What is the treatment for fissures in the soles?

Treatment of Fissures in the Soles

For fissures in the soles, apply a humectant-rich formulation containing 15% alpha-hydroxy acids and 15% urea once or twice daily, or use 40% urea cream once daily as first-line therapy, combined with proper hydration of the skin before application and occlusion when possible. 1, 2

First-Line Topical Treatment Approach

Keratolytic and Humectant Therapy

• Apply 40% urea cream once daily to remove excessive keratin and promote healing of hyperkeratotic skin with fissures 2
• Alternatively, use a humectant-rich formulation containing 15% alpha-hydroxy acids plus 15% urea once or twice daily (no significant difference in efficacy between frequencies) 1
• For FDA-approved options, salicylic acid 6% can be used as a topical aid for removal of excessive keratin in keratosis palmaris and plantaris 3

Application Technique for Maximum Efficacy

• Hydrate the skin for at least 5 minutes prior to application using wet packs or baths to enhance penetration 3
• Apply the medication thoroughly to affected areas and cover with occlusive dressing overnight after washing and before bed 3
• Wash off in the morning; if excessive drying occurs, apply a bland cream or lotion 3
• Hands should be rinsed thoroughly after application unless the hands themselves are being treated 3

Adjunctive Wound Care for Deep or Painful Fissures

Occlusive Therapy

• Apply propylene glycol 50% in water for 30 minutes under plastic occlusion nightly, followed by hydrocolloid dressing application 4
• This approach accelerates wound closure and protects the fissure from further trauma 4

Antiseptic Management

• Consider antiseptic baths with potassium permanganate 1:10,000 concentration to accelerate wound closure 4
• Alternatively, topical silver nitrate solutions may be used 4
• Apply emollients to surrounding skin to prevent secondary fissure formation 4

Expected Outcomes and Monitoring

Treatment Response Timeline

• The humectant-rich formulation increases skin hydration, removes scales, and reduces thickness of hyperkeratotic skin within 2-3 weeks 1, 2
• A 100% cure rate was achieved in patients with severe hyperkeratotic foot conditions after 2-3 weeks of combined urea and topical therapy 2
• Once clearing is apparent, occasional use maintains remission 3

Barrier Function Considerations

• The humectant-rich formulation efficiently relieves xerosis without weakening skin barrier function 1
• In normal skin, treatment actually improves barrier resistance to external insults 1
• Some patients may experience mild smarting and stinging, which is generally tolerable 1

Critical Pitfalls to Avoid

• Do not excessively or repeatedly apply keratolytic agents, as this will not increase therapeutic benefit but could result in increased local intolerance and systemic adverse effects such as salicylism 3
• Avoid hot showers and excessive use of soaps, which dehydrate the skin 4
• Do not use alcohol-containing lotions or gels; favor oil-in-water creams or ointments instead 4
• For children under age 2 years, urea ≥10% is not recommended except once daily on limited areas such as palms and soles 4

When Standard Treatment Fails

If fissures persist despite appropriate keratolytic therapy:

• Evaluate for underlying conditions including ichthyoses, psoriasis, or inflammatory dermatoses 4, 3
• For inflammatory conditions with erythema and desquamation, add topical corticosteroid preparations such as prednicarbate cream 4
• Consider referral to dermatology for evaluation of systemic therapy options including oral retinoids for severe hyperkeratotic conditions 4