Winter can cause problems for skin, but with the right product recommendations and self care advice, pharmacy teams can help make things a lot better.
When winter arrives, the temperature drops, environmental humidity is low and keeping the skin happy and hydrated can become more difficult.
This is a particular problem for pharmacy customers who have conditions like eczema and psoriasis, and also poses challenges to people who suffer from cold sores and other skin complaints.
While dermatological symptoms often don’t receive much attention, they can cause significant discomfort and distress, and should be taken seriously. In fact, nine out of 10 dermatologists agree that not enough importance is placed on the psychological effects of skin conditions, according to a survey by the British Skin Foundation.
Prevalence is high, with one in 10 people being affected by eczema, according to the National Eczema Association. Altogether, one in four people are affected by a skin condition of some type during their lifetime, says the American Academy of Dermatology.
Dr Derrick Phillips, consultant dermatologist and British Skin Foundation spokesperson, explains that winter can worsen symptoms for some patients. He says: "Widespread use of central heating over the winter months reduces indoor humidity by drying out the air as the temperature rises. This can cause irritation and trigger flare-ups in patients with dry skin conditions such as eczema, psoriasis, senile pruritus and ichthyosis.
"The tendency for hot baths and showers during this period can further exacerbate these conditions as they strip essential oils from the outer layer of the skin, causing further drying and irritation."
With these problems in mind, let’s take a look at the various skin conditions pharmacy customers may have, and ask for help with, during the winter months.
As already noted, eczema is a common skin condition. However, it is important to appreciate that the reasons why it occurs can vary significantly. There are also many different types of eczema, although by far the most common is atopic eczema, which causes the skin to become dry, itchy, cracked and sore.
While people can get atopic eczema in different places on their bodies, it is most common on the folds of the skin behind the knees and elbows, and also on the scalp and face in children. Most people who have the condition develop it before their first birthday, but it can occur at any time.
Atopic eczema is an autoimmune disease and many people who have it will also have related conditions such as asthma or hay fever, or have a family history of the condition. It is generally considered chronic as there is no cure.
This and other types of eczema can be made worse by cold weather. In fact, it is more likely to be exacerbated by cold weather than warm, says Alice Lambert, head of services at the National Eczema Society.
"The winter gives rise to more circumstances in which the skin is likely to dry out," says Alice. "So, for example, if someone goes out and there’s a cold, dry kind of wind, that can be drying on the skin. Or when they’re inside and the central heating is on, that can be drying as well."
To combat the impact that the colder weather has on eczema, Alice says the National Eczema Society recommends not only using emollients more frequently, but also broadening the types used. "Using a thicker emollient, such as an ointment, may help," she advises.
Using a product that contains known moisturising ingredients such as glycerine or urea may also help.
The NHS recommends using corticosteroids during eczema flare-ups to keep them under control, and also to try to reduce scratching, which can make eczema worse and increase the risk of infection.
Alice says that people should also avoid sitting next to heat sources such as radiators and fires. "Don’t spend too long in the bath or shower (maximum 20 minutes in the bath)," she adds, "and use warm or lukewarm water instead of hot water."
She points out that there is another form of eczema that is more common in winter – discoid eczema. This is characterised by oval or round patches on the skin that can be very itchy. Treatments and self-care are similar to that recommended for atopic eczema.
Another chronic dry skin condition that may present in the pharmacy is psoriasis. It is also an autoimmune disease. However, it is quite different to eczema.
Psoriasis causes inflammation, which appears on the skin in the form of scaly plaques. It is thought that over-activity in the immune system speeds up skin cell growth, which causes cells to pile up on the surface of the skin and create plaques, which can be itchy and may sting. They can occur anywhere on the body, but most commonly appear on the elbows, knees and scalp.
The condition usually appears in adults under 35, but can develop at any age. As it doesn’t just affect the skin, one in three people with the condition can go on to develop psoriatic arthritis due to inflammation around their joints. People who suspect this is happening should seek help from their GP as soon as possible because whilst it can be mild, it can affect the joints if left untreated for too long.
Psoriasis can also be worse in the winter months, says Dominic Urmston, patient advocacy and communications manager at the Psoriasis Association. "Psoriasis is different for everybody. For some people, there is a greater likelihood of flare-ups in the winter," he says. "Factors that can cause this include the cold weather itself, which can be drying for the skin, and central heating at home drying the air out. Wearing more layers of clothing made from different materials in the winter may irritate the skin as well. However, this isn’t the case for everybody."
To combat problems that do arise in the winter months, Dominic recommends: "The most important rule really is to moisturise, to have a good moisturising routine, and that’s something that pharmacy teams can advise on because there are plenty of effective emollients available both over the counter and on prescription.
"Applying emollient regularly is key – making sure that the skin stays hydrated and moisturised. Pharmacists can advise that using an emollient can also help other active topical treatments that a person might be prescribed by their GP or dermatologist, to work more effectively. That’s a key healthcare tip and applicable at all times of year, but particularly in the winter."
