Association of Pharmacy
Technicians UK (APTUK)
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Skinformation

Our skin takes a beating in winter, with fluctuating temperatures and harsh winds leaving it feeling dry and uncomfortable and exacerbating common skin conditions

When the weather outside is frightful, but the fire (or central heating) is so delightful, nothing quite beats the thought of cosying up on the sofa. But while this may do wonders for our comfort levels, it comes at a cost to our skin.

Winter woes

The skin has three main functions: protection, regulation and sensation. Above all, it’s the body’s first line of defence against the elements. Dr Emma Wedgeworth, consultant dermatologist and British Skin Foundation spokesperson, explains: “There’s a misinterpretation that the skin is just a thin layer of cling film, but it’s actually a multi-layered, dynamic and very complex organ. When there’s low humidity, temperature drops and other changes in weather, the skin undergoes transepidermal water loss and dries out. It happens particularly in centrally heated houses.” 

This dehydration means that the skin’s barrier layer becomes damaged, making dry, rough and sensitive patches of skin more likely. The changing weather and moving from cold outside air to centrally heated buildings also causes blood vessels in the skin to change size rapidly to account for the fluctuating temperature, which can leave the skin looking flushed, red and weather beaten. People with long-term skin conditions such as eczema, psoriasis and rosacea will suffer the most, as their skin’s barrier layer is already fragile and therefore prone to reacting to these environmental triggers. 

But it’s not just the winter weather that can cause skin conditions to flare up. Allergens such as house dust mites can also make symptoms worse for some eczema sufferers, and these creatures are more prevalent in winter as central heating offers them the perfect breeding environment. Harsh alcohol- or soap-based products can aggravate conditions such as eczema and psoriasis too. Chris Griffiths, professor of dermatology at the University of Manchester and British Skin Foundation spokesperson, explains that age can also exacerbate problems. “The older you get, the worse it gets because the skin loses its oils over time and becomes fragile as it ages,” he says. 

Fighting back

Since there are a number of different factors that can cause or worsen dry skin conditions, it’s important for people to be aware of their own triggers so that they can avoid them, or at least limit their impact. Dr Wedgeworth has the following top tips for managing and preventing dry skin:

  • Turn the heating down a degree or so. This not only saves money, but also improves skin condition by keeping it more hydrated
  • Avoid incredibly hot baths or showers as these have a similar sort of drying effect as central heating
  • Think about what’s used on the skin. Naturally, the skin is very acidic and if we alter its pH and make it more alkaline with harsh soaps, shower gels or anything that foams significantly, then its barrier function starts to break down. It’s important therefore to cleanse the skin with a soap-free wash
  • Recommend unfragranced moisturisers to help to compensate for any barrier abnormality and water loss.

Other self care measures include avoiding materials such as wool and synthetic fibres next to the skin as these can scratch and irritate it. Instead, customers should opt for softer fabrics such as cotton. And although scratching can offer immediate relief to dry and itchy skin, it can lead to further breakdown of the skin’s natural barrier, which exacerbates irritation and skin damage so should be warned against.

Emollients should be used for first line treatment and prevention. “Emollients are used to try and compensate for the barrier loss and also put back in a bit of the hydration that the skin might have lost,” explains Dr Wedgeworth. 

Emollients work in two ways – they make the skin feel more comfortable and improve its appearance, and they help to reduce irritation and itching. Dr Wedgeworth explains: “Shea butter is a very intensive moisturiser, urea is quite good for significantly dry skin, and lauromacrogol can help with itching, so those are some of the types of ingredients that should be considered.” 

Emollients are available as lotions, creams and ointments, as well as shower and bath products and soap substitutes. Customers may prefer certain types or like to use a combination to achieve the greatest benefits.

The ideal regimen

“People like messages which are ‘one size fits all’, but in fact, this can’t be the case,” says Dr Wedgeworth. “That’s because everybody’s skin is made in a different way and the dryness of the skin is genetically determined. Some people can get away with not putting any moisturiser on and it’s not a regular part of their routine; people with basic dry skin should find once a day sufficient, and some people find that they need to use something multiple times a day, so it really depends on how they’re responding,” she continues.

Dr Wedgeworth recommends regularly monitoring the skin and reacting appropriately. “I think it’s a complete fallacy, particularly around facial skincare, that women and men are indoctrinated with that ‘cleanse, tone, moisturise’ message,” she says. “But actually, I say to people: ‘look, if you have oily skin, you don’t necessarily need to apply a moisturiser all the time. If you’re starting to get very red, dry, itchy skin, you may find you need to start applying moisturiser or apply it more often’.” 

The bottom line is, says Dr Wedgeworth, supporting the physiological function of the skin in whichever way is appropriate for the person. 

That said, customers may wish to focus on individual problem areas, such as the hands, and give them an extra layer of protection. Professor Griffiths adds that people should moisturise as necessary, but should aim to moisturise exposed areas, especially the hands, before going outside. “In winter, the skin on the hands needs more intense moisturising and heavier moisturisers which are greasier and have more of a protective effect,” he explains. This is especially important as hand washing tends to be more frequent in winter in order to combat cold and flu viruses and this can strip away the natural oils that protect the skin, leaving it dry and sometimes cracked and painful.

