FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

TOO MUCH WASHING, COLD AND DRY AIR CAN CAUSE "SPLIT" FINGERS

Question: After being in cold weather for only a couple of hours, my fingers and thumb tips split. Then, it takes days of wearing Band-aids and Neosporin before they heal. I have handled a good deal of petroleum-based oils over the years and wonder if this could be part of the problem. I'm 51 and otherwise in excellent health. What's causing this problem?

Answer: Our skin serves an important role in maintaining the body's internal environment and simultaneously protecting us from the external one. The nerve endings on the skin surface also allow us to sense temperature, moisture, texture and pressure and, thus, to keep "in-touch" with the external environment. A "split" in the skin, what we doctors call a fissure, is a disruption in the continuity of the tough layer of dead skin cells that form the outer barrier of the skin. A fissure continues below the dead cells and into the living part of the skin without going all the way through as occurs in a cut. The "split" defeats most of the important barrier functions of skin while simultaneously sending a sensory signal that indicates the presence of that injury. Consequently, the "split" reminds you of its presence every time you use your hands. Petroleum products can cause irritation to the skin -- but at the time of exposure, not days or weeks later. Have you had repeated episodes of hand irritation from your years of exposure? Probably not, or you would have said so in your letter. Therefore, I don't think that is the direct cause of your split fingertips.

I think it's likely that you have used a harsh cleanser to clean your hands that not only removed the dirt and petroleum products but also the moisture from the skin. The loss of moisture makes the outer layer of skin cells more brittle and prone to cracking or "splitting" when stressed by normal use.

Then, with your skin already somewhat dry, the cold and dry air causes two addition problems that bring on your fissured skin. The first of these is the low humidity that draws additional moisture from your exposed skin. The second is the cold temperature that "shuts off" perspiration in the hands that would help keep the skin more moist if you were in a warm but dry climate. Consequently, when you go outside in cold weather your fingertips succumb to this double threat and the tips split as you described.

There are many definitions of middle age and old age. Some of these are humorous, while others are more practical. Having your fingertips split in cold weather is a good example of a practical one. At 51, you have arrived!! Dry and splitting skin is a common wintertime problem. The hands are often involved but the lower legs and arms are common areas of dryness, redness, itching and splitting as well. Moving to Hawaii where it is warm and moist year round, or at least spending the winter there, could avoid this annoying condition. Impractical! A realistic solution is to avoid unnecessary bathing.

Though bathing and hand washing involve water, that water doesn't moisturize the skin. Instead, the protective oils of the skin are washed away. The water from bathing and some water from within the skin evaporate shortly afterwards. The end result is the skin is now dryer than it was before washing. Skin drying associated with bathing can be reduced by several measures. It is better to bathe with warm instead of hot water. Use a mild moisturizing body wash or bar instead of a strong soap. Bathe only when you are dirty instead of when the clock says it is time. And the most successful approach is to apply a moisturizing product (creams are better for this than lotions) within five minutes of toweling off. And by the way, the main ingredient of the product you use to heal your split fingers is petroleum based.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.