Should Your Child See a Doctor?

Cracked or Dry Skin

Definition

  • Skin is cracked (especially hands, feet and lips) OR
  • Dry, rough skin (usually of entire body surface).

Causes of cracks in the skin

  • Most cracked skin is found on the feet, hands or lips.
  • Feet: The soles of the feet are most commonly involved, especially on the heels and big toes (called tennis shoe dermatitis). Deep cracks are very painful and periodically bleed. The main cause is frequently wearing wet or sweaty socks or swimming a lot.
  • Hands: Cracks can develop on the hands in children who frequently wash their hands or wash dishes. Can also occur from working outside in winter weather. The worse cracks of the fingers occur with thumbsucking.
  • Lips: The lips can become chapped in children from excessive exposure to sun or wind. If the lips become cracked, it's usually from a "lip-licking" habit. The skin around the lips can also become pink and dry if the child sucks on the lips.

Causes of dry skin

  • Dry skin is a common condition.
  • Mainly caused by too much bathing and soap (soap dermatitis)
  • Soap removes the skin's natural protective oils and once they are gone, the skin can't hold moisture.
  • Dry climates make it worse, as does winter weather (called winter itch)
  • Genetics also plays a role in dry skin.
  • Dry skin is less common in teenagers than younger children, because the oil glands are more active.
  • Dry, rough, bumpy skin on the back of the upper arms is called keratosis pilaris. It's made worse by soaps. Treated with moisturizing creams.
  • Dry pale spots on the face are called pityriasis alba. These are more prevalent in the winter time and are also made worse by soaps. Treated with moisturizing creams.
  • Eczema: Children with eczema have very dry itchy skin.

Liquid crack sealer for deep, chronic cracks

  • Liquid plastic skin bandage is a new product that seals wounds with a plastic coating that lasts up to 1 week.
  • It is the best way to relieve pain and promote healing. As the crack heals from the bottom upward, it pushes the plastic seal out of the way.
  • After the wound is washed and dried, the liquid is applied with a small brush or with a swab. It dries in less than a minute. Then apply a second coat. It's resistant to bathing and may last a week.
  • Example: Nexcare Skin Crack Care by 3M
  • Available without a prescription at your local pharmacy.

See More Appropriate Topic (instead of this one) If

When to Call Your Doctor

Call your doctor now (night or day) if

  •  Your child looks or acts very sick
  • Looks infected (spreading redness or red streak)
  • Cracked red lips and fever present 5 days or more
  • You think your child needs to be seen urgently

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

  • You think your child needs to be seen, but not urgently
  • Looks infected (pus but no spreading redness)
  • Bleeding from cracked lips
  • Cracks on feet that interfere with walking

Call your doctor during weekday office hours if

  • You have other questions or concerns
  • Cracks from thumb-sucking or finger-sucking
  • Widespread peeling skin and cause unknown
  • After 2 weeks of treatment, cracked lips not healed
  • After 2 weeks of treatment, cracked skin not healed
  • After 2 weeks of treatment, dry skin is still itchy

Parent care at home if

  • Cracked skin on the feet and you don't think your child needs to be seen
  • Cracked skin on the hands and you don't think your child needs to be seen
  • Chapped lips
  • Dry, itchy skin caused by soaps or cold/dry weather

Home Care Advice for Cracked or Dry Skin

Treatment for Cracked Skin on the Feet

Reassurance

  • Cracked skin of the feet is usually due to excessive and repeated exposure to wetness.
  • The main cause is frequently wearing wet (or sweaty) socks. Swimmers also have this problem.
  • The soles of the feet are commonly involved, especially the heels and big toes.
  • This is sometimes called tennis shoe or sneaker dermatitis.
  • Cracked, dry feet usually can be treated at home.

Shallow cracks: use ointment

  • Cracks heal faster if protected from air exposure and drying.
  • Keep the cracks constantly covered with a plain ointment (e.g., petroleum jelly) 3 times a day.
  • If the crack seems mildly infected, apply an antibiotic ointment (no prescription needed) 3 times a day instead.
  • Covering the ointment with a Band-Aid or socks speeds recovery.
  • Option: If you have it, a liquid crack sealer works even better. Don't use crack sealer and ointment together.

Deep cracks: use liquid crack sealer

  • Deep cracks of the feet or toes usually do not heal with ointments.
  • Apply a liquid skin bandage (no prescription needed) that will completely seal the crack (e.g., Nexcare Skin Crack Care by 3M)
  • Start with 2 layers. Reapply another layer as often as needed.
  • As the crack heals, the plastic layer will be pushed out to the skin surface.

Prevention

  • Change socks whenever they are wet or sweaty.
  • Take an extra pair of socks to school.
  • Avoid shoes when practical.
  • Go barefoot or wear socks only.
  • Avoid bubble bath or other soaps in the bath water. Soaps take the natural oils out of the skin.
  • Apply a moisturizing cream to the feet after baths or showers.
  • Wear shoes that allow the skin to "breathe".

Expected course

  • Most cracks heal over in 1 week with treatment. Even deep cracks of many years' duration can be healed in about 2 weeks if they are constantly covered with crack sealer.

