Urea-Containing Creams for Cracked Heels
For cracked heels, apply 10-20% urea cream twice daily to the affected areas, increasing to 20-40% urea for severe hyperkeratosis or deep fissures. 1, 2
Recommended Treatment Approach
First-Line Therapy: Urea-Based Creams
- Start with 10% urea cream applied twice daily for general dry skin, scaling, and mild-to-moderate heel cracks 1, 2
- Escalate to 20% urea concentration for more pronounced hyperkeratosis and deeper fissuring 1, 3
- Reserve 20-40% urea formulations for localized areas of severe, thick hyperkeratosis on the heels 1, 2
The British Association of Dermatologists specifically recommends urea-containing emollients for hyperkeratosis and scaling conditions, with concentration titrated to severity 1, 2. Clinical evidence demonstrates that 20% urea cream provides significantly greater hydration and keratolytic effect on plantar skin compared to lower concentrations or placebo 4.
Application Technique
- Apply at least twice daily, ideally after bathing when skin is slightly damp to maximize absorption and hydration 1
- Continue treatment for 4 weeks minimum to achieve optimal reduction in scaling, roughness, and cracking 5
- Urea can be used as monotherapy or combined with other topical treatments 1
Alternative Keratolytic Option
- Salicylic acid 5% combined with 10% urea (e.g., Kerasal ointment) provides comparable efficacy to 12% ammonium lactate for foot xerosis after 4 weeks of treatment 6
- This combination leverages both keratolytic mechanisms, though urea alone at higher concentrations (20%) may be equally effective 4, 6
Critical Safety Considerations
- Avoid application to open fissures or actively inflamed areas, as keratolytics can cause burning, stinging, and irritation 1, 2
- Do not use urea ≥10% in children under 1 year except on very limited areas like palms and soles 1
- Common side effects include mild itching, burning sensation, and local irritation, but systemic toxicity is not a concern 1, 7
Why Urea Over Other Options
Urea demonstrates superior safety compared to salicylic acid, particularly for widespread application, with no reports of systemic toxicity 7. The keratolytic, moisturizing, and antiproliferative properties of urea at high concentrations make it ideal for hyperkeratotic conditions like cracked heels 3. A randomized controlled trial in ichthyosis vulgaris (a condition with similar hyperkeratosis) showed 10% urea lotion achieved 65% reduction in scaling, roughness, redness, and cracking compared to 40% with standard glycerol-based emollient 5.
Common Pitfalls to Avoid
- Do not start with concentrations that are too low (5% urea showed no significant difference from placebo for heel hydration) 4
- Do not apply to broken skin or deep, open cracks until initial healing occurs with emollient therapy alone 1, 2
- Do not expect immediate results—consistent application for 2-4 weeks is required for meaningful improvement 5, 6