Victoria Goldman considers the best way to treat dry skin conditions

Eczema affects one in five children and one in 12 adults in the UK. Commonly causing red, dry and cracked skin, this chronic skin condition can have a serious impact on sufferers’ lives, with constant itching and disturbed sleep. Keeping the skin supple and moisturised with emollients is the key to keeping eczema under control and reduces the need for topical steroids, which are often used to treat flare- ups.

Pharmacists play an important role in advising customers on choosing and using the right emollients for them. “Customers with eczema should be using emollients at least twice a day even if their skin is symptom- free,” says Sam Preston, pharmacist for Careway, the new community health partnership from Celesio UK. “If their skin is dry, they should apply emollients more frequently. Apply the emollient all over the body, not just the dry areas, and use smooth strokes in the direction of hair growth.”

Computer artwork of the epidermis affected by eczema. Fluid accumulates in the epidermis, resulting in separation of the cells (spongiosis). Clumps of epidermal cells disintegrate to form vesicles. Blood vessels in the underlying dermis are dilated, and an immune response (white blood cells, green) can be triggered

Complete regime

Eczema patients should be advised to use emollients for moisturising, washing and bathing, as part of a complete emollient regime (CER). In January this year, RB’s E45 brand teamed up with the Living Care Group an independent pharmacy chain in West Yorkshire, to promote the benefits of CER to pharmacy customers. Pharmacy staff focused on talking to customers about dry skin conditions, offering advice and in-store demonstrations to showcase the correct way to apply emollients.

“A vital element in the treatment and management of eczema, regardless of severity, is the use of emollients such as E45,” says Jerome Lemaire, UK marketing director at RB. “Pharmacists need to explain to their customers that, by using the right products throughout the whole day, the symptoms of mild eczema can often be relieved with a CER. E45 offers a CER range including moisturising lotion, bath oil, shower cream, wash, shampoo, and foot and heel cream. E45 also has a junior range specifically for children, offering nappy cream, foaming bath milk, hand and body wash and moisturising lotion.”

According to GSK, less than 15 per cent of GP patients are prescribed both bath and cream emollients. This provides an important opportunity for pharmacists to help customers by recommending an emollient wash product or cream. Providing information on how to apply an emollient cream or ointment correctly will help the customer get the most out of their treatment.

Only one in five who use an emollient for eczema are applying it three to four times per day as recommended

It is also important that pharmacists and pharmacy assistants communicate to customers about the recommended quantities, as many people underestimate the amount needed. For generalised eczema, adults should be using around 600g per week and children should be using around 250g. GSK advises investing time in pharmacy learning resources, such as MyPharmAssist.

“Pharmacists are well placed to support consumers when deciding on what product to use and how often,” says Caroline Fredj, senior brand manager for Oilatum. “We have just launched an eczema service pack, which can be followed online or downloaded. The pack consists of a patient support booklet, patient-orientated eczema measure (POEM), two patient leaflets and two A2 posters. Additionally, we have created a range of in- store materials that can help leverage expertise in skin services whilst maximising sales. These include a product tray, shelf barker, shelf wobbler and a product specific poster.”

Daily use

Emollients have to be used frequently and generously, in larger amounts than other eczema treatments. However, new research by MSD among 500 adults living with eczema, revealed that only one in five who use an emollient for eczema are applying it three to four times per day as recommended. Over half of those who use their emollient less than this said that one of the reasons was because their pot or pump was too big to carry around. In addition, some people may be missing their applications altogether, as one in 10 admitted to not taking their emollient on holiday because it was too big, heavy or inconvenient to carry around.

Providing consumers with the option to purchase conveniently sized emollient products is therefore important, as it may help improve compliance. MSD – the manufacturer of Diprobase emollient (ointment, cream and lotion) – has expanded its range for pharmacy self-selection with more convenient sizes (50g cream, 50g ointment, 50ml lotion and 300ml lotion).

“The symptoms of eczema can have an impact on daily life, particularly when people experience painful flare-ups,” says consultant dermatologist Dr Justine Hextall. “Having a conveniently sized range of products that offer heavier or lighter moisturisation as required, should help people suffering achieve greater control.”

New for juniors

To encourage daily emollient use, Oilatum (a Stiefel range of products from GSK) recently launched Oilatum Daily Junior Lotion, which is designed to deliver everyday protection of dry skin for children. “Research indicates that 44 per cent of parents claim their child has had a dry skin condition, and we’ve identified a gap in the market for a moisturising product which consumers can use on their children ona daily basis,” says Ms Fredj. “As a brand with a long heritage, Oilatum is growing at more than double the rate of the skin flare-up market and we are confident that the launch of Oilatum Daily Junior Lotion will help drive category penetration and continue to be a firm choice with our target consumer.”

There are many different forms of eczema, with atopic eczema being the most common. Spontaneous flare-ups are often due to specific triggers such as soap and detergents, house dust mites, pollen, overheating and skin infections. The British Association of Dermatologists recommends that eczema patients don’t put their fingers into a pot of emollient, as it may become contaminated and increase the risk of infection. Instead, patients should remove an adequate amount to cover the skin with a spoon or spatula and put this on a saucer or piece of kitchen towel.

New Cetraben lotion is the latest addition to the Cetraben Emollient range from Thornton & Ross. The new leave-on lotion is available in an innovative airless pump dispenser, proven to minimise the risk of bacterial cultivation compared to pots. “Patient choice leads to better treatment compliance and optimisation, so it’s really important for me to offer my patients a range of emollient treatments,” says Julie Van Onselen, dermatology nurse specialist. “The airless pump dispenser definitely offers added benefits as it makes the lotion easy-to-apply and is more hygienic as it helps prevent bacteria from entering the container.”