Dermatologist Backs Urea Ointments Over Foot Peels for Cracked Heels

Dr Dray

Petrolatum-based urea formulations dissolve thick calluses and restore barrier hydration far more effectively than mechanical salon shaving, which offers only temporary relief before cracks return.

AI-assisted summary of Best Treatment for Dry, Cracked Heels? A Dermatologist Explains — original source. Check the original for full context.

Source published: 2026-10-13

Key ideas

Urea is the primary evidence-based ingredient for hyperkeratotic heels, functioning as a humectant at low concentrations and as an active keratolytic between 10% and 25% to break down intercellular adhesion in stubborn calluses. (3:52)
Petrolatum-based ointment vehicles significantly outperform lighter creams and lotions by facilitating deeper penetration through thick skin, resisting friction from walking, and delivering maximal occlusive moisture retention. (9:11)
Underlying causes of heel cracks extend beyond mechanical pressure to include menopausal keratoderma climactericum, inflammatory dermatoses, and athlete's foot (tinea pedis), which requires targeted antifungals rather than urea alone. (5:27)
Keratolytic foot repair ointments combining urea and salicylic acid should be used nightly during a two-week corrective phase before tapering to once or twice weekly for maintenance to prevent excessive skin thinning and friction blisters. (13:03)

Detailed notes

## Background Published on YouTube by board-certified dermatologist Dr. Dray on October 13, 2026, this video addresses effective, evidence-based treatments for dry, rough, and cracked heels. The accompanying description highlights why urea is a premier skincare ingredient for hyperkeratotic feet, explains how to choose appropriate product formulations and concentrations, and details underlying causes ranging from mechanical stress to diabetes and menopause.

## TL;DR Dr. Dray explains that cracked heels develop when thick, callused stratum corneum loses elasticity under repetitive mechanical strain or underlying conditions like diabetes, eczema, and keratoderma climactericum. She highlights urea as the premier, research-backed ingredient that acts as a humectant at lower concentrations and a potent keratolytic between 10% and 25% to chemically dissolve compacted dead skin. Emphasizing that petrolatum-based ointment vehicles outperform creams by enhancing penetration and resisting friction, she recommends applying products like Kerasal nightly under socks during a corrective phase before tapering to maintenance to avoid friction blisters.

## Atmosphere & style The presentation is clinical, authoritative, and direct, cutting cleanly through marketing hype and viral internet trends with no-nonsense dermatological expertise. Dr. Dray communicates in a calm, instructional tone peppered with dry humor and grounded everyday analogies, such as comparing barrier hydration to powdered drink mix. The experience feels educational and empowering, reassuring viewers with clear scientific mechanisms and structured regimens rather than costly salon procedures or gimmicks.

## Bulletin - [03:52](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=232s) Urea is the primary evidence-based ingredient for hyperkeratotic heels, functioning as a humectant at low concentrations and as an active keratolytic between 10% and 25% to break down intercellular adhesion in stubborn calluses. - [09:11](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=551s) Petrolatum-based ointment vehicles significantly outperform lighter creams and lotions by facilitating deeper penetration through thick skin, resisting friction from walking, and delivering maximal occlusive moisture retention. - [05:27](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=327s) Underlying causes of heel cracks extend beyond mechanical pressure to include menopausal keratoderma climactericum, inflammatory dermatoses, and athlete's foot (tinea pedis), which requires targeted antifungals rather than urea alone. - [13:03](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=783s) Keratolytic foot repair ointments combining urea and salicylic acid should be used nightly during a two-week corrective phase before tapering to once or twice weekly for maintenance to prevent excessive skin thinning and friction blisters.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=0s) The exceptionally thick stratum corneum on the soles of the feet undergoes constant mechanical pressure and friction, producing hard calluses that lose elasticity and split into painful fissures under walking strain. - [01:56](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=116s) Urea is an endogenous component of the skin's natural moisturizing factor that hydrates at lower percentages and acts as a keratolytic at higher concentrations by chemically loosening stuck-together dead skin cells. - [01:56](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=116s) Applying human urine to the feet is an unhygienic and ineffective folk remedy compared to formulated topical urea products. - [03:52](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=232s) Over-the-counter products require roughly 10% to 25% urea to achieve a true keratolytic effect on thickened calluses, though chasing higher percentages like 40% is unnecessary if the vehicle is well-formulated. - [03:52](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=232s) The inactive vehicle carrying an active ingredient is as crucial as the concentration itself because it determines skin contact time and depth of penetration through dense tissue. - [05:27](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=327s) Heel fissures can stem from diverse medical conditions, including perimenopausal keratoderma climactericum, eczema, psoriasis, and athlete's foot. - [05:27](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=327s) Moccasin-type tinea pedis mimics simple dry skin; applying urea can soften the scales but will not clear the underlying fungal infection without an antifungal agent. - [07:28](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=448s) Because diabetic neuropathy and poor circulation elevate the risk of non-healing ulcers and bloodstream infections, diabetic patients with open, red, or warm fissures should seek medical care rather than using foot creams. - [07:28](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=448s) Diabetic xerosis represents the most extensively researched patient population for urea, establishing its safety and clinical efficacy for dry, cracked skin. - [09:11](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=551s) Petrolatum ointment vehicles are uniquely suited for feet because they maximize active penetration, resist being rubbed off by movement, and form a powerful occlusive moisture seal. - [09:11](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=551s) Aggressive and prolonged use of high-strength keratolytics without scaling back can over-thin the soles, making the skin vulnerable to painful friction blisters. - [12:16](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=736s) Kerasal Intensive Foot Repair Ointment is widely recommended by dermatologists due to its synergistic formulation of urea, salicylic acid, and a petrolatum base. - [13:03](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=783s) A phased treatment routine involves applying keratolytic ointments nightly for about two weeks to dissolve calluses, followed by maintenance use once or twice per week. - [13:03](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=783s) Wearing socks after applying petrolatum-based ointment to clean, damp feet prevents product transfer to bedding and continuously redistributes the formula across the heels overnight.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=0s) The Reality of Foot Care Marketing vs. Evidence-Based Ingredients

