Cracked skin of feet: an ignored entity in the tropics.

Vertical cracking of skin at the edge of the soles is seen in many adults of Sri Lanka. However, none of the standard textbooks on dermatology or general medicine describe it as an entity. We were able to find it mentioned in one textbook written by Finnish and African authors [1]. A survey of MEDLINE using key words “cracking of skin”, “cracked skin” and “splitting of skin” did not reveal a single article suggestive of this disorder (accessed on 14 October 2003). The objective of our study was to assess the prevalence, complications and possible aetiological factors of cracked skin of feet. We conducted two pilot studies in adults (>18 years) from rural areas (Moneragala District) and in an urban population (National Hospital, of Sri Lanka). In the rural study, the samples consisted of consecutive adults attending the general Outpatients’ Department (OPD) of Moneragala Base Hospital (n=42) and those selected from a community survey (n=33). In the urban study the prevalence was noted from a consecutive sample of adults attending the general OPD of the National Hospital of Sri Lanka (NHSL) and living in Colombo (n=100). Exclusion criteria were the presence of serious illness, requiring bed rest or overt skin disease (such as allergy). A separate case control study of 112 persons was also conducted in the general OPD of NHC, with those observed to have cracked skin of feet being matched for age and sex. Trained pre-intern medical officers collected data and examined participants using structured questionnaires. The results of the rural study revealed that there were 46 with cracked skin of feet (overall rate of 61.3%, mean age 38.1 years, male:female ratio = 12:34 = 2.83) and 29 (38.7%) without (mean age 20.4 years, male:female ratio = 11:18 = 1.63). The principal complaints were that of pain (23, 50%) and bleeding (7, 15.2%). Pruritus was rare (present only in 2). Moderately or very thick skin in the soles were observed in 43 (93.4%) of those with cracks, whereas only 12 (41.4%) controls had the feature (p<0.05). Regular footwear was used by six (13%) of those with cracks and 11 (37.9%) controls (not significant). To the Editor: