Independent pharmacies can help patients find accurate information which is not always easy in an age of misinformation. Victoria Goldman reports…

Many people with eczema and other chronic skin conditions notice their symptoms flare up when the weather turns colder. Even people who don’t usually experience dry skin may find that their skin becomes particularly dry and sensitive at this time of year.

Pharmacy customers may therefore be seeking some extra support and advice on looking after their skin during the winter months.

“While not everyone’s eczema will flare up at the first sign of colder weather, patient surveys show many people experience a worsening in their condition linked to seasonal changes in the weather,” says Andrew Proctor, chief executive of National Eczema Society.

“For effective self-management, people with eczema need to develop an effective skincare regime to help manage the dry skin associated with the condition.

“At the National Eczema Society, we know that people ask their pharmacists for advice, so it’s important that we continue to raise awareness of eczema and how to treat it.”

Professor Carsten Flohr, spokesperson for the British Association of Dermatologists, says information is key when it comes to managing dry skin conditions.

“Finding impartial advice in the internet age can be difficult, so signposting patients towards accurate information is important,” he says.

“The British Association of Dermatologists publishes publicly available patient information leaflets (PILs) for a wide range of conditions, and these can be found online.

“They even have QR codes for a patient to scan and read it on their phones, if pharmacy teams wanted to share this with them in the pharmacy.

“In addition, the British College of Dermatology, our educational arm, has launched a series of online courses specifically written for pharmacists, which tackle a number of topics including management of eczema, acne and psoriasis. These are available on the BCD Education Hub.”

Cold weather changes

Around 1 in 5 children and 1 in 10 adults in the UK have atopic eczema. Research at the University of Bristol, published in Clinical and Experimental Dermatology in September 2023, found UK children with eczema had more prominent symptoms in the colder winter and fewer symptoms in the warmer summer, with some evidence that cold weather increased the risk of a flare-up.

Usually, the epidermis (the skin’s top layer) provides a natural barrier against the environment, keeping moisture in and irritants, allergens and pathogens out.

Sebum provides an extra oily layer to stop the skin from drying out and cracking, but sebum production often reduces in the winter months. Cold temperatures, dry air and harsh winds can further disrupt the skin’s natural barrier function. 

“Changes in humidity, spending more time indoors with central heating, moving from hot to cold environments and wearing winter clothes can all impact our skin,” says Andrew Proctor.

“The seasonal shift can cause skin to dry out and be more prone to an eczema flare-up, with symptoms such as cracking, soreness, bleeding and blistering.”

Dry, itchy skin in the winter can have many other causes, including rosacea, psoriasis and cold urticaria. If there’s no noticeable rash or underlying skin condition, it may be a symptom of ‘winter itch’, which is triggered by cold weather.

Winter itch is most common on the legs, feet and ankles, tends to be worse at night and can be aggravated by woollen clothing. Professor Flohr says it’s important that patients understand their triggers.

“If skin gets very dry and itchy in winter, is it after a shower?” he says. “Is it after a walk outside when it’s cold? Is it because of the fabric gloves are made of?

“As well as moisturising, general advice includes making sure to wrap up warm so the skin is protected from the elements that might cause it to dry out and avoiding wearing harsher fabrics next to the skin.”

Management approach

Emollients are the mainstay of eczema treatment and may also be recommended to treat winter itch and other dry skin conditions such as psoriasis.

“It’s important that people use their emollients more frequently when the weather changes, if needed, to keep their skin moisturised and protected,” says Andrew Proctor.

“Dry skin often means itchy skin. They might need to apply emollients several times a day, paying particular attention to sensitive areas of skin that are vulnerable to weather exposure.”

According to the University of Bristol study, published in September 2023, there have been no studies comparing the effectiveness of different emollients in cold weather, and there’s no indication that the type of emollient has any effect on temperature-related eczema flares.

However, guidelines, patient charities and advice guides recommend switching to thicker emollients such as ointments in the winter months.

Professor Flohr says patients may need to try several different products to see what works for them. “‘Complete emollient therapy’ is the mainstay of treatment for all patients with eczema,” he says.

“This means regular application of a moisturiser, especially when they are outside during a cold day. It may also be helpful to wash with a moisturiser instead of soap (known as a soap substitute) and use a moisturising bath oil.”

Dr Mary Sommerlad, consultant dermatologist and British Skin Foundation spokesperson, says pharmacists should remind eczema patients to use around 500g to 1kg of emollient per week.

“This equates to moisturising top to toe in a downward direction two to three times per day,” she says. “Ideally recommend moisturisers that also contain lipids, especially ceramides which help maintain the integrity of the skin barrier.

“Encourage people with eczema to see their GP or dermatologists if they are missing work/school or have any other impacts on quality of life, as they may need prescription medication.”

Self-help

To reduce the risk of dry skin flare ups during the winter months, the National Eczema Society recommends the following general tips:

• Keep all the rooms in the home at a regular temperature (18°C is ideal).
• Wear thin removable clothing layers.
• Place a bowl of water near radiators to humidify rooms.
• Open windows every day to air the room.
• Damp-dust hard surfaces, and vacuum carpets and other soft furnishings regularly.
• Choose soft, seam-free fabrics for hats, scarves and gloves.
• Wear 100% cotton fabrics close to the skin where possible (e.g. underwear, nightwear, tights and socks)
• Maintain a good daily skincare routine to help keep skin clean and keep it hydrated.