Getting to Know Rhagades

RHAGADES: UNDERSTANDING THEM, TREATING THEM, PREVENTING THEM

Rhagades are a very common condition that can affect different areas of the body, causing discomfort and sometimes significant complications. They are small tears in the skin or mucous membranes, often located in particularly sensitive areas. Understanding fissures means recognizing their main symptoms and identifying triggers, such as microtrauma, skin dryness, or local infections.

The term "rhagades" comes from the Greek word rhagades, meaning "cleft," a name that accurately describes their nature.

WHAT ARE RHAGADES?

Rhagades are thin tears that affect the skin or mucous membranes, taking a shape similar to small, sharp, linear cuts. Although these lesions are generally superficial, affecting layers such as the epidermis and, in some cases, the dermis, they can be very painful, especially when located in areas subject to frequent movement or pressure, such as the anus or labia. 

Their length rarely exceeds a few centimeters, but the intensity of the discomfort they cause can interfere with normal daily activities. In most cases, they manifest as simple dry lesions, but in the presence of complications they may produce secretions or show signs of infection.

Underlying the appearance of fissures is often a loss of skin elasticity. This phenomenon can be promoted by environmental factors, such as exposure to extreme temperatures, prolonged rubbing, or the use of irritating products. Not infrequently, these lesions are related to skin disorders or inflammatory states, including psoriasis, dermatitis, hemorrhoids, or infections such as angular cheilitis.

Anal rhagades and hemorrhoids: what are the differences?

Although anal rhagades and hemorrhoids often affect the same anatomical area, namely the anal region, they are distinct conditions in origin, symptoms, and treatment.

Rhagades are small linear tears in the anal mucosa, usually caused by local trauma, such as the passage of hard stools or problems related to reduced elasticity of the skin. They manifest with intense pain, often described as a cutting or burning sensation during and after defecation, sometimes accompanied by traces of live blood.

Hemorrhoids, on the other hand, are dilations of blood vessels in the anal canal. They can cause symptoms such as bleeding, itching, swelling and, in some cases, prolapse. The pain is generally less acute than that of fissures, except in cases of hemorrhoidal thrombosis.

Types of rhagades

Rhagades can form in different parts of the body, manifesting as superficial, often painful tears affecting areas particularly subject to stress, friction or exposure to environmental factors. Here are the main categories:

Anal rhagades

This form of fissures occurs when the mucosa of the anal canal undergoes a tear, often caused by the passage of hard or bulky stools, and can be classified into two main types:

• Internal rhagades, which form over the anal sphincter;
• External rhagades, localized at the level of the sphincter.

Other factors such as diarrhea, previous surgery, or local inflammation may contribute to their occurrence. Anal rhagades are distinguished by intense pain, especially during and after defecation, and the presence of traces of live blood. In severe cases, they can cause discharge and itching, making it difficult to carry out normal daily activities. 

Lip rhagades

These fissures, which affect the corners of the mouth or the surface of the lips, are often the result of an inflammatory condition known as cheilitis. They present as painful fissures that can worsen with mouth movement or in harsh weather conditions.

Rhagades on hands and feet

Rhagades on hands and feet develop mainly during the winter months, when cold weather and dry air compromise the elasticity of the skin. Hands, being more exposed to external agents, are more prone to this condition, especially in the knuckle areas, interdigital spaces and around the nails. On the feet, on the other hand, fissures are more frequently located at the heels, where the skin is subjected to pressure and friction. These lesions can be very painful, especially with movement or contact with irritants.

Vaginal rhagades

Vaginal rhagades are a less common condition than other types of fissures, but they can cause considerable discomfort. These lesions present as thin tears in the vaginal mucosa or vulvar area and are often associated with factors such as vaginal dryness, painful intercourse, or local trauma. They can manifest with symptoms such as pain, burning, and discomfort, especially during sexual activity, urination, or personal hygiene.

What are the causes of rhagades?

