors (tacrolimus 0.1%) probably improve symptoms when assessed after three weeks of treatment 4
• UV phototherapy (PUVA or narrow-band UVB) may be considered for refractory cases 4

Common Pitfalls to Avoid

• Never use superglue (ethyl cyanoacrylate) to seal fissures, as this can cause allergic reactions 1
• Avoid petroleum-based hand lotions if wearing latex gloves, as petroleum degrades latex 1
• Do not pick at dermatitis-induced scale, as this worsens the condition 1
• Avoid occluding fingers with adhesive bandages containing bacitracin or benzalkonium chloride without first ruling out allergy 1
• Do not use disinfectant wipes directly on hands as a substitute for proper hand washing 1

Three-Step Regimen for High-Risk Individuals

For those with occupational exposure to irritants (healthcare workers, food handlers, cleaners):

1. Hand protectant cream: Apply at least twice daily and after each hand washing 3
2. Specific gentle cleanser: Use instead of harsh soaps 3
3. Repair cream: Apply each evening to restore barrier function 3

This regimen has been shown to restore damaged skin barrier and improve stratum corneum hydration in individuals prone to occupational irritant contact dermatitis 3