Board-certified dermatologist Dr. Dray introduces the widespread problem of dry, rough, and cracked heels, highlighting how consumers are constantly bombarded by skin care products promising "baby soft feet." The market is saturated with exfoliating masks, foot peels, heavy creams, ointments, and mechanical gadgets, making it remarkably difficult for the average shopper to distinguish legitimate treatments from pure hype. Rather than falling for marketing buzzwords, consumers should focus their attention on the single most well-studied, evidence-based ingredient for targeting rough, dry foot skin: urea.

The skin on the soles of the feet is biologically unique compared to the rest of the body. Its outermost protective shield, the stratum corneum, is exceptionally thick. It constantly endures immense mechanical pressure from standing, paired with persistent friction from walking or running. Over time, these forces trigger the accumulation of thick, dead skin known as calluses. When this hardened skin dries out, it loses its elasticity and suppleness, ultimately splitting open into deep, painful cracks called fissures. Continued walking places repetitive mechanical strain directly onto these cracks, widening them and intensifying the pain. While mild surface dryness can easily be resolved with a standard daily moisturizer, stubborn thickening and cracking require an active, targeted approach.

```mermaid flowchart TD accTitle: Progression of Dry Callused Feet to Painful Fissures accDescr: Flowchart illustrating how mechanical pressure, friction, and lack of hydration turn thick skin into deep fissures. A["Mechanical Stress & Pressure<br>(Standing, walking, running)"] --> B["Thickened Stratum Corneum<br>(Callus formation)"] B --> C["Moisture Loss & Reduced Flexibility"] C --> D["Deep, Painful Fissures<br>(Heel cracks)"] D -->|"Repetitive walking strain"| E["Worsening, Deeper Cracks"] ```

[01:56](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=116s) What Is Urea and How Does It Work on Rough Skin?

Urea is far from a synthetic foreign compound; it is naturally synthesized by the human body and present within the outermost layer of the skin as a natural moisturizing factor (NMF). It is highly hygroscopic, meaning it actively attracts and binds water to maintain optimal hydration within the stratum corneum. Dr. Dray emphasizes that water content in this outermost layer is fundamental to overall barrier function, offering a vivid comparison: it is the difference between trying to drink powdered Kool-Aid straight out of a dry packet versus drinking it smoothly through a straw once the correct amount of water is mixed in. A depleted stratum corneum cannot function. Addressing an infamous internet myth, she directly dispels the bizarre folk remedy circulating on social media: while urea is indeed excreted in urine, "putting your own urine on your feet is not the best way to take advantage of the hygroscopic properties of urea."

Topical urea exerts a unique dual-action mechanism that varies according to its concentration: - **Humectant Action (Lower Concentrations):** Acts similarly to classic hydrators like glycerin and hyaluronic acid, pulling ambient moisture into the epidermis to replenish barrier hydration. - **Keratolytic Action (Higher Concentrations):** Directly performs keratolysis by chemically breaking down the intercellular adhesion—the "stuck-together dead skin"—allowing stubborn, heaped-up calluses to shed efficiently. - **Barrier Recovery:** Removing the dense barrier of dead cells enables the skin beneath to retain moisture effectively, jumpstarting normal hydration and epidermal repair.

[03:52](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=232s) Understanding Urea Concentrations and Formulation Vehicles

In over-the-counter foot care, urea concentrations dictate whether a product is simply hydrating or actively sloughing off dead tissue. Products with lower percentages primarily hydrate, which is beneficial for minor maintenance. However, to achieve a true keratolytic effect capable of dissolving dense, cemented calluses, formulations generally need to feature concentrations between 10% and 25% urea.

Dr. Dray warns consumers against becoming "hyper-fixated" on chasing the highest number on the label. A 40% or 30% urea cream will not automatically outperform a 20% formulation. The vehicle—the inactive base or background formulation carrying the urea—plays an equally critical role: - The base determines how long the product clings to the skin, maximizing contact time. - The vehicle directly influences how deeply and effectively the urea penetrates through the dense stratum corneum. - While seeing the exact percentage is a helpful guide (aiming for 10% or higher for thick calluses), consumers should not dismiss products that do not disclose their precise percentages, provided the vehicle and overall formulation are well-engineered.

[05:27](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=327s) Identifying the Root Causes of Cracked Heels

Before rushing out to buy treatments, individuals must understand why their heels are cracking. Dr. Dray compares this to cooking: trying to pick products before knowing the underlying condition is "like trying to buy ingredients for a recipe before you've decided what recipe you're going to make." Just as hair loss serves as an umbrella term covering various distinct conditions, cracked heels can stem from several distinct etiologies:

- **Mechanical Overload:** Prolonged standing on hard surfaces for work, intense athletic activity (running, walking), and the combined friction of footwear mixed with foot sweat. - **Keratoderma Climactericum:** A poorly understood yet common condition occurring around perimenopause and menopause. Dropping estrogen levels are believed to trigger dense, stubborn, thick calluses on the soles. While hormone replacement therapy lacks definitive research regarding its impact on this presentation, topicals containing urea or other keratolytics remain the frontline standard of care. - **Inflammatory Dermatoses:** Eczema, allergic contact dermatitis, and foot psoriasis, all of which compromise skin barrier integrity and drive excessive scaling. - **Tinea Pedis (Athlete's Foot):** A fungal infection that mimics simple dry skin by creating a flaky, thickened "moccasin-type" appearance. Although urea can soften and moisturize the scaling, it lacks antifungal properties; relying on urea alone allows the fungal infection to thrive unchecked.

[07:28](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=448s) Special Foot Care Considerations for Diabetics

Diabetes mellitus warrants special dermatological caution. As a systemic metabolic disease, diabetes frequently causes severe dry skin, especially along the lower extremities. In diabetic patients, cracked heels are compounded by peripheral neuropathy (loss of protective sensation) and peripheral vascular disease (poor circulation). This triad makes diabetics exceptionally vulnerable to minor heel cracks that rapidly escalate into non-healing ulcers and severe infections.

Interestingly, diabetes is the exact patient population where urea has been most thoroughly evaluated in scientific literature, proving safe and efficacious for treating xerosis and fissures in both type 1 and type 2 diabetes. However, Dr. Dray issues an urgent clinical warning: if cracked heels present alongside signs of active infection—such as an open wound, localized warmth, spreading erythema, swelling, or bleeding—patients must bypass foot creams entirely and consult a medical doctor immediately, as untreated diabetic foot infections carry a high risk of spreading hematogenously to the bloodstream.

When shopping for foot products, consumers should ignore extravagant marketing claims and instead inspect the active ingredient panel for proven keratolytics. While urea is the gold standard, it is frequently combined with complementary chemical exfoliants, such as alpha hydroxy acids like glycolic acid and lactic acid, to provide enhanced peeling power.

[09:11](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=551s) Why the Vehicle Matters: Ointments vs. Creams

When evaluating foot care formulations alongside active keratolytics like salicylic acid or ammonium lactate (a salt of lactic acid), consumers frequently make the mistake of obsessing over ingredient rankings on the label under the assumption that "if it's up high, it must be better." In reality, the vehicle—whether a product is formulated as an ointment, cream, lotion, or toner—is just as critical as the actives themselves. For the thick skin of the feet, petrolatum-based ointments are far superior to lighter vehicles for three distinct reasons:

