From the Guidelines
For a patient with a dry, cracked, and bleeding finger crease, I recommend immediate gentle cleansing with mild soap and water, followed by application of a thick emollient like petroleum jelly (Vaseline) or Aquaphor several times daily, especially before bed, as the most recent evidence from 1 suggests avoiding products containing topical antibiotics like neomycin or bacitracin due to potential allergens.
Key Considerations
- Avoid harsh soaps, hot water, and irritating chemicals, as they can further dry out the skin and exacerbate the condition, as noted in 1 and 1.
- Apply a thick hand cream containing ingredients like ceramides, urea, or glycerin regularly throughout the day, particularly after washing hands, to maintain good hand hydration and prevent recurrence.
- Consider using liquid bandage products or hydrocolloid dressings to create a protective barrier and promote healing, as suggested in 1.
- If the crack doesn't improve within 5-7 days, shows signs of infection (increasing redness, warmth, swelling, pus), or if the patient has diabetes or other conditions affecting healing, they should seek further medical evaluation.
Treatment Approach
- Gentle cleansing and moisturizing are crucial in managing dry, cracked skin, as emphasized in 1 and 1.
- Topical treatments like emollients and barrier creams can help replenish the skin barrier and promote healing, as noted in 1.
- Avoiding irritants and allergens, such as certain soaps or topical antibiotics, is essential in preventing further skin irritation and promoting healing, as suggested in 1.
From the FDA Drug Label
Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage The patient should clean the affected area and apply a small amount of bacitracin (TOP) on the area 1 to 3 times daily. The area may be covered with a sterile bandage. 2
From the Research
Assessment and Treatment of Dry, Cracked, and Bleeding Skin
The patient presents with a dry finger at the crease of the hand that is cracked and bleeding. This condition may be related to eczema or atopic dermatitis, which is a chronic inflammatory skin disorder characterized by dryness, irritation, and skin barrier dysfunction.
Emollients and Moisturizers
- Emollients or moisturizers are widely recommended for patients with eczema to soften and soothe the skin 3, 4.
- The regular and liberal use of emollients can help to improve the skin's barrier function and reduce the risk of irritation and infection.
- Different types of emollient creams can have diverse physiological effects on the skin barrier, with some creams (such as those containing urea and glycerol) being more effective than others 4.
Topical Corticosteroids
- Topical corticosteroids are an essential tool for treating inflammatory skin conditions such as psoriasis and atopic dermatitis 5, 6.
- The choice of topical corticosteroid depends on the severity of the condition, the location of the affected area, and the patient's age and medical history.
- Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema 6.
Management of Secondary Skin Infections
- Secondary infections in patients with atopic dermatitis are common and can be difficult to treat 7.
- Topical antibiotics such as gentamicin, fusidic acid, and mupirocine may be prescribed for mild to moderate secondary infections.
Treatment Recommendations
- Apply a moisturizer or emollient cream to the affected area to help soften and soothe the skin 3, 4.
- Consider using a topical corticosteroid to reduce inflammation and irritation, under the guidance of a healthcare professional 5, 6.
- If a secondary skin infection is suspected, consult a healthcare professional for guidance on treatment with topical antibiotics 7.