Combatting winter skin woes

From dry skin to eczema: How pharmacies can support patients this winter. Ade Williams and Safa Karma Jilal from Bedminster Pharmacy explain…

Winter has always brought a significant influx of patients to community pharmacies for skin-related conditions, even before the introduction of the Pharmacy First Service.

The skin is our protective natural barrier to environmental changes. It defines our identity, providing us with self-esteem and confidence. As the temperature drops in winter, skin dryness increases; although this can happen year-round, it tends to worsen with the cold. The most common problem is dry skin, which occurs when the skin fails to produce enough sebum; this insufficiency makes it harder for the skin to retain moisture, leading to dryness and also making it easier for irritants like soaps to react with the skin, causing the skin become itchy and sore.

Ironically, the most common triggers that weaken this natural barrier, apart from the cold weather, include long hot showers and central heating!

Community pharmacy teams must take on the mission of educating and supporting our patients in protecting their skin during the winter.

Speak With Us, We Can Help

So how can community pharmacy teams help patients with dermatological conditions, like common eczema, which we often see during the cold weather? A face-to-face or excellent video consultation in a suitable consultation room ensures privacy and comfort for the patient. The setting must be professional and culturally inclusive in a manner that is vital to help inform diagnosis or consider the best suitable support.

Consider and address any communication/language, the emotive nature, and whether a same-gendered dialogue would work better for the patient.

Assessing The Rash

A key step is examining the rash.

The NICE clinical guidelines have different categories when considering eczema:

1. In adults, the rash is primarily found on the hands and is characterised by intense itching and visible dryness.
2. In children and adults with chronic pathological conditions, it is localised in the flexures of the limbs.
3. In infants, it is more common on the face, scalp, and extensor surfaces of the limbs.

After carefully considering the patient's history, combined with appropriate knowledge of skin conditions and evidence-backed solutions, appropriate treatments will be possible in a shared care decision.

Talking of appropriate knowledge, how confident are you in examining the skin of different colours, especially from various racial backgrounds?

Problems with diagnosis and misdiagnosis of patients, especially children from brown/black backgrounds, have resulted in a plethora of educational resources for health care professionals like community pharmacy teams to educate and equip us better. Not only is this addressing the health inequity that we know racial difference collates with, but it also makes the patient more confident to take our advice.

No one should apologise or be apologised that their skin is not the same colour as the images from the dermatological reference source, "so here is our best guess"!

If eczema is the differential diagnosis, the key message is always the importance of using moisturisers at least three times a day, even when symptoms are under control. Similarly, it is vital to guide the patient toward using fragrance-free, hypoallergenic soaps to avoid triggers of inflammation and itching.

Take extra care to listen and inquire about the patient's preference, including failed treatments in the past, so you offer options that aim for dermatologically proven and cosmetically acceptable solutions. This applies to everyone, especially female patients, and our knowledge should enable this outcome. Try to ensure that the entire team is competently trained to do this. This is an opportunity for team learning, especially understanding different skin types, the impact of the hormonal cycle on the skin, and the factors that influence skin care regime choices.

However, the skin may sometimes flare up even with the appropriate use of emollients.

In such cases, it may be appropriate to guide the patient to use creams containing steroids, such as hydrocortisone 1%. It is essential to note the clinically relevant and licensing restrictions related to using over-the-counter steroid creams to treat eczema.

Commonly, the patient should be referred to a general practitioner if the eczema affects the face or neck.

Steroid cream should be applied twice a day as soon as a flare-up appears for a maximum of seven days. If the eczema does not resolve, this is another reason to refer the patient to the general practitioner.

Also, remember the effect of occupational settings on the skin during winter.

Patients who work outdoors or sit in offices with air-circulatory heating systems. We must be ready to advise across age groups; parents with young children with skin conditions are battling throughout the year, so be prepared to offer them expert input even if reinforcing the advice already provided by another healthcare professional.

When To Refer To The Doctor

1. Flare-ups that do not resolve/improve with OTC treatment
2. Eczema covering the face and neck if not indicated for OTC/PGD treatment
3. Rash showing signs of infection, such as clusters of blisters
4. Rash suddenly worsens or spreads
5. The patient has a high temperature or feels generally unwell.

Authored by Ade Williams MBE, Superintendent Pharmacist at Bedminster Pharmacy, and Safa Karma Jilal, Community Pharmacist at Bedminster Pharmacy.