```mermaid flowchart TD accTitle: Advantages of Petrolatum Ointment Vehicles for Foot Care accDescr: Flowchart illustrating the three main benefits of using a petrolatum ointment vehicle for cracked heels: enhanced penetration, surface longevity, and moisture retention.

subgraph Vehicle["Petrolatum Ointment Base"] direction TB V1["Enhanced Penetration"] V2["Surface Longevity"] V3["Maximal Hydration"] end

First, an ointment vehicle actively enhances the cutaneous penetration and localization of active ingredients like urea into the exceptionally dense stratum corneum found on the soles. Second, ointments provide sustained longevity on the skin, staying put much better than creams despite the constant mechanical friction and stress caused by walking. Third, petrolatum ointment on its own—even without added urea, lactic acid, glycolic acid, or salicylic acid—is one of the most effective occlusives available to prevent transepidermal water loss and restore hydration to parched skin.

- **Keratolytic vs. Maintenance Strengths:** When dealing with thick, accumulated calluses, prioritize higher, keratolytic-strength urea formulations rather than paying a nail salon to mechanically shave them down, which only offers temporary relief before they recur. - **Risk of Blisters:** Once the calluses have resolved, scale back the treatment frequency or switch to lower non-keratolytic percentages for maintenance. Dr Dray notes that being on one's feet constantly while using potent keratolytics too aggressively can over-thin the skin and lead to friction blisters.

[12:16](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=736s) Recommended Product: Kerasal Intensive Foot Repair Ointment

When asked "What is the best product for cracked heels?", dermatologists must clarify that clinical research evaluates active ingredients rather than specific commercial brands. However, based on both her clinical practice and personal use, Dr Dray highlights **Kerasal Intensive Foot Repair Ointment** as a gold-standard over-the-counter recommendation widely favored by U.S. dermatologists.

The effectiveness of Kerasal boils down to its synergistic formulation: it combines urea with salicylic acid inside a rich petrolatum ointment base. This combination delivers moisture, chemically exfoliates compacted dead skin cells, and seals the skin surface without needing separate product steps.

[13:03](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=783s) Step-by-Step Application Protocol and the "Sock Strategy"

How often you use a keratolytic foot ointment depends on whether you are correcting severe build-up or maintaining smooth skin:

- **Corrective Phase:** Apply nightly for a couple of weeks until thickened cracks and rough build-up significantly soften. - **Maintenance Phase:** Scale back application to just one or two nights per week to prevent irritation and blister formation.

For optimal absorption, apply the ointment at night right before going to bed. Take a bath or shower, pat the skin dry so there is no pooling water, and smooth the ointment directly over the heels while the skin is still freshly hydrated.

Immediately cover the feet with a pair of socks. The socks serve a vital mechanical purpose: they prevent the petrolatum from smearing off onto your floors and linens, while any ointment that absorbs into the inner fabric remains in close contact with the heels, constantly redistributing onto the stratum corneum overnight. For those who dislike sleeping in socks, Dr Dray recommends keeping them on for at least an hour while relaxing before taking them off for sleep.

[14:27](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=867s) The Evidence for Urea and Final Foot Care Tips

A comprehensive search of review papers on PubMed confirms that urea remains the undisputed, research-backed heavy hitter for treating hyperkeratotic, cracked heel conditions. Because scientific studies evaluate the mechanism of urea as an endogenous component of natural moisturizing factor rather than specific brand names, focusing on the ingredient itself is the most dependable path to smooth skin: "urea, urea, urea is what I recommend. It's what the research supports. It gets results."

To wrap up, Dr Dray urges viewers to leave comments sharing what products have worked for them and directs them to an end-screen video detailing non-product lifestyle habits to combat heel cracks for free, concluding with her signature sign-off: "don't forget sunscreen and subscribe."

