Causes And Treatment Of Skin Chapping
( Originally Published 1936 )
Chapping of skin is simply the formation of fissures or cracks in the skin due to a combination of particularly dry and scaly skin and exposure to cold or wind. The condition is more likely to occur during the winter, although any condition of exposure may cause it, even extreme heat.
It occurs most frequently on the parts of the body where the skin is thickened and inelastic, especially in regions subjected to frequent movement. This includes the angles of the mouth and of the eyelids, the palms of the hands, the ridges over the knuckles and the clefts between the fingers and toes.
While naturally dry skin is most subject to this, it can, of course, occur in any person. One thing which predisposes to it on the hands is manual labor, especially the handling of dry or rough objects, such as in stone-cutting, brick-laying, etc.
With the contraction of the skin which is caused by exposure to cold, this dry and thick skin, in attempting to meet the increased elasticity due to temperature changes, becomes cracked. It is these small fissures which constitute the essentially painful nature of chapped skin. The fissures extend down to the deeper layers of the skin and irritate the fine nerves there, which are more sensitive than those anywhere else in the body.
The treatment of chapped skin becomes evident from the explanation of its nature. One of the things which is known to aggravate it is the use of soap and water. Soap dries out the skin and removes the natural oil and moisture and, therefore, makes a naturally dry skin more liable to crack. After the fissures have occurred the soap is actually irritating and tends to prevent healing.
Movement, especially when chapping occurs over joints, tends to deepen the fissures and make the condition worse. Continued exposure is also calculated to increase the discomfort.
The use of oils and ointments, especially when they have a slightly antiseptic character, is plainly indicated. Carbolated vaseline is as good as anything for these things, but sterile olive oil is often just as good in the mild cases. Best of all, perhaps because it is an animal fat, is sterile lanolin. The latter also has a tendency to help healing.
When the fissures become infected and deep, special methods to reduce the infection must be instituted, such as the use of mercurochrome or tincture of iodine applied locally. Under all circumstances, after the application of the oil or ointment, the part should be covered —the hands with gloves—until healing has begun and the skin begins to feel comfortable again.
WINTER CAUSES AN INCREASE IN SCALY CONDITION OF SKIN
Many people have a natural or a congenital increase in the horny layer of the skin. During the summer months, when the skin and all the appendages, such as the nails and hair, grow more rapidly, probably on account of the increased amount of blood in the skin during the heated periods, this gives little trouble because the skin grows sufficiently fast that the horny layer is thrown off rapidly. But in the winter the scales are liable to accumulate on the surface and cause a rough, chapped appearance.
When normal skin is viewed under the microscope, it is possible to distinguish five layers of the true skin, which rest upon the corium, or elastic tissue beneath. Strictly speaking, however, these layers are simply modifications of the same sort of cell, changed as they are pushed upward by the process of growth. The basic cell is large and multiplies rapidly. As these cells are pushed upwards by the formation of new cells underneath, they become flattened and more horny in character. It is the upper layer of such cells that is affected in the conditions we are discussing.
There are several varieties of this abnormality, varying from heavy scales universally over the body—the so-called fish skin or ichthyosis, to a slightly increased scruffiness of the skin on the exposed surfaces in cold weather. Ichthyosis, or fish skin, is a congenital disease, making its appearance usually during the second year of life and characterized by the presence of gray, dry, rough or scaly skin. In an extreme case it is broken up by fine fissures, and this causes the skin in such persons to be subject to eczema.
No treatment has been wholly successful in freeing the individual of discomfort during the winter, and no treatment has yet been devised which will prevent the recurrence of the disease in succeeding seasons.
The best results occur from the use of the x-ray or ultra-violet light. Hot alkaline baths containing borax or sodium bicarbonate, or baths containing starch or bran, soften the skin and in this way prevent excessive scaling. The clothing should be warm and of a sufficiently fine texture to avoid irritation. Frequent inunctions of fatty material, such as coco butter and other bland oils, have proved beneficial.
A variety of the condition consists in the appearance of small horny spots about the opening of the hair follicles. These are of pin-head size and frequently are mistaken for pimples. Due to the coiling of the hair during its growth and the collection of grease in these spots, they are, in fact, very likely to become infected and actually to be pimples. The treatment is the same as that described in the preceding paragraph for true ichthyosis.
DAILY BATHING AGGRAVATES SKIN WHICH IS THIN AND DRY
In people of a certain bodily type, especially middle-aged and elderly people, there is considerable itching during the winter months.
The bodily type is that in which the skin is thin and silky in appearance. As atrophy of all layers of the skin occurs with the process of age, the condition is naturally worse in later life, and becomes increasingly bad as time goes on. Many elderly people are badly tortured with this condition, which, in large part, can be avoided.
The condition is aggravated by frequent bathing and by the use of strong soaps, and this is the lesson to be learned by people troubled by itching in the winter. Elderly people should give up the habit, if they have acquired it, of a daily bath during the winter months. Anyone who finds the skin irritated or with a tendency to itch during the winter, should also cut down on the number of baths taken.
The atrophy of the skin which occurs in this condition causes a diminution in the amount of secretion of the natural oil which lubricates the skin. This dryness leads to the irritable and itching sensations. Naturally, bathing and the use of soaps remove whatever there is of this oil and hence make the trouble worse.
Young people with vigorous, healthy skin and a great deal of natural secretion can afford to take a bath once a day all the year round, but after 45 it is advisable to reduce this in the cold months, and after 50 it should be still further reduced. After the age of 60, especially in those with thin, inelastic skin in which wrinkling gives an evidence of atrophy, it is well to reduce the number of baths all the year round, winter and summer included, and at the age of 70 one bath a week in the winter is quite sufficient, both for cleanliness and the sake of the skin's health.
Of course, this advice supposes that the itching of the skin is not actually due to any definite skin disease, especially to the presence of itch-mites, which would themselves be the cause of the itchy sensations.