Pharmacy expert Deborah Evans shares advice for pharmacy staff supporting patients with winter skin conditions

15th January 2018

In category | Blog

The pharmacy team are well placed to engage with customers about how to effectively treat winter skin conditions but to do so, need to have knowledge and confidence. Health Champions and healthcare assistants can put together winter skin displays which will creatively engage the public and some manufacturers produce leaflets to further advise. It can be helpful to have someone take the role in leading a winter skin campaign and to involve their colleagues in finding innovative ways of raising awareness in the pharmacy. They can combine this campaign with good health promotion messages around eating plenty of fruit and vegetables, increasing oily fish and foods rich in omega oils, keeping hydrated, reducing alcohol and caffeine as well as keeping active. All of which, support a healthy skin.

Letting the team sample products can also be very effective in getting their support to promote specific brands, if they can become advocates for products then customers are more likely to take their advice and make the purchase. Below, I offer advise for pharmacists when advising patients on the most common patient queries during the winter season.

A customer who suffers from a dry and flaky scalp in winter

A dry and flaky scalp can have a number of causes including seborrheic dermatitis, psoriasis, eczema, poor nutrition, dehydration (caused by central heating in Winter) and too much shampoo. Simple changes can help such as avoiding over-hot water, rinsing shampoo fully from the scalp and avoid using heat when styling the hair. Stimulating the scalp by massage, particularly with an oil such as olive, coconut or Bio-Oil, can help. Use gentle circular motions and leave in the scalp for around 45 minutes, wrapped in a warm towel.

If the dry, irritated scalp is caused by an overgrowth of yeast on the skin, then a medicated shampoo can help. The rash can be red and with greasy looking skin flakes. Anti-dandruff shampoos containing agents such as zinc pyrithione, selenium sulphide or ketoconazole can be used regularly. For best results, wash into the scalp, then wait 5-10 minutes before rinsing. Thick scales can be removed before shampooing by applying a descaling preparation containing coconut oil and salicylic acid for several hours or overnight. This can be messy, but it usually works well. The pharmacist can help further if the dandruff is particularly persistent.

A customer who suffers from tight, dry and itchy skin during the winter months

Many of us get dry and itchy skin, particularly in the winter when we wear more clothes and our skin is challenged by both cold weather and central heating. When we scratch our skin to relieve an itch, then we stimulate release of chemicals called histamines and these further cause itching. We end up in a cycle which can leave our skin raw and cracked. Preventing the skin from getting to this sore, itchy and broken state is far better than cure, so moisturise the skin frequently throughout the day and especially after a shower or bath when the skin is still moist. Use mild soaps or bath oils and avoid any alcohol based products which can dry it out further. In severe cases, an anti-histamine tablet can help break the itch-scratch cycle.

A customer who suffers from chapped skin particularly on their lips, nose, cheeks

Cold weather can cause the skin to get chapped especially on areas that are exposed to extreme weather and the skin can become cracked, sore and even bleed. Open skin, especially on the mouth can become infected and take time to heal, so prevention is key. As soon as the weather starts to turn, get into the habit of using a lip balm or oil whenever going outside, and avoid licking your lips which can dry out the delicate skin further. Use moisturiser with a minimum of SPF factor 15 on the face, and cover up as much as possible when the weather is really cold. Keep hydrated with 6-8 glasses of water and avoid spicy foods when your lips are cracked as this can hurt and make any inflammation worse. Speak to the pharmacist if you think there is a cold sore or the area Is becoming infected.

A customer who suffers from dry and cracked hands and feet during the winter months

Dry, cracked hands and feet can be very painful and can get worse during the winter months when extreme weather conditions and central heating dry out the skin further. Keeping the skin moisturised with regular applications of an emollient or product such as Bio-Oil helps to prevent the skin cracking. Use at least twice a day, morning and evening and after washing your hands to avoid the skin drying out. Avoid harsh soaps and especially those containing an antibacterial or alcohol as these can further irritate the skin. Products containing a minimum of 10% Urea can be very helpful for cracked feet, and if the skin is itchy and inflamed then a mild steroid cream applied for up to two weeks can help reduce the irritation. The key to healthy skin on the hands and feet is to use products regularly and consistently. Sleeping in cotton gloves and socks can also help after applying the oil or moisturiser and avoids walking with slippery feet!

A customer who suffers from dry and brittle cuticles

Dry, brittle cuticles can result from nail biting that damage the bed on which the nail grows and can lead to the nails not growing properly and infections under the nail and discolouration. Nail conditions can also be a sign of a severe lack of nutrients such as iron deficiency or a thyroid problem, so do speak to your pharmacist if you’re concerned. With many of us using gel nail varnish, this can also lead to weaker nails as the varnish and removal can dry out nails further. Taking care of nails with proper manicure methods and moisturiser helps to keep them healthy. Keep nails and cuticles clean and dry after washing, clip dry hangnails (don’t bite them off!) and rub an oil, such as Bio-Oil, directly onto dry cuticles and nails, at least twice daily.

A customer who suffers from an itchy winter skin rash after being out in the cold for too long

The extremes in temperature from freezing cold to heated homes and offices in winter can bring with it an itchy rash for some people during the winter months. The lower humidity in the air and cold temperatures contribute to the dryness but we don’t help ourselves with long hot showers and baths. Hot water strips our skin of essential oils and the outer layer of skin, decreasing moisture in the lower layers of the skin. Using strong fragranced soaps, bubble baths and other chemicals can further add to the problem. Check also washing powders; strong biological versions can make itchiness worse as we layer on the clothing.