Professor Griffiths concludes: “It’s a matter of making skin maintenance part of the everyday routine, particularly in the elderly, and carers too should be made aware of the importance of this. If nothing is done, skin becomes drier and leads to itching, which has a huge physical and psychological impact and can be quite disabling by affecting sleep and quality of life.”

Next steps

If flare-ups are severe, with the skin being dry, red, flaky, inflamed and not responding to moisturisers alone, then Dr Wedgeworth explains that using an anti-inflammatory cream like a mild steroid can help. OTC 1% hydrocortisone would be an example of this. “The pharmacy would be the first port of call for this,” she says. “People are always so worried about using steroids and it’s probably one of the main reasons we see failure of treatment because people are very worried. But actually, used under supervision and used carefully, they can be very successful and change things around,” she adds.

If severe dry skin is ignored or poorly managed then it’s likely to increase in severity, in which case, stronger anti-inflammatory steroids would be needed. It’s therefore advisable that customers try to tackle dry skin conditions as early as possible using self care measures and emollient therapy in the first instance.

Under the microscope

Eczema

According to the National Eczema Society, one in five children and one in 12 adults suffer from eczema, and Dr Emma Wedgeworth, consultant dermatologist and British Skin Foundation spokesperson, says it’s important to recognise that it’s not just a condition of childhood; people can develop eczema at any time.

Atopic eczema is the most common form of the condition. It can occur all over the body, but usually affects the hands and fingers, the insides of the elbows or backs of the knees, as well as the face and scalp in children. It’s characterised by itchy, dry, cracked, sore and red skin. There will usually be periods where the symptoms improve, followed by flare-ups.

Emollients are the mainstay of treatment and should be applied at least twice a day in downward strokes, following the direction of hair growth. For adults, an average of 600g per week is recommended. If the condition doesn’t improve, the skin is painful, cracked, bleeding or looks infected, or if severe eczema is on the face, the patient should be referred to the pharmacist. Topical corticosteroids can be used to reduce swelling and redness during flare-ups.

Psoriasis

Psoriasis is thought to be an immune condition and affects two to three per cent of the population. It speeds up the skin’s replacement process so it takes just three or four days to replace skin cells rather than the usual 21-28 days. This accumulation of skin cells builds up to form raised ‘plaques’ on the skin, which are red, flaky and covered with silvery-white scales. The knees, elbows, torso and scalp are most commonly affected. People with the condition can experience periods with mild or no symptoms, followed by flare-ups. Symptoms are often worse in winter, although as Chris Griffiths, professor of dermatology at the University of Manchester and British Skin Foundation spokesperson explains, it’s not really known why. Although some OTC treatments are available, it’s best to refer customers to the pharmacist.

Rosacea

Rosacea is a chronic relapsing condition characterised by repeated episodes of flushing, persistent reddened skin and spots on the face. Fair-skinned women aged between 30 and 50 years are the most commonly affected, and symptoms can be triggered by extremes of weather, stress, strenuous exercise, spicy food, caffeine, alcohol and hot drinks.

The exact cause is unknown and the condition cannot be cured, but long-term treatment can help keep the symptoms under control. Avoiding triggers is recommended, as is using sensitive facial skincare products. Customers with suspected rosacea should be referred to a GP for diagnosis and prescription of topical treatments. Oral antibiotics are prescribed for more severe cases and help to reduce inflammation of the skin.

Acne

Sebum is a natural oily substance that helps keep the skin moist and waterproof. When too much is produced, it can get trapped in the hair follicles, along with skin cells, causing a blockage which can lead to acne. In winter, layers of clothing can trap dead skin cells, irritating the skin and leading to breakouts in acne-prone skin. 

There is no cure for acne and treatment options depend on the severity. Mild acne can be treated with OTC products containing ingredients such as benzoyl peroxide, nicotinamide, salicylic acid and salicylates. Customers suffering from acne should be advised not to squeeze or pick at spots as this can cause scarring. An exfoliant scrub used weekly will clear skin of the build-up of dead skin cells that can clog hair follicles and cause spots, and washing the skin with a gentle cleanser twice a day, avoiding very hot water, and patting the skin dry with a clean towel can help.

Cold sores

Cold sores are caused by the herpes simplex virus and usually start with a tingling or burning sensation on the lips or around the mouth, before developing into small, fluid-filled blisters. About 70 per cent of the adult population is infected with the virus, but only a quarter suffer regularly from cold sores. Triggers such as having a cold or flu, being upset or under stress, and being in strong sunshine or cold weather for any length of time can activate the virus. It is also highly contagious and can easily be passed on from person to person.

Cold sores usually clear up by themselves without treatment within seven to 10 days, but antiviral creams containing aciclovir or penciclovir are available OTC. These may ease symptoms and speed up healing time. They are most effective when applied at the initial tingling stage.

In winter, the skin on the hands needs more intense moisturising and heavier moisturisers which are greasier and have more of a protective effect



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