Winter weather can be a pain for people with skin conditions such as eczema and psoriasis. For the rest of us, it can result in dry, itchy skin that needs to be kept in good condition. Steve Titmarsh explains…

Winter weather, particularly in northern climes, can adversely affect skin making it dry and itchy, and cold, dry conditions can exacerbate existing skin conditions such as atopic dermatitis.¹

Skin structure

The epidermis of the skin consists of five main layers – stratum basale, stratum spinosum, stratum granulosum, stratum lucidum and stratum corneum.

The stratum corneum is the outer layer and is made up of a complex structure of 20–30 layers of cells, as well as proteins and lipids that protect against ingress of micro-organisms and allergens.²

The structure also prevents too much water loss through the skin. Intracellular hydrophobic lipids and other molecules, including amino acids, organic acids, urea and inorganic ions together known as natural moisturising factors, are important in keeping the skin properly hydrated along with the barrier function provided by the thickness of the stratum corneum.^1,2

Effect of a cold dry environment

Low relative humidity has been found to result in skin that is more susceptible to mechanical stress and fracture than in conditions of high relative humidity, and healthy skin becomes dry in conditions of low humidity.¹

Lipid levels in the stratum corneum are lower in winter than in spring, for example, and it has been suggested that lower levels of lipids can have an effect on skin hydration such that it disrupts the skin’s barrier function.

The thickness of the stratum corneum increases in winter and number of skin pores is lower in winter compared with summer.³ Skin elasticity is also reduced in dry conditions.¹

Those working in dry environments – aircraft cabin crew, for example – have more skin symptoms on their face and hands than people who work in offices, for example. And symptoms are reported to improve among office workers when air humidification is introduced.¹

The effect of environmental conditions on skin complaints has been reported in the scientific literature since the 1890s. Skin chapping due to high barometric pressure was studied as far back as the 1950s.

It is thought that high pressure forces water out of the epidermis, drying the skin and leading to chapping. Also during winter the level of lipids in the stratum corneum falls and there is a rise in unsaturated fatty acids; the pH of the stratum corneum rises and skin becomes stiffer and levels of elements that make up the natural moisturising factors – potassium, lactate, sodium and chlorine – have been found to be lower.

An increased reaction to irritants alongside drier skin seems to mean that skin is more fragile and permeable during the winter.¹

The overall risk of a flare-up of conditions such as atopic dermatitis is greater during cold and dry conditions is increased for some people.

Skin irritation has also been associated with changes in climatic conditions, for example and association between dermatitis caused by physical irritants and low humidity, and contact dermatitis being seen more often during the winter months.

Effect of winter weather on some skin conditions

Chilblains

Areas of redness, swelling, pain and itching, most commonly affecting the fingers, can result from repeated exposure to damp, non-freezing cold.⁴

Chilblains will usually clear up without treatment. A GP visit may be needed if they do not. Symptoms can be reduced by avoiding cold temperatures by wearing warm clothing, and taking an analgesic for pain if needed.

However, people should be advised to resist applying heat directly to affected areas in an attempt to warm up because that can make symptoms worse.⁵

Psoriasis

Psoriasis can present as red, flaky, crusty skin patches covered with silvery scales. The patches usually appear on elbows, knees, scalp and lower back, although any area of the body can be affected.⁶

Changes in the weather can affect psoriasis – some people say their disease is worse in winter, for example.⁷

Emollients help moisturise the skin and reduce water loss. These products are the mainstay of treatment for mild disease.⁶ Applying emollients in generous amounts can help reduce itching and redness. Fragrance-free products are preferable.⁸

Other strategies that can help manage psoriasis during the winter in particular include:⁷

• Take warm showers as hot water can dry the skin; using an emollient as a soap substitute can also be beneficial.
• Cotton or silk clothes may be better than those made from artificial fibres as they are less likely to rub or irritate the skin.
• Drink plenty of water to keep skin hydrated.
• Central heating can be drying so using a humidifier or putting a bowl of water near radiators can help add moisture to the air.
• Some people who find their psoriasis is worse during the winter months may need additional help from their GP such as increased dosages of prescribed medicines they may be taking for their psoriasis.

Eczema

The relationship between cold and the risk of flare-ups of eczema (atopic dermatitis) is well documented, with dry skin contributing to the risk.⁵ Extremely dry skin coming into contact with chemical allergens such as those found in shampoos or cleansers can also raise the risk of a flare-up in people with eczema. Other allergens such as house dust mite can also trigger eczema, as can pollens, moulds and dander from pets.⁹

Spending more time indoors during cold weather may increase exposure to these. Avoiding triggers and applying emollients every day can help control symptoms. Topical steroids may be needed for some flare-ups.⁹

A generous application of an emollient before going out in cold weather can reduce the risk of a flare-up.⁵

Conclusion

Problems with itchy, dry, red skin can be worse in the winter months when the cold can dry the skin making it more vulnerable as a result of being more permeable and fragile.

In addition, people with existing skin conditions such as eczema and psoriasis find their condition may be worse during the winter months.

Keeping skin hydrated by using emollients and avoiding cold exposure by dressing in warm clothing can help reduce problems that winter may bring for our skin.

References 

1. Engebretsen KA, Johansen JD, Kezic S, et al. The effect of environmental humidity and temperature on skin barrier function and dermatitis. J Eur Acad Dermatol Venereol 2016 Feb;30(2):223–49.
2. Yousef H, Alhajj M, Sharma S. Anatomy, Skin (Integument), Epidermis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 (www.ncbi.nlm.nih.gov/books/NBK470464/#; accessed October 2023).
3. Camilion JV, Khanna S, Anasseri S, et al. Physiological, Pathological, and Circadian Factors Impacting Skin Hydration. Cureus 2022;14(8):e27666.
4. Danzi DF. Nonfreezing tissue injuries (www.msdmanuals.com/professional/injuries-poisoning/cold-injury/nonfreezing-tissue-injuries#v1114858; accessed October 2023).
5. Patient.info. Dry skin in winter: what cold weather can do to your skin (https://patient.info/news-and-features/what-winter-weather-can-do-to-your-skin; accessed October 2023).
6. NHSinform. Psoriasis (www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/psoriasis#treating-psoriasis; accessed October 2023).
7. Psoriasis Association. Tips for managing psoriasis (www.psoriasis-association.org.uk/news/cold-weather-tips; accessed October 2023).
8. National Eczema Association. Eczema causes and triggers (https://nationaleczema.org/eczema/causes-and-triggers-of-eczema; accessed October 2023).
9. Patient.info. Atopic eczema (https://patient.info/skin-conditions/atopic-eczema; accessed October 2023).