## Notable quotes > [01:56](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=116s) putting your own urine on your feet is not the best way to take advantage of the hygroscopic properties of urea. — Dr. Dray

> [03:52](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=232s) hyper-fixated — Dr. Dray

> [05:27](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=327s) like trying to buy ingredients for a recipe before you've decided what recipe you're going to make. — Dr. Dray

> [09:11](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=551s) if it's up high, it must be better. — Dr. Dray

> [12:16](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=736s) What is the best product for cracked heels? — Dr. Dray

> [14:27](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=867s) urea, urea, urea is what I recommend. It's what the research supports. It gets results. — Dr. Dray

> [14:27](https://www.youtube.com/watch?v=GKwS9hUfQuw&t=867s) don't forget sunscreen and subscribe. — Dr. Dray

## Mentioned Dr. Dray, Urea, Kerasal Intensive Foot Repair Ointment, Salicylic acid, Lactic acid, Glycolic acid, Ammonium lactate, Petrolatum, PubMed

## Video description Kerasal Intensive Foot Ointment: https://amzlink.to/az05VWDfND6wS

Struggling with dry, rough, or cracked heels? Dermatologist Dr. Dray explains why urea is one of the most useful skincare ingredients for treating dry, thickened skin on the feet and what to look for when choosing a foot cream or ointment.

Urea is a humectant that helps the skin retain moisture. At higher concentrations, it also acts as a keratolytic, helping soften and loosen excess thickened skin. This makes urea particularly useful for rough, callused heels that are prone to cracking.

In this video, Dr. Dray discusses how urea works, which concentrations may be helpful for dry and rough feet, and why the formulation matters just as much as the active ingredients. She also explains other potential causes of cracked heels, including mechanical stress, aging, keratoderma climactericum associated with menopause, eczema, psoriasis, and athlete's foot.

People with diabetes should take particular care of their feet because cracks can increase the risk of infection, especially when neuropathy or circulation problems are present.

Dr. Dray also reviews Kerasal Intensive Foot Repair Ointment, a product she likes for thick, rough heels. Its combination of urea, salicylic acid, and an ointment vehicle helps hydrate and soften thickened skin while reducing moisture loss.

Discover why urea is worth looking for in foot care products, how ointments compare with creams and lotions, and how to care for dry, cracked heels without relying on aggressive exfoliation or marketing claims.

TIMESTAMPS

0:00 Intro: The Best Ingredient for Dry, Cracked Heels 1:10 Why Do Heels Get Dry and Cracked? 1:56 What Is Urea? 2:56 How Urea Works on Dry, Rough Skin 3:52 What Concentration of Urea Should You Look For? 5:27 Other Causes of Dry, Cracked Heels 7:28 Diabetes and Cracked Heels: Important Foot Care Considerations 8:41 What to Look For in a Foot Cream or Ointment 12:16 Kerasal Intensive Foot Repair Ointment Review 13:03 How to Use Foot Repair Ointments 14:27 Final Tips for Smoother, Softer Heels

#CrackedHeels #DryFeet #UreaCream #UreaForFeet #Kerasal #KerasalFootRepair #FootCare #FootCareTips #DrySkin #CallusedFeet #HeelCracks #Dermatologist #DrDray #SkincareIngredients #salicylicacid

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[Source](https://www.youtube.com/watch?v=GKwS9hUfQuw)

中文简报

皮肤科医生建议使用尿素软膏而非足膜应对脚后跟干裂凡士林基底的尿素配方能有效溶解厚茧并恢复屏障水合，其效果远胜于美甲沙龙的机械刮除修脚，后者仅能提供短暂缓解，随后干裂仍会复发。 Dr. Dray 解释称，当增厚起茧的角质层在反复机械应力或糖尿病、湿疹及更年期角化病等基础疾病影响下失去弹性时，就会引发脚后跟干裂。她强调，尿素是经过研究证实的理想成分，低浓度时作为保湿剂，在 10% 至 25% 浓度区间则作为强效角质剥脱剂，能够通过化学方式溶解顽固堆积的死皮。她指出，凡士林基质的软膏剂型在增强渗透和抵抗摩擦方面明显优于乳霜，因此建议在矫正期每晚涂抹 Kerasal 等产品并穿上袜子，随后逐步减少用量过渡至维持期，以避免因角质过度变薄而产生摩擦水疱。尿素是应对足跟角化过度的首要循证成分，在低浓度下起到保湿作用，在 10% 至 25% 浓度下则作为活性角质溶解剂，能够分解顽固老茧中的细胞间黏附。 (3:52) 凡士林基质软膏显著优于质地较轻薄的乳霜和乳液，它有助于更深层地穿透增厚皮肤，耐受步行引起的摩擦，并提供最大程度的封闭性锁水效果。 (9:11) 脚后跟干裂的潜在病因不仅限于机械压力，还包括更年期掌跖角化病、炎症性皮肤病以及足癣（脚气），其中足癣需要针对性的抗真菌药物治疗，而非仅靠尿素。 (5:27) 结合了尿素与水杨酸的角质剥脱足部修护软膏应在为期两周的矫正期内每晚使用，随后逐步减少至每周一到两次进行维持，以防止皮肤过度变薄并引发摩擦水疱。 (13:03)

