Look at your knuckles real quick. Are they a bloody disaster?
Of course they are, if you’ve foolishly chosen to build your life outside the tropics. It’s horrible, tundra-like winter so your hands are surely desiccated messes. And for many of us, that leads to cracking, bleeding and endless irritation.
There are no quick fixes. (One dermatologist told us to just move to a hot, humid climate, so there’s that, I guess.) But with a little common sense and tolerance for greasiness, you can fix your busted knucks.
Why Does It Happen?
Cold air holds less moisture so the air is dry, and forced air heat is still the norm in a lot of interior environments. Couple that with everyone’s obsessive handwashing to avoid the flu (you ARE doing that, right?) and skin disasters are almost inevitable.
“Our hands are one of the areas most susceptible to forming dry, cracked skin in winter,” says Dr Meghan Feely, a board-certified dermatologist practising in New York and New Jersey.
In addition to how much we move them all day long, the makeup of the skin on our mitts makes it tougher to treat irritation there.
Dr Ross Radusky, a board-certified dermatologist in practice with Soho Skin and Laser Dermatology, PC, in New York, points out that the skin on our hands is 30 times thicker than the skin on our eyelids. The thickness serves as a natural barrier for lotions, ointments and creams, as well as the elements.
“It’s just tough for us to get the treatment where you want it to be,” he says.
The stratum corneum, the outermost layer of the epidermis, is composed of around 20 layers of dead cells, in a matrix including natural oils and fatty acids. It’s the first barrier between the outside and our insides.
Dr Dhaval G. Bhanusali, a board-certified dermatologist practising in New York City and Miami, describes the cell layer as a crosslinked structure. In dry, windy settings, the oil in the matrix diminishes and the cells don’t move smoothly over one another, leading to little nicks.
“The skin is not as elastic,” he says. “There’s little breaks in the armour.”
It’s more or less inevitable if you live in a cold climate that you’ll have this problem. Hooray.
When conditions are Hoth-like, it’s tempting to spend a bunch of time in a hot, humid place — the shower. But if you don’t want to destroy your skin, that’s a hard nope.
“Unfortunately, your skin will be both literally and figuratively in hot water if you spend too long in the bath or shower,” says Feely. “Hot water ironically draws moisture out of your skin.”
Keep showers brief and tepid, no matter how tempting a long hot one is.
“Seven minutes or less,” says Bhanusali. “Once the mirror gets foggy, you’re already in there too long.”
Pat dry — don’t rub. Radusky says air dryers are fine for your hands in public restrooms, but stop just before getting perfectly dry.
All three docs say that humidifiers are your friend. Feely says to aim for between 30 and 50 per cent humidity in your home. More than that and you risk mould. Drinking water is a great health practice in general, but it won’t really help with your skin.
Creams, Lotions And Ointments (And Krazy Glue), Oh My!
After every handwashing and every shower, you’ll need to moisturise right away. It may seem like a lot, but consistency is key. The docs recommend the thickest creams or ointments you can stand.
“Anything in a pump is simply too watery and I don’t recommend it for the hands,” Radusky says. “You want to move to creams, which have less water, or ointments, which are petrolatum-based. Those are nice and greasy.”
Ah yes. “Nice and greasy.”
Ideally, we’d all have a slimy layer of Vaseline on our hands all day long, grimy little pawprints all over our TPS reports be damned. But we need to make concessions to reality, of course.
“There’s a difference between what we can treat functionally versus what we can treat ideally,” says Bhanusali. “It’s harder if it’s glopped all over your hands.”
If you can’t walk around with slimy fingers all day, use a thick cream and switch to an ointment at night. You may grease up your bedsheets a bit, but hey — this is a battle and there are going to be casualties.
All three docs say sleeping in gloves is a good idea. It may keep your sheets a little cleaner, but that isn't the most important reason. Gloves will help the cream or ointment penetrate your skin — Bhanusali says it leads to a 30 per cent improvement.
Radusky says cotton gloves are a mistake. They slurp up the cream or ointment themselves, instead of helping it penetrate your skin. He recommends nitrile gloves instead.
Let’s say your hands have already split open, and you are past the point of creams and ointments. You could use a liquid bandage, but why not get a little krazy? Yes, actual doctors recommend using Krazy Glue on your skin if it’s split open.
“It’s a fun derm hack,” Bhanusali says. “I told my own mum that. She was like, ‘We sent you to medical school for this?’”
Your Shopping List
OK, you’re ready to grease up. What should you look for?
Feely says to look for fragrance-free and oil-based products that include ceramides and humectants.
“Ceramides are a natural component of the skin’s lipid bilayer that makes the skin waterproof, locking in moisture,” she says. “Humectants such as alpha-hydroxy acids and glycerin draw moisture to the skin.”
Radusky looks for products with urea, a low percentage of salicylic acid, or lactic acid. Those ingredients are exfoliating and so can be irritating, and you may only want to use them once a week to supplement your regimen. He likes CeraVe Renewing SA Cream.
Bhanusali also calls for ceramides and CeraVe, as well as Vaseline.
Both Bhanusali and Radusky (and your humble correspondent) come out strong for Neutrogena’s Norwegian Formula Hand Cream.
You want this stuff. It sinks in pretty quickly — like by the time you’re done checking your teeth for spinach in the mirror before you leave the bathroom. It comes in an unscented version. Get a biggie size for your bedside table and a wee one for your bag, your car, your workspace, whatever. It’s thick with a lot of glycerin, but with a much lower glop factor than Vaseline or any of the others.
“That’s the one I’ve been using since med school,” says Bhanusali. “It’s a staple of my bag.”
If none of this stuff works, it may be time to go see a dermatologist. You could be suffering from eczema, contact dermatitis or an allergic reaction.