Rhagades develop when the skin loses elasticity and strength, becoming fragile and prone to thin tears. This condition can be caused by a combination of factors that disrupt skin balance, including:

• Extreme weather conditions: intense cold, wind or excessive heat can dehydrate and stiffen the skin, making it more vulnerable.
• Prolonged exposure to moisture: hands or feet that stay wet for a long time without being dried properly tend to macerate, weakening the skin barrier.
• Repeated mechanical trauma: rubbing, repetitive motion or constant pressure can damage the most delicate areas of the skin.
• Use of harsh chemicals: unsuitable detergents, solvents or products can deplete the skin's protective film, promoting dryness.
• Inflammatory or dermatological diseases: conditions such as psoriasis, dermatitis or eczema can alter the structure of the skin and make it more fragile.

These factors, often combined, reduce the ability of skin to adapt to daily stresses, resulting in cracks that can arise in various areas of the body.

SYMPTOMS AND SIGNS

Rhagades are distinguished by some specific features that make them easily recognizable:

• Localized, intense pain: this is the predominant symptom, often described as a sharp burning or stinging sensation that intensifies with movement or direct contact with the affected area.
• Sensation of skin tightness: the skin around the fissure appears pulled and fragile, with a constant sense of discomfort, especially in regions subject to frequent stretching.
• Bleeding and discharge: in more advanced stages, fissures may bleed slightly or release a serous fluid, a sign of a deeper lesion. This is particularly evident in anal or nipple fissures.
• Surrounding callosities: if neglected, fissures can evolve to form thickened tissue around the lesion, which makes healing more complex.
• Interference with daily activities: associated pain and sensitivity may limit common actions, such as walking (in the case of foot ragadas), writing or washing hands (for those on the hands) or defecating (for anal ragadas).

In particular, a troublesome feature is their repeated occurrence in the same areas, especially if predisposing conditions are not adequately treated.

Complications

Rhagades, if not treated promptly, can lead to complications that worsen the clinical picture and require more complex interventions. The skin lesion, although superficial, is a gateway for microorganisms, predisposing to secondary infections. 

In the case of nipple or breast areola rhagades, the main risk is the development of mastitis, an inflammation that can cause intense pain, swelling and fever, interfering with breastfeeding.

In other locations, such as the anal area, fissures can become chronic, causing skin thickening (such as sentinel polyps) or infectious complications, which can spread to surrounding tissues. 

In some cases, symptoms may be aggravated by the presence of irritants such as harsh soaps, sweating, or excessive rubbing, increasing the sensation of discomfort and delaying the healing process.

Diagnosis of rhagades

Diagnosis of rhagades is a simple clinical process that relies on direct observation of the lesion to distinguish the condition from other possible skin or mucosal conditions.

In more complex cases, or if specific systemic or dermatologic diseases are suspected, the physician may request further investigations, such as skin tests or blood tests, to identify any less obvious triggers.

PREVENTION

Adopting a few simple precautions can significantly reduce the risk of developing rhagades by acting on the factors that make the skin more fragile and less elastic. Prevention relies mainly on daily skin care and protection from irritating or harmful elements.

Here are some useful strategies to prevent the occurrence of rhagades:

• Regular moisturization: keeping the skin well hydrated is essential to preserve its elasticity. Applying emollient or moisturizing creams, especially after bathing or showering, helps restore the skin's natural balance.
• Dry skin thoroughly: after contact with water, soaps or detergents, it is important to dry hands, feet or other sensitive areas thoroughly to avoid maceration.
• Protection from the cold: in the winter months, it is essential to protect hands and face from exposure to wind and low temperatures by using gloves, scarves or protective lip balms.
• Limit the use of harsh detergents: prefer mild soaps, free of irritants, to avoid altering the skin's protective film.

NATURAL REMEDIES

Natural remedies can offer valuable support in the treatment of rhagades, helping to reduce pain, promote healing and improve overall skin health. While these approaches do not replace medical treatment in cases of severe or complicated injuries, they can be an excellent option for preventing and relieving symptoms in the early stages.