Reading summary

Board-certified dermatologist Dr. Dray identifies topical urea formulated in an occlusive petrolatum vehicle as the most evidence-based treatment for dry, cracked heels, emphasizing that effective care requires identifying the root cause rather than relying on marketing claims or mechanical salon filing. Identifying the Causes Behind Heel Fissures (5:27) The soles of the feet feature an exceptionally thick stratum corneum adapted to bear continuous mechanical strain. When excessive pressure, standing, and friction dry out this protective layer, accumulated calluses lose elasticity and split into deep, painful fissures. Dr. Dray stresses that successful treatment requires diagnosing the root etiology rather than treating all dry skin identically. Heel cracks can arise from mechanical overload, inflammatory conditions such as eczema or psoriasis, fungal infections like athlete's foot (tinea pedis), or keratoderma climactericum—a poorly understood thickening associated with perimenopausal and menopausal estrogen declines. Distinguishing these causes is vital for proper management. Dr. Dray notes that while urea softens thick scaling, it possesses no antifungal properties and cannot resolve athlete's foot on its own. Furthermore, individuals with diabetes mellitus face heightened risks because neuropathy and impaired peripheral circulation can cause minor cracks to rapidly escalate into non-healing ulcers. Diabetic patients presenting with redness, localized heat, open wounds, swelling, or bleeding must seek immediate medical attention rather than self-treating with topical foot creams. Urea as a Hydrator and Keratolytic (1:56) Rather than an artificial additive or a folk remedy derived from urine, urea is an endogenous compound synthesized by the body and present in the stratum corneum as a natural moisturizing factor (NMF). Topical urea functions through a concentration-dependent dual mechanism. At lower concentrations, it acts as a humectant comparable to glycerin, binding ambient moisture to rehydrate the epidermal barrier. At higher strengths—typically between 10% and 25%—urea exerts a keratolytic effect, chemically breaking down the intercellular adhesion holding compacted dead skin cells together and allowing thick calluses to slough off. Dr. Dray cautions consumers against assuming higher percentages are universally superior. Formulations containing 30% or 40% urea do not automatically outperform a well-formulated 20% product, as the vehicle carrying the active ingredient largely determines its real-world performance. Why Petrolatum Ointments Outperform Creams (9:11) A product's vehicle—whether formulated as an ointment, cream, lotion, or toner—plays as critical a role as the active ingredient itself. Dr. Dray advises that thick sole skin responds significantly better to petrolatum-based ointments than lighter formulations for three reasons: petrolatum enhances the cutaneous penetration of active keratolytics like urea or salicylic acid into dense tissue, stays on the skin far longer despite continuous walking friction, and functions as a powerful standalone occlusive barrier that prevents transepidermal water loss. While dermatological research evaluates active ingredients rather than proprietary brands, Dr. Dray cites Kerasal Intensive Foot Repair Ointment as a clinical standard because it pairs urea and salicylic acid within an occlusive petrolatum base. This combination chemically dissolves dead skin while trapping hydration, providing a safer, longer-lasting alternative to salon razor shaving. Corrective Application Protocols and Maintenance (13:03) To treat thick calluses and fissures without damaging healthy skin, Dr. Dray outlines a two-phase protocol. During the corrective phase, a keratolytic ointment should be applied nightly for a couple of weeks until hard calluses soften. For optimal absorption, the product should be applied immediately after bathing onto towel-dried skin, trapping residual moisture within the stratum corneum. Covering the feet with socks overnight is essential to this regimen: socks prevent the ointment from wiping onto floors and bedding while continuously redistributing the formulation against the skin. Once calluses clear, patients should transition to a maintenance schedule of one or two nights per week or switch to lower non-keratolytic concentrations. Dr. Dray warns that aggressively applying strong keratolytics to active feet can over-thin the epidermis, increasing the risk of friction blisters. Dr. Dray concludes that urea remains the undisputed, research-backed cornerstone for treating cracked heels, though lasting resolution depends on matching the formulation vehicle to the thick skin of the feet, tapering application to avoid barrier over-thinning, and ruling out underlying systemic or fungal conditions.

Source quotes

[1:56] Dr. Dray: putting your own urine on your feet is not the best way to take advantage of the hygroscopic properties of urea. [3:52] Dr. Dray: hyper-fixated [5:27] Dr. Dray: like trying to buy ingredients for a recipe before you've decided what recipe you're going to make. [9:11] Dr. Dray: if it's up high, it must be better. [12:16] Dr. Dray: What is the best product for cracked heels? [14:27] Dr. Dray: urea, urea, urea is what I recommend. It's what the research supports. It gets results. [14:27] Dr. Dray: don't forget sunscreen and subscribe.

