5 Steps to Treating Psoriasis That Cracks and Bleeds

For some people with psoriasis, the thick, scaly plaques that form on the surface of the skin can crack and bleed. This results in deep cracks, known as fissures, and open sores on the skin, which may be painful and even become infected.

Fissures due to psoriasis are most common on the palms of the hands and soles of the feet, says Dana Marshall, M.D., a board-certified dermatologist at Klinger & Marshall Dermatology in New Orleans, Louisiana. “Because of walking or frequent movement, they can split open,” she explains. But fissures can develop anywhere you have plaque psoriasis.

Fissures and open sores can cause discomfort, pain, and risk of infection. They can have an adverse impact on a person’s emotional well‑being and mental health, too.

Moisturizer Is Key to Prevention

Prevention is the best tactic, Marshall says, and the key way to avoid fissures and open sores is to apply plenty of emollient—good choices are a prescription ointment or an over-the-counter moisturizer containing urea or salicylic acid. She recommends applying the treatment to affected areas per your doctor’s directions; and, if the plaques are on your palms or the soles of your feet, put on cotton gloves or socks immediately after. This is certainly most convenient to do last thing at night before going to bed, but if you can also do it in the morning, or at some point during the day, you’ll feel the benefits.

The National Psoriasis Foundation suggests that a combination of topical coal tar, salicylic acid, and corticosteroids may be effective to treat palm and sole psoriasis. If topical treatments don’t work, systemic medication, such as methotrexate (either in oral or injectable form) can clear many cases within four to six weeks.

If you experience fissures and open sores on psoriatic skin regularly, let your doctor know what’s happening. It’s possible that your condition isn’t as well controlled as it could be, and a change to your treatment plan might make a difference.

Steps to Treating Open Sores

Sometimes, even the most careful and dedicated care can’t prevent cracks and fissures from forming. But if you know how to treat them quickly, you can accelerate healing, protect your skin from further damage, and hopefully avoid infection.

1. Gather the Right Supplies

First of all, make sure you have everything you need in your first aid kit: gauze pads or cloths, medical tape (or an adhesive bandage or liquid bandage), a healing ointment (like Aquaphor or Vaseline) and Band-Aids. Before you do anything else, wash your hands with warm, soapy water for at least 20 seconds. This is an important step, as it eliminates any chance of the transfer of bacteria and dirt, says Ava Shamban, M.D., a board-certified dermatologist at Ava MD in Santa Monica, California.

2. Apply Pressure

If the fissure is bleeding, Shamban advises applying medium but even pressure with a clean gauze pad or cloth until it stops, then removing it. “Don’t leave the gauze there to dry into the blood,” she warns.

3. Clean the Wound

Next, rinse the wound with warm water or a gentle saline solution, taking care to remove all dirt and debris. “Clean and clear is key,” Shamban says. After rinsing, gently cleanse the area with gentle soap and warm water and pat dry with a clean cloth.

4. Seal the Wound

At this point, do your best to seal the wound area, keeping the skin close together but not causing additional pain. “This is usually best done with medical tape, which will help the skin to heal and will also protect the area from future ‘intruders’ and irritation, as well as infection,” Shamban says.

5. Look Out for Signs of Infection

If you begin to develop signs of infection, see your doctor as soon as possible. These include soreness, redness, swelling, discharge from the sore, and fever. It’s also important to see your doctor if the wound doesn’t seem to be healing. Your doctor will be able to assess and clean your sores, and may offer additional treatment options.

Keeping Skin Soft and Healthy

To help soften thick, scaly lesions and make them less prone to cracking, Debra Jaliman, M.D., a board-certified dermatologist in New York City and American Academy of Dermatology spokesperson, suggests taking coal tar baths. She says these baths can help control the itching and inflammation associated with psoriasis. But check with your dermatologist first, to see whether they may benefit you—because everybody is different.

If you get the go-ahead, you can create a coal tar bath by adding six to 10 capfuls of your chosen coal-tar product to your bath and mixing it well with lukewarm water before soaking for up to 20 minutes. Jaliman recommends Cutar Emulsion Coal Tar Solution, which contains 1.5 percent coal tar.

Colloidal oatmeal, Epsom salts and gentle, fragrance-free bath oils in your bath water might also help to soften hard plaques. And to ensure your skin retains as much moisture as possible, apply an ointment-based, fragrance-free moisturizer on your skin right after your bath or shower.

Shamban suggests making healthy lifestyle choices to help manage outbreaks. She recommends her patients track their triggers, which may help to prevent lesions that can lead to fissures or sores. “If your flares are triggered by stress, for instance, try to keep a schedule of fitness, meditation, deep breathing, yoga, or listening to music,” she says.

Preventive measures and self-care practices are always a key part of helping to keep psoriasis symptoms under control. But if your condition is severe, you can’t always stop fissures and open sores. Remember, your doctor is there to listen to your concerns, and by working together, you can decide on a treatment plan to manage your condition most effectively.