Generality
Rhagades are linear lesions of the skin and mucous membranes that appear as small cuts or lacerations .
Although they may appear deep, these cracks affect the superficial portion of the skin (epidermis and, sometimes, dermis); rarely, the fissures exceed the length of a couple of centimeters. These injuries can be very painful and sometimes limit normal daily activities.
In general, fissures result from a pathological reduction or loss of epidermis distensibility . The underlying causes of their onset are mainly exposure to extreme heat or cold, repeated rubbing and the use of products that are too aggressive for the skin or mucous membranes. Rhagades can be associated with dermatological diseases (such as contact dermatitis and psoriasis) and various inflammatory states (angular cheilitis, hemorrhoids, mastitis, etc.).
Most ragadiform lesions improve with simple remedies, such as the local application of moisturizing, healing and keratoplastic creams. Sometimes, it may be necessary to use anti-inflammatory drugs, antibiotics and surgery.
What are
Ragadi: what are they?
The fissures appear as small cuts of linear form, more or less deep. These lacerations are characterized by hard margins and a net bottom .
More frequently, fissures open up in the thickness of the skin, involving the epidermis and the more superficial layers of the dermis, but can also arise at the level of the mucous membranes or at the point of transition between these and the skin, as in the case of the anal region or of the lips.
Ragadiform lesions do not generally result in a loss of substance, but if complications are required a serous or serum-hematic secretion may occur.
The term " ragade " comes from the Greek rhagades, which means "crack".
Causes and Risk Factors
Rats: what are they caused by?
The onset of fissures is caused by the reduced distensibility of the skin tissue, secondary to a drying up or thickening (hyperkeratosis). The loss of this property makes the skin thin, less elastic, dehydrated and prepared for "breakage".
The underlying causes of their debut are mainly:
- Exposure to extreme temperatures (hot or cold) and adverse weather conditions (eg wind or high humidity);
- Repeated mechanical stresses ;
- Rubbing trauma ;
- Chemical aggressions (eg detergents and soaps);
- Inflammatory diseases of the skin .
The fissures are particularly frequent in the nipples, anus and lips . However, these lesions can localize in different parts of the body.
Aggravating and predisposing factors
The formation of fissures can be prepared by:
- Extreme dryness of the epidermis;
- Alterations of the normal hydrolipidic film ;
- Dehydration of the surface of the skin and mucous membranes.
This set of phenomena favor the inflammatory infiltration of the dermis, therefore they make the skin sensitive even to the most modest stretches.
Humidity is certainly one of the irritating factors that aggravate the symptoms. The fissures of the hands can get worse, for example, if they get wet often or are not dried well after washing them.
To learn more: Hands of the Hands »ANAL RAGADI
Anal fissures are caused, in most cases, by the expulsion of hard or bulky stools : the effort made at the time of defecation causes an excessive dilation of the anus, which, in certain situations, predisposes to tearing the canal wall .
Other predisposing factors are:
- Diarrhea with irritating stools (secondary to the diet, enteric infections or pharmacological therapies);
- Loss of elasticity of the anal canal secondary to surgical operations (eg for fistulas and hemorrhoids);
- Inflammatory states of the anus itself or of the genitals (eg vaginal infections);
- Traumas resulting from the introduction of foreign bodies (eg cannulae for enemas).
The characteristic symptom of the presence of an anal fissure is the very intense burning pain and during the passage of the feces. This sensation typically appears with each defecation and can last from a few minutes to a few hours. Bleeding is characteristic of the fissure, therefore it is possible to notice a streak of bright red blood on the faeces or on the toilet paper. If abundant, the secretion of serum from the fissure can cause itching in the anal region.
RAGADI DEL CAPEZZOLO OR OF THE MAMMARY AREA
The nipple fissures or surrounding mammary areola generally arise during lactation (especially in the first few days and in primipara), due to the traumatizing action of sucking and the macerating properties of the newborn's saliva. Their onset can signal the incorrect posture of the child when it is attached to the mother's breast or the duration of too long breastfeeding.
Here, fissures can be a temporary nuisance and disappear spontaneously after a few days or they can worsen until they bleed, causing rather intense pain, especially during sucking.
The factors that can predispose to the development of breast fissures include some anatomical features of the mother, such as the introflexed nipples, or of the child, such as the lingual frenulum too short. In the latter case, the nipple continuously rubs on the palate of the infant, rather than remaining fixed at the bottom of the palate itself.
RAGADI OF THE LIPS
The fissures at the corners of the mouth or lips are often the expression of inflammation ( cheilitis ).
For further information: Cheilite - Inflammation of the Lips »
Possible disorders associated with fissures
Rhagades are lesions that can occur in association with various pathologies.