Original transcript

[0:00] Well, hey guys, welcome back. If you're [0:01] new here, I'm Dr. Dray. I'm a [0:03] board-certified dermatologist. If you [0:05] deal with dry, rough, cracked feet, [0:07] there's a good chance you have come [0:08] across a skin care product that claims [0:10] it's going to give you smooth, baby soft [0:12] feet. It can be very hard to know if [0:14] these products are legitimate or not. [0:16] They range from exfoliating masks, [0:18] peels, creams, ointments, and all sorts [0:21] of gadgets. In this video, I'm going to [0:23] pull back the curtain on all of the [0:24] marketing hype with different foot [0:26] creams and tell you about an ingredient [0:28] that you really should be focusing your [0:30] attention on when it comes to targeting [0:31] dry, rough skin on the feet. And that is [0:33] urea. Urea is one of the most [0:36] well-studied, best evidence-based [0:38] ingredients specifically for dry, rough [0:40] skin on the feet. If you pay attention [0:42] to ingredients, you will come to learn [0:44] that many foot care products contain [0:46] urea. In today's video, we're going to [0:47] talk not only about what urea is, how it [0:50] works, reasons why you have dry skin on [0:52] your feet in the first place. I'm also [0:54] going to tell you guys about how to [0:56] begin being a more discerning consumer [0:59] when it comes to purchasing foot creams, [1:01] etc. for getting softer, smoother feet, [1:03] and what to look for in these products [1:05] rather than just falling for marketing. [1:07] The skin on the soles of our feet is [1:08] very different from the skin on the rest [1:10] of our body. The outermost protective [1:12] layer, which is called the stratum [1:13] corneum, is very, very, very thick. And [1:17] it's under a lot of pressure cuz you [1:19] stand. It also is exposed to a lot of [1:21] friction. These forces can lead to the [1:23] buildup of dry, rough skin, callus. And [1:27] as the skin becomes dry, it loses [1:28] flexibility and can develop these deep, [1:30] painful cracks known as fissures. [1:32] Walking puts repeated mechanical stress [1:34] on those fissures, which can make them [1:36] deeper and all the more painful. Cracked [1:38] heels are often due to a combination of [1:40] dryness, thickened skin, and mechanical [1:42] stress on the feet. It's important for [1:43] you to understand this when going about [1:45] choosing a product because if your skin [1:47] is just simply dry on your feet, a basic [1:48] moisturizer will achieve that and you [1:50] can move on. But if you've got stubborn, [1:52] dry, and/or cracked feet, mhm, this is [1:55] where you need to listen up. Urea is a [1:57] skin care ingredient, but it's also [1:58] naturally found in skin's outermost [2:00] layer. It is what is referred to as a [2:02] natural moisturizing factor. It is [2:04] hygroscopic, so it helps to optimize [2:06] water content in the stratum corneum. [2:08] And when it comes to the normal biology [2:10] of maintaining skin's barrier function [2:13] and retaining moisture, water content in [2:15] the outermost layer is key. This is the [2:17] difference between the ability of you to [2:20] drink, let's say, Kool-Aid out of a [2:22] straw when it's had optimal water added [2:25] to it versus when it's just in the [2:27] powder in the packet. In other words, a [2:29] dry stratum corneum leads to [2:31] dysfunction. Urea is not some strange [2:34] foreign substance, and while it is [2:36] naturally found in your urine, it's also [2:38] naturally found throughout the body and [2:40] in your skin. And no, putting your own [2:42] urine on your feet is not the best way [2:45] to take advantage of the hygroscopic [2:47] properties of urea. [2:49] Yes, I need to tell you that because [2:50] yes, there are videos out there that you [2:52] will encounter on the internet claiming [2:54] that if you pee on your feet, you'll [2:55] have baby smooth skin. At lower [2:57] concentrations in a topical skin care [2:59] product, urea primarily works as a [3:01] humectant, similar to things like [3:02] glycerin and hyaluronic acid. But at [3:04] high concentrations, it has specific [3:07] effects on the buildup of dry, rough [3:09] skin that are known as keratolytic. What [3:11] does that mean? Well, it means it gets [3:12] in there and does keratolysis. It breaks [3:15] apart the dry, stuck-together dead skin [3:18] so that it can efficiently shed, and the [3:20] result is smoother skin. Also, once that [3:24] dry heaped-up stuff that is taking up [3:26] space on the surface of the skin is [3:29] efficiently removed, guess what will [3:31] start to improve as a natural [3:33] consequence? The water content in the [3:36] stratum corneum. And you guessed it, all [3:38] things hydration, maintenance, barrier [3:41] recovery are going to be on track. In [3:43] other words, urea plays two roles. A, it [3:46] is hydrating and improves water content, [3:47] and B, it helps to actively smooth the [3:50] skin by breaking apart dry, [3:52] stuck-together skin cells. Now, you may [3:53] notice that foot care products contain [3:55] different percentages of urea. In [3:57] general, lower concentrations focus [3:59] primarily on hydration, which is nothing [4:01] to smirk at. That is one of the main [4:03] things that you want from urea in skin [4:05] care products. But, a product that [4:06] contains anywhere from 10 to 25% urea [4:10] can be particularly effective because at [4:12] this percentage, the urea can get in [4:14] there and begin to dissolve that dry, [4:16] stuck together stuff. In other words, [4:18] that's really when the keratolytic [4:20] effect starts to be observed. I would [4:21] not get hyper-fixated, however, on [4:23] finding the optimal or the maximum [4:26] percentage of urea. That doesn't [4:28] necessarily tell you everything you need [4:30] to know about how well a given foot [4:32] product is going to perform for you. [4:34] It's not just about the percent of urea [4:36] in the formula. It's about the overall [4:38] formulation. In other words, you can [4:40] have a 30% urea foot cream, and you can [4:43] have a 20% we'll say urea foot cream, [4:46] and the 20% one might actually perform [4:49] better, give you better results than the [4:51] 30% solely related to factors about the [4:55] vehicle, the background stuff that the [4:58] urea is suspended in, basically. Some [5:00] vehicles are going to have better [5:02] longevity on the skin, allowing for [5:05] enhanced contact, and they're going to [5:06] facilitate better penetration of that [5:09] urea. But, generally speaking, 10% and [5:12] above is what you want to be kind of [5:13] looking for if you're looking for that [5:15] keratolytic