The rash with small bumps and itchiness is mostly caused by having a dry skin and so avoiding the skin getting dry in the first place is the best treatment. Cut showers down to a maximum of 10 minutes and only have one per day and lower the temperature and time spent in the bath. Use a moisturising oil, cream or lotion liberally after patting yourself dry from the shower or bath. If the rash is particularly bad in some patches then apply a hydrocortisone cream, available from the pharmacist, sparingly twice daily. Avoid scratching the area and if the rash doesn’t go away or worsens, you have joint pain or fever with a sore throat or the rash develops after a new medication, then speak to your pharmacist or doctor.

A customer whose skin becomes more oily as opposed to dry during the winter months

Our sebaceous glands in the skin produce oil to keep our skin supple and protected from microbes which cause infection however they can become overactive. Common causes of this over-activity include our genetics, diet and hormonal changes. Environmental changes can also trigger oil production and this can happen more for some people in the winter – our bodies kick up oil production in response to drier, centrally heated air.

It can be tempting to use stronger soaps or medicated cleaners when skin becomes oily however this can over-dry the skin even more and make it red and irritated. Instead use gentle cleaners and moisturisers to keep the skin hydrated so that the sebaceous glands don’t need to work overtime. Some people don’t think of applying an oil to oily skin, yet a product such as Bio-Oil can be really helpful as it contains Vitamin A and is non-comedogenic which means it does not cause acne or spots.

A customer whose skin is prone to becoming red and sore during winter

Many people get dry skin leading to irritation during the winter months however there are a number of conditions which may be the cause of red and sore skin. Three common conditions which can get worse in winter include eczema, folliculitis and rosacea.

Red, itchy and dry skin patches are usually eczema or dermatitis and commonly found on face, hands and feet. Hydrocortisone cream and regular application of emollients can help reduce the symptoms. Folliculitis is a bacterial infection causing red, painful and inflamed hair follicles and is commonly found on the face, scalp and groin. Shaving is a common cause.  An antibacterial soap used twice daily can help, together with a product containing lavender oil, such as Bio-Oil, or tea tree oil. Rosacea can flare up in susceptible people due to sudden temperature changes and is commonly seen as a butterfly shape rash across the face on the nose and cheeks. Avoiding triggers can reduce the severity of this condition but it frequently requires an antibiotic gel or cream from the doctor.

Winter skin tips for all of the above conditions include moisturising regularly to avoid dry skin, especially on the face, hands, feet and elbows, and staying warm to protect the skin. Wear gloves, hats, scarves to protect areas that get exposed.

Be aware of trends and important issues in the Winter Skincare market

Pharmacies should and do consider seasonality in the range of products that they stock and this is true for winter skin care. The local market should be evaluated for opportunities including looking at the local populations needs, whether their needs change during the winter if they travel abroad for example and local demographics such as age and income.

Some conditions worsen in winter, such as prevalence of cold sores, chapped lips, dandruff and dry irritated skin, and so consideration should be given to stocking both effective and market leading brands. Protection from colds and flu means that more people will consider a hand rub, but should also be advised to moisturise as the alcohol can further dry the skin.

Advice on how to build a good winter skin conditions category in the pharmacy

Getting the team involved early is critical to building a profitable winter skin conditions category so that everyone agrees that it is important and how to support. Do your research into your customers and what they want and the other local facilities they use – what does this tell you about them? Identify which are the market leaders in the different aspects of skin care and what local competitors are offering so that you can optimise your stockholding. It is tempting to hold large ranges and many different variants and sizes, but if yours is a small pharmacy then rationalise the stock into the most commonly used products and avoid over-stretching the range. Promotions can help but be aware of the value associated with the advice you provide and that price is not always the driver for product choice. Receiving excellent advice and the personal touch creates value and means customers are frequently happy to pay the full price for a product and choose a brand rather than a generic.

When considering where to promote and place your winter skin conditions range, look at your pharmacy layout from a customer’s perspective. Give more space to faster moving products and consider discontinuing the slower lines; stock rationalisation is becoming increasingly important to avoid tying up cash in stock that does not move.

Key questions for you and your team to consider are: how do we optimise our customer’s experience and make it easy for them to buy; what can we do to make their experience the best it can be and; does our pharmacy environment promote the professional advice and support a customer can expect from us?

Training for pharmacists to support people in self-caring for their skin

Like any topic, there is always something new to learn and having seen the Bio-Oil professional series, I would recommend the resources as being very relevant for pharmacists to help them empower patients to self-care for a range of skin care conditions.

Complimentary CPD training for pharmacists:

Bio-Oil Professional a complimentary training for pharmacists on the topic of managing scarring in primary care, with a certificate sent upon completion:

Resources for your patients:

Deborah Evans

This article was written by: Deborah Evans

Deborah is considered a national pharmacy leader and is an elected member of the English Pharmacy Board and Fellow of the Royal Pharmaceutical Society. She led the national, award-winning Healthy Living Pharmacy (HLP) pathfinder work programme. Her professional achievements include being made a Fellow of the Royal Pharmaceutical Society, Faculty Fellow of the RPS and visiting senior lecturer at King’s College, London. Deborah feels it is important to connect with patients and still works regularly in community pharmacy connected to a GP surgery.


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