As for the skin surface, the formation of these cracks is found in dermatological diseases such as contact dermatitis and psoriasis . Rhagades can also be a consequence of atopic dermatitis, a condition in which the appearance of chronic eczema can be complicated by such injuries.
Diabetes is a risk factor for the formation of sores, cracks and fissures on the feet.
To learn more: Cracked Heels and Foot Cracks »The appearance of anal fissures is strongly associated with constipation : the stools rest in the intestine longer than normal, they harden and can produce small superficial lesions.
Ragadi: who is most at risk?
Rhagades can affect people of any age.
The risk of developing these cracks is greater in who:
- It has a very sensitive or dry skin;
- Practice sporting or professional activities that force you to have your hands or other parts of the body often immersed in water or in contact with irritating substances (for example: hairdresser, beautician, etc.).
Symptoms and Complications
Ragadi: which are the most affected locations?
The fissures manifest themselves mainly in the regions of the body subjected to recurrent phenomena of stretching and distension, as in the case of:
- Labial commissions;
- Anal folds;
- Hands (in particular: on the palm, around the nails, on the fingertips and in the interdigital spaces);
- Foot and heel plan;
- Nipple;
- Breast areola.
Ragadi: how do they manifest themselves?
The fissures appear as linear cracks, about 1 or 2 centimeters long . These lesions can have a variable depth : in some cases, they can resemble linear cuts caused by a pointed knife.
Rhagades are usually very painful and, in severe cases, make even the most common daily tasks difficult.
Unlike ulcers, ragadiform lesions manifest themselves without loss of substance, ie they present themselves as a continuous solution .
Over time, however, the skin around the fissure thickens and forms calluses. If neglected, these cracks can become even deeper, associated with the loss of serum or serum-blood secretion . Rhagades can recur, which means they often recur.
Possible complications
- Rhagades can predispose to the development of secondary infections .
- The nipple fissures or the mammary areola can evolve into a mastitis .
Diagnosis
When the fissures are particularly painful and / or occur in a recurrent way, it is advisable to consult your doctor or the dermatologist of reference.
The fissures are classified among the secondary elementary lesions of the skin, therefore they represent the evolution of a primitive alteration of the same.
Ragadi: which exams are necessary?
The diagnosis of fissures is based on the clinical aspect, so a simple objective examination of the affected area is envisaged. During the visit, the doctor can collect anamnestic information to determine what causes the disorder. In fact, knowledge of the factors responsible for fissures makes it possible to establish the most appropriate therapeutic procedure to prevent the problem from recurring again. Further details may be indicated by the doctor to ascertain a specific cause.
Treatment and Remedies
The fissures must always be treated in the correct way, otherwise they can become very painful, leading to episodes of bleeding and loss of serum. The best approach to the problem is to limit the cause that caused it to appear .
The treatment basically uses the local application of healing, keratoplastic and, if necessary, antibiotics ointments. With adequate attention, fissures heal within 15-20 days.
Drugs and other therapeutic interventions
To cure fissures and prevent their appearance, it is necessary to keep the "vulnerable" areas well hydrated with creams based on panthenol, glycerin, ceramides, urea and vitamin E.
In the case of deeper injuries or if an infection occurs, the doctor may indicate the application of antibiotic ointments . Furthermore, if the clinical conditions require it, cortisone-based creams can also be prescribed.
On the market, there are specific plasters and fluid products that form a sort of film over the fissures of the hands or feet, able to protect from external aggressions, avoid reopening of the lesion and promote healing. In particular situations, if the problem does not resolve itself, surgery may be necessary .
Anal fissures: therapy
The treatment of anal fissures involves a rigorous local hygiene combined with the use of laxatives to minimize trauma during defecation (eg stool and fiber emollients) and local anesthetics (eg benzocaine or lidocaine) for temporary relief.
The correct closure of the laceration is facilitated by the use of protective ointments or glycerine suppositories, useful for reducing anal pressure and lubricating the lower part of the rectum. Sometimes, injections of botulinum toxin type A may also be indicated. However, if the fissures do not heal with conservative treatments or become chronic, it is necessary to resort to surgery.
How to avoid the appearance of fissures?
Some tricks can help to limit the formation of fissures.
In particular, it is necessary to intervene on the factors that make the skin surface more vulnerable, dehydrated and less elastic. To counteract the onset of fissures, therefore, it is important to make sure that you moisturize your skin well, especially after baths and showers.
Another tip is to dry carefully, especially after contact with soaps and detergents. Furthermore, in the colder months it is advisable not to leave with wet hands or lips, trying to protect these areas with warm clothing such as gloves and scarves.