Dominic also points out that the winter months can be challenging for some people’s mental health, and that people with psoriasis may have additional challenges with this. "There’s also the wider life impact of having psoriasis," he explains. "It’s not just the symptoms on the skin that people find difficult to manage, but also associated feelings of low self-esteem, embarrassment and stigma of living with a visible condition because there’s this misconception that psoriasis is contagious, which it is not. For some people, psoriasis can also flare up more with stress, so obviously there is a vicious cycle there too.
"We know that winter being what it is – the shorter days, colder weather, the dark – it has an impact on people’s mental health anyway. That coupled with your skin flaring up may cause further challenges for you in terms of your mental health."
People who have cold sores will often be aware of what triggers them. For many, it will be changes in the weather, such as the seasonal switch from autumn to winter and a 'cold snap'. This brings some meaning to being ‘under the weather’. Menstruation can also be a trigger for some people, as can stress or being unwell.
Cold sores are caused by a virus, and similar to eczema and psoriasis, they are a chronic condition: once a person has the virus, it stays in their system for life.
"Herpes labialis or the common cold sore is caused by infection by the herpes viruses (HSV1 or HSV2)," says Dr Phillips. "Following resolution of the initial infection, the virus persists in the nerve roots supplying the skin. The virus can subsequently travel down the nerves to the skin and induce cold sores."
Cold sores start with a tingle, often in a recurring site. Antiviral creams containing aciclovir can be recommended to treat cold sores over the counter. These are most effective when applied at this initial stage. If left untreated, over the next 48 hours, fluid filled blisters will appear, and they may take up to 10 days to resolve. However, people experiencing their first cold sore may have a more severe infection that lasts longer. If someone is worried that their cold sore has not healed after 10 days, or if it is very large or painful, refer them to the pharmacist.
No matter how big a cold sore is, it is important to realise that they are contagious. The virus can be passed on from the first tingle, so people should refrain from touching the area and kissing other people – and they should keep their hands clean, particularly before and after putting on any treatments.
Aside from aciclovir, there are creams you can recommend to ease pain and irritation, as well as patches which cover and protect cold sores while they heal.
If cold sores are particularly painful, customers can take paracetamol, ibuprofen or aspirin (although under-16s should not take aspirin and ibuprofen is not suitable for everybody).
Making sure to drink plenty of fluids to prevent dehydration is also important.
Other skin conditions
There are a number of other skin conditions that can be exacerbated by the cold, including chilblains and rosacea.
Dr Phillips explains: "Chilblains are tender, itchy, red/blue violaceous lumps that occur at distal extremities – for example, on the fingers and toes, following exposure to damp, cold, non-freezing conditions. They are caused by local inflammation in the blood vessels (vasculitis). Chilblains are more common in smokers, participants in winter sports and fishermen."
Chilblains can be prevented by keeping warm when out in the cold, and not placing hands or feet on warm surfaces such as radiators and hot water bottles, as this can aggravate or cause the problem.
If a customer does have chilblains, over the counter painkillers can be taken if they are painful, while creams can be applied to relieve itching and inflammation. Calamine lotion or witch hazel may also help.
Another skin problem that can be exacerbated by winter weather is rosacea. This appears as reddening of the skin on the face, leading either to a flushed look or broken blood capillaries that do not go away.
Rosacea is a chronic inflammatory condition that has many triggers, including cold air. To prevent flare ups, patients can be advised to avoid cold air by covering their face as much as possible when they’re outside, and not drinking hot drinks or alcohol, or eating spicy food. Wearing sunscreen of at least SPF30 every day may help some people too. Customers should use gentle skin care products, and green coloured creams can help to camouflage redness. For more severe cases, customers can ask their GP for a prescription treatment.
Could supplements help?
It isn’t just cold temperatures that can make skin conditions worse: cold and flu viruses can also leave people run down and more vulnerable to flare ups of chronic conditions. "Colds and flu tend to be more common in winter months and they can make eczema worse," says Alice Lambert, head of services at the National Eczema Society.
"There is limited evidence connecting vitamin D to an improvement in eczema symptoms," says Dr Derrick Phillips, consultant dermatologist and British Skin Foundation spokesperson. "However, vitamin D is good for general health, particularly bone, teeth and muscle health. So we would recommend that people with eczema follow the Government’s advice to consider taking a daily vitamin D supplement during the autumn and winter."
The effect of overall health is important to bear in mind for cold sores as well, adds Dr Phillips. He explains: "Cold sores can be triggered by UV exposure and emotional or physiological stress – for example, illness. Cold weather per se is not a trigger for cold sores. However, the physiological stress caused by respiratory viruses over the winter months can lead to flares."
This reinforces how important it is to look after the health of the patient as a whole, in order to help them with their skin during winter, or indeed at any time of the year.