Call your doctor if

  • Starts to look infected (redness, red streak, pus)
  • Cracks persist over 2 weeks on treatment
  • Your child becomes worse

Treatment for Cracked Skin on the Hands

Reassurance

  • Cracked skin of the hands is usually caused be excessive and repeated exposure to wetness.
  • Examples are frequently washing dishes or frequently washing the hands.
  • Soap removes the natural protective oils from the skin.
  • Cracked, dry hands usually can be treated at home.

Shallow cracks: use ointment

  • Cracks heal faster if protected from air exposure and drying.
  • Keep the cracks constantly covered with a plain ointment (e.g., petroleum jelly) 3 times a day.
  • If the crack seems mildly infected, apply an antibiotic ointment (no prescription needed) 3 times a day instead.
  • Covering the ointment with a Band-Aid or gloves speeds recovery.
  • Option: If you have it, a liquid crack sealer works even better. Don't use crack sealer and ointment together.

Deep cracks: use liquid crack sealer

  • Deep cracks of the fingers usually do not heal with ointments.
  • Apply a liquid skin bandage (no prescription needed) that will completely seal the crack (e.g., Nexcare Skin Crack Care by 3M)
  • Start with 2 layers. Reapply another layer as often as needed.
  • As the crack heals, the plastic layer will be pushed out to the skin surface.

Prevention

  • Wash the hands with warm water.
  • Use soap only if the hands are very dirty or for substances that won't come off with water.
  • Wear gloves when washing dishes.
  • During cold weather, wear gloves outside.
  • Apply a moisturizing cream to the hands after anytime they have been in water.

Expected course

  • Most cracks heal over in 1 week with treatment. Even deep cracks of many years duration can be healed in about 2 weeks if they are constantly covered with crack sealer.

Call your doctor if

  • Starts to look infected (redness, red streak, pus)
  • Cracks persist over 2 weeks on treatment
  • Your child becomes worse

Treatment for Chapped Lips

Reassurance

  • The lips can become chapped in children from excessive exposure to sun or wind.
  • If the lips become cracked, it's usually from a "lip-licking" habit.
  • The skin around the lips can also become pink and dry if the child sucks on the lips.

Chapped ips

  • A lip balm should be applied frequently, even hourly. Be sure to apply it after eating or drinking.

Avoid "lip-licking"

  • Help your child give up the habit of lip-licking or sucking.
  • This habit usually is not seen before age 6.
  • This habit will only change if you can gain your child's active participation.
  • Appeal to your child's pride. Show your child in a mirror how lip-sucking has affected their appearance.
  • Give them a lip lubricant to apply to their lips whenever they feel the urge to suck on them. Another possible replacement activity is chewing gum.
  • Offer an incentive (e.g., money, or points towards a prize) for going an entire day without lip-sucking.
  • Avoid any pressure or punishment. It will backfire, cause a power struggle and make the habit last longer.

Call your doctor if

  • Starts to look infected (redness, red streak, pus)
  • Cracks persist over 2 weeks on treatment
  • Your child becomes worse

Treatment for Dry or Itchy Skin

Reassurance

  • Dry skin is a common condition.
  • Mainly caused by too much bathing and soap (soap dermatitis).
  • Soap removes the skin's natural protective oils and once they are gone, the skin can't hold moisture.
  • Dry climates make it worse, as does winter weather (called winter itch)
  • Genetics also plays a role in dry skin.
  • Dry skin is less common in teenagers than younger children, because the oil glands are more active.

Soap and bathing

  • Young children with dry skin should avoid all soaps. Soaps take the natural protective oils out of the skin. Bubble bath does the most damage.
  • For young children, the skin can be cleansed with warm water alone. Keep bathing to 10 minutes or less.
  • Most young children only need to bathe twice a week.
  • Teenagers can get by with using soap only for the armpits, genitals, and feet. Also, use a mild soap (e.g., Dove).
  • Avoid any soap on itchy areas or rashes.

Moisturizing cream

  • Buy a large bottle of moisturizing cream (avoid those with fragrances).
  • Apply the cream to any dry or itchy area three times per day.
  • After warm water baths or showers, trap the moisture in the skin by applying the cream everywhere within 3 minutes of completing the bath.
  • During the winter, apply the cream every day to prevent dry skin.

Steroid cream

  • For very itchy spots, use 1% hydrocortisone cream (no prescription is needed).
  • Apply up to 3 times per day as needed until the itching is better.
  • Eventually, the moisturizing cream will be all that you need for treating dry skin.

Humidifier

  • If your winters are dry, you can protect your child's skin from the constant drying effect by running a room humidifier full time.

Preventing dry skin

  • Avoid soaps and bubble bath.
  • Wash the hands with warm water. Use soap only if the hands are very dirty or for substances that won't come off with water.
  • Avoid swimming pools and hot tubs (Reason: pool chemicals are very drying).
  • Run a humidifier in the winter if the air is dry.
  • During cold weather, wear gloves outside to protect against the rapid evaporation of moisture from the hands.
  • Encourage adequate fluid intake.

Call your doctor if

  • Dry skin persists over 2 weeks on treatment
  • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

References

  1. Stewart K, Pace S. Juvenile palmar-plantar dermatosis. Contemp Pediatr. 2010;27:38-41.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Revised: 8/1/2011 3:44:20 PM

Content Set: Pediatric HouseCalls Symptom Checker

Version Year: 2012

Copyright 1994-2012 Barton D. Schmitt, M.D.