effect. The other thing is [5:17] that not all foot creams tell you up [5:19] front how much is in there, and I [5:20] wouldn't necessarily bail on a product [5:22] because of that, either. But, it can be [5:24] a very helpful thing to have some idea [5:26] of when going in. It's also important to [5:28] recognize why you have dry, cracked [5:30] heels in the first place. Just like hair [5:32] loss is not a diagnosis, but rather an [5:34] umbrella category of many different [5:36] diagnoses, each with their own specific [5:38] causes and treatments, dry, cracked [5:40] heels are very similar. Having dry, [5:42] cracked heels, well, why do you have [5:45] them in the first place? This is a [5:46] question you should always be asking [5:48] before trying to find a product. Why do [5:50] I have this in the first place? Until [5:52] you know why you have something, trying [5:53] to buy a product for it, it's like [5:55] trying to buy ingredients for a recipe [5:57] before you've decided what recipe you're [5:59] going to make. It doesn't make a whole [6:00] lot of sense. But, one of the most [6:02] common triggers for dry cracked heels is [6:04] simply mechanical stress. If you stand [6:06] on your feet for a prolonged period of [6:07] time, say at your job, boom, there you [6:09] have it. Or, if you walk a lot, you run [6:12] a lot, you're very active on your feet, [6:14] and you have repeat mechanical stress [6:16] and friction, plus sweat, all of those [6:18] factors come together to lead to a dry [6:20] cracked feet. But, another condition [6:22] that not many people are familiar with, [6:24] that a lot of women deal with, is known [6:25] as keratoderma climactericum. Basically, [6:28] around the time of menopause and [6:29] thereafter, women can develop stubborn, [6:32] dry, thick callus on the bottoms of the [6:34] feet, thought to be related to the [6:36] decline in estrogen. There's not a lot [6:38] of menopause-specific research on how [6:40] maybe hormone replacement therapy alters [6:43] this. Basically, the go-to treatment for [6:46] it is, you guessed it, a urea or some [6:49] other keratolytic. As I said at the [6:50] start of the video, urea is one of the [6:52] most well-studied ingredients for dry [6:55] skin on the feet. Other skin conditions [6:56] can cause dry cracked heels, as well. [6:58] Eczema, contact dermatitis, and [7:01] psoriasis. Also, if you have a little [7:04] fungal foot infection known as tinea [7:06] pedis, aka athlete's foot, well, that's [7:08] going to make your skin look very dry [7:10] and thick and flaky. You can use all the [7:12] urea in the world, it will soften, it [7:14] will hydrate, but you need to know that [7:16] you have athlete's foot, otherwise [7:18] you're going to allow the fungus to [7:20] thrive there, because urea does not [7:22] destroy the fungus. It just moisturizes [7:24] the skin, but you don't want to let that [7:26] fungus continue to thrive there. [7:28] Specifically, though, I want to mention [7:30] a condition that is very common, and [7:32] that is diabetes. Diabetes is a [7:34] metabolic disease that, um, actually is [7:37] commonly associated with dry skin in [7:39] general, but especially on the feet. It [7:41] is one of the pain points when it comes [7:44] to diabetes because not only do they [7:47] have dry skin, but it's often in [7:49] combination with an underlying [7:51] neuropathy that leads to pain in the [7:53] feet coupled with problems and poor [7:56] circulation. These factors come together [7:58] to make the diabetic a particularly [8:01] vulnerable patient group for um foot [8:04] injuries and for foot infections. Where [8:07] urea for dry feet is probably most well [8:10] studied is specifically when it comes to [8:13] treating dry cracked heels of patients [8:15] with both type 1 and type 2 diabetes. [8:18] It's important to note if you have a [8:20] diabetes and you develop not only dry [8:22] cracked heels, but you have an open [8:24] wound, you have warmth to the skin, you [8:27] have redness, bleeding, swelling, these [8:30] are signs of infection. Don't just try [8:31] and treat those with a urea foot cream. [8:34] You need to see your health care [8:35] provider because diabetics are very [8:37] prone to uh wound infections that can [8:40] enter the bloodstream and make you very [8:41] sick. So, try to move away from [8:43] marketing claims and start looking very [8:46] specifically at the ingredients in foot [8:48] care products when trying to decide if [8:50] something is going to be helpful for [8:52] your dry cracked feet or not. For dry [8:54] rough skin on the feet, urea without a [8:55] doubt is the most evidence-based [8:57] ingredient for this condition. But, you [8:59] might also look for other keratolytic [9:01] ingredients that likewise can work and [9:03] are frequently combined here with urea. [9:06] So, you kind of get an add-on. That [9:08] includes glycolic acid, lactic acid, or [9:11] uh ammonium lactate, which is a salt of [9:13] lactic acid, as well as salicylic acid. [9:16] You also want to take a look at the [9:18] vehicle. People often ignore the vehicle [9:20] and they focus too much on where on the [9:22] ingredient list the ingredient falls. If [9:24] it's up high, it must be better. And [9:26] that's not true. You want to focus on [9:27] the overall vehicle. Like, is this an [9:29] ointment? Is it a cream? Is it a lotion? [9:31] Is it a toner? Why does all of that [9:33] matter? Well, ointments are what you're [9:35] going to want to reach for. Why? [9:37] Ointments are petrolatum based vehicles. [9:40] And the reason this is particularly [9:42] valuable here are, well, a couple of [9:44] reasons. Number one is that ointment [9:46] vehicles tend to enhance penetration of [9:49] the ingredients in the formula into the [9:51] skin. And when we're talking about the [9:53] feet, remember what I said about the [9:55] soles of the feet, that stratum corneum [9:57] is so, so, so thick. So, you want a [10:00] vehicle that is really going to allow [10:02] for good localization of the urea. [10:05] Second, ointments have very good [10:06] longevity on the skin in comparison to a [10:08] cream. In other words, a ointment will [10:11] stay on the skin much better. And when [10:14] we are putting a given area under repeat [10:17] mechanical stress, that makes a [10:19] difference. Third is that petrolatum [10:22] ointment, by itself, without any urea, [10:25] salicylic acid, glycolic acid, lactic [10:27] acid, is probably one of the best things [10:29] you could be putting on your feet to [10:31] address the dryness and to get, over [10:33] time, better water content in the skin [10:36] because it maximally locks in hydration [10:38] very