Among the main natural remedies:

• Aloe vera: Because of its soothing, moisturizing and regenerating properties, aloe vera gel can be applied directly to the fissure to soothe pain and promote healing.
• Coconut oil: rich in essential fatty acids, coconut oil helps keep skin soft and moisturized, reducing dryness that can aggravate injuries.
• Honey: known for its antimicrobial and healing properties, honey can be used as a natural compress to protect the affected area and accelerate tissue repair.
• Olive oil: an excellent natural emollient, olive oil helps keep the skin supple, preventing further tearing.
• Shea butter: rich in vitamins and nutrients, shea butter helps regenerate the skin and reduce irritation.
• Chamomile: Applying chamomile compresses, due to its soothing and anti-inflammatory properties, can reduce the redness and discomfort associated with fissures.

MEDICAL TREATMENTS

Treatment of fissures aims to promote skin healing, relieve pain and prevent complications. Therapies focus on repairing damaged tissues and restoring optimal skin conditions, adapting to the severity of injuries.

• Local therapies: the first therapeutic approach involves the application of healing and moisturizing creams, which support skin regeneration and reduce skin dryness. For deeper lesions or in cases of infection, the doctor may recommend antibiotic ointments or, in cases of severe inflammation, cortisone-based creams to reduce swelling and discomfort.
• Protective products: there are specific solutions for fissures on hands and feet, such as patches or protective fluids that form an insulating film over the lesion. These products protect the skin from external aggression, prevent the fissure from reopening, and accelerate the healing process.
• Advanced interventions: in situations where fissures persist despite local treatments, more invasive approaches may need to be considered. For example, for chronic or complicated anal fissures, the physician might propose minor surgery to promote definitive healing.

INTERACTIVE MEDICINE: NEXT-GENERATION PLANT-BASED TREATMENTS

In recent years, dermatological research has made significant strides in skin treatment. Alongside traditional remedies and medical treatments, new solutions based on the use of natural ingredients have been developed: this innovative approach, which we can call "interactive medication," aims not only to relieve symptoms but also to promote natural and lasting skin regeneration.

Among the topical treatments in the interactive dressing, the Hyperoil^® product stands out for the treatment of fissures. Its herbal formulation, based on the properties of Neem and Hypericum, is designed to provide relief and promote tissue regeneration without further irritating the skin. For anal fissures we recommend the use of Hyperoil® Gel Procto 30ml tube, this product comes with a specific applicator, which facilitates the precise application of the gel directly on the lesion. For fissures in general, however, we recommend the use of Hyperoil® Derm Gel 75ml tube or 5ml vials.

During the acute phase, Hyperoil^® gel should be applied morning, evening and after every hygiene for the first 5 days. Once improvement of symptoms is observed, application can be reduced to once daily, preferably in the evening, and after daily hygiene. Treatment should be continued for at least 15 days or until symptoms completely disappear.

Try Hyperoil^® Gel

In addition to preventing infection and stimulating cleansing and fibrinolytic activity, products in the Hyperoil^® line are interactive dressings that do not require the use of disinfectants or other primary dressings, making them a practical and cost-effective treatment.

GENERAL TREATMENT ADVICE

Dealing with fissures requires a focused approach that combines effective remedies and good daily practices.

With proper care and careful management, fissures generally heal within 15 to 20 days. However, to avoid recurrence, it is essential to combine medical treatment with a preventive routine that protects the skin and preserves its health. 

TIPS:

• Before applying any remedy, gently clean the affected area to avoid infection.
• Natural remedies must be used consistently, at least once or twice a day, to achieve visible results.
• If symptoms do not improve or the fissure worsens, it is critical to consult a physician to evaluate further interventions.
• Incorporating foods rich in vitamin E, vitamin C and omega-3 into the diet promotes healthy skin and accelerates healing processes.
• Use protective gloves, socks or balms in cold weather or when the skin is exposed to chafing or trauma.

Particular attention should be paid by those who are more prone to the problem, such as people with sensitive skin or those who engage in activities that involve frequent contact with water or irritants. In these cases, following medical instructions scrupulously and taking preventive measures is essential to avoid recurrence and promote complete healing.

Consistency in treatment and adoption of good daily practices can make a difference in the healing process, significantly improving quality of life.