well. So, rather than getting so [10:40] hung up on, "Well, they're not telling [10:42] me the percentage." or [10:44] "I don't know, this person said it was [10:46] good." Think critically about the [10:47] vehicle, okay? Because that that is is [10:50] helpful. Don't ignore the percentage, it [10:52] can certainly be very, very helpful to [10:54] you. It also depends on where in the [10:57] treatment stage of things you are. For [10:59] example, you definitely want to be [11:01] looking for those keratolytic strengths [11:03] if possible. Again, they don't always [11:05] disclose that and don't necessarily [11:06] dismiss something because they don't, [11:08] but you want to be looking for those [11:09] keratolytic strengths when you are like, [11:11] "Okay, I've developed this and I haven't [11:13] been treating it and I've got very [11:15] thick, dry build-up callus." This is the [11:17] kind of thing that a lot of people will [11:19] go into the pedicure salon and have, you [11:21] know, pay big bucks to have them scrape [11:23] off. It'll come right back, okay? So, [11:25] this is this is a situation where rather [11:27] than paying all that, look for a [11:29] keratolytic strength urea foot ointment, [11:32] ideally, okay? But, if you are looking [11:34] for something to maintain that has urea, [11:37] then it's fine to use the lower [11:38] percentages. In fact, once you get to a [11:41] good place where you are in the [11:42] maintenance phase of things, you [11:44] probably might consider going down to a [11:47] lower percentage that isn't necessarily [11:49] keratolytic because you don't need that [11:51] effect anymore. And if you have that [11:54] effect on there, you can start to [11:56] develop, well, blisters. I personally [11:58] haven't encountered that, which is why [12:00] the keratolytic foot ointment that I [12:02] recommend, I only personally use myself [12:05] one or two nights a week at most because [12:07] I am on my feet a lot and I have gotten [12:10] blisters as a result of going to to [12:14] all in with the keratolytic on the feet. [12:16] What is the product that I recommend, [12:18] okay? First of all, it's important to [12:20] know that this is just based on my [12:21] personal and clinical experience. Asking [12:24] the question, "What is the best product [12:26] for?" is never going to be met with a [12:28] wholly objective answer. Research [12:30] studies tend to support the use of [12:32] ingredients over other ingredients, but [12:35] never a branded product over another [12:38] branded product per se. But, this is one [12:40] that not only do I use and recommend [12:42] widely, but it is widely used amongst [12:44] dermatologists here in the US. And I [12:46] I've recommended it in many videos. It's [12:47] the Kerasal Intensive Foot Repair [12:50] Ointment. Not only does this contain [12:51] urea, but it also has salicylic acid and [12:54] it's in a petrolatum ointment base. So, [12:56] those features about this are why I [12:58] believe it ends up working out well for [13:00] most people [clears throat] and for many [13:01] different conditions where you do have [13:03] dry, cracked heels. How do you use this? [13:05] Like I said, it sort of depends a little [13:08] bit on how far along you are in [13:10] addressing your dry, cracked feet. If [13:12] you're at a phase where you know this is [13:14] an issue that pops up for you, but your [13:16] feet are looking pretty good these days, [13:18] well, you might, like myself, only use [13:20] it a couple of nights a week as [13:21] maintenance. Whereas, if you're like, [13:23] "Okay, I need something to to correct [13:25] this right away, um what should I do? [13:27] Try using it every night for a couple of [13:30] weeks and then once things get on track [13:32] backing down to just a couple of nights [13:34] a week so you don't run into the blister [13:36] issue. Um, here's the other thing I [13:38] suggest doing. Now, as far as when to [13:40] use this, I suggest putting this on your [13:41] feet at night time before you go to bed. [13:43] Ideally after you've just gotten out of [13:45] the shower or the tub, pat dry the skin [13:47] on your feet of any visible water and [13:50] then immediately put this on. Cover [13:52] immediately with socks because the socks [13:55] will allow that ointment to not only [13:58] stay on the skin better, but as it comes [14:01] off in your sock, it will go back on the [14:03] skin as opposed to come off of your feet [14:05] and go all over the floor and that's the [14:08] end of that, okay? [laughter] [14:10] Um, so that is how I recommend using it. [14:12] People will say I cannot possibly stand [14:15] sleeping with socks. Okay, at least wear [14:18] them for an hour um, while you do [14:20] something else, okay? That that's really [14:22] what I suggest, but ideally you go to [14:24] bed that way because it really helps to [14:27] lock in that hydration. All right, guys, [14:28] if you're dealing with dry rough skin on [14:30] your feet, drop a comment down below. [14:32] What have you used? What has worked for [14:34] you? Without a doubt, as far as PubMed [14:36] papers that you can find, even uh, [14:39] review papers on all of the available [14:41] research, it's going to be a urea, okay? [14:44] Keep in mind when they do these reviews [14:46] of all of the published papers, the [14:48] studies are not all using the same exact [14:50] urea, which is why the question what's [14:52] the best product for is not usually the [14:55] best question to be asking other than if [14:57] you're hoping to get someone's personal [14:59] anecdotal experience. If you want what [15:01] is the most research backed thing that I [15:03] can use for this, it's probably going to [15:05] be an ingredient. What does the research [15:07] suggest? How does the ingredient work? [15:09] This case, urea, urea, urea is what I [15:12] recommend. It's what the research [15:13] supports. It gets results and uh, it's [15:16] naturally present in your skin, so go [15:18] ahead and give it a try. I I today's [15:20] video was helpful for you all. Now, on [15:22] the end slate I'm going to put another [15:24] video about your dry cracked heels. [15:27] Watch that one next if this is something [15:29] you have been struggling with because I [15:30] give even more lifestyle tips and tricks [15:33] for managing your dry cracked feet and [15:35] most of those tips don't involve you [15:37] buying anything. All right, guys. I hope [15:39] you enjoyed today's video. If so, give [15:40] it a thumbs up, share it with your [15:41] friends and as always don't forget [15:43] sunscreen and subscribe. I'll talk to [15:45] you guys tomorrow. Bye. [16:06] >> [music]