Influenced by environmental factors, winter can be a particularly challenging season for many patients suffering from eczema.

Clinical observations and several studies indicate that a significant number of eczema patients experience a worsening of symptoms during the winter months.^1,2 This increase in prevalence during winter underscores the need for heightened awareness and proactive management strategies. 

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterised by itchy, red, and dry skin. It affects people of all ages but is particularly common in children.² 

PATHOPHYSIOLOGY 

Eczema is primarily a result of skin barrier dysfunction and an abnormal immune response. The skin's ability to retain moisture is compromised, leading to dry and cracked skin that is susceptible to irritants and allergens. During winter, the reduced humidity and cold air exacerbate this barrier dysfunction. Individuals with eczema have an overactive immune response to environmental triggers. In winter, increased exposure to indoor allergens, such as dust mites and pet dander, can further stimulate this immune response, leading to inflammation and itchiness. ² 

TREATMENT STRATEGIES 

Effective management of eczema, particularly in winter, requires a multifaceted approach. 

1.Emollients and moisturisers

The cornerstone of eczema management is the regular use of emollients and moisturisers to restore the skin barrier and retain moisture.² 

• Frequency: Advise patients to apply emollients at least twice daily and immediately after bathing. 

• Types: Recommend thick creams or ointments rather than lotions, as they provide a better barrier against moisture loss. 

• Ingredients: Look for products containing ceramides, glycerin, or urea, which are beneficial for skin hydration.² 

2. Topical Corticosteroids

Topical corticosteroids are the mainstay for managing acute flare-ups by reducing inflammation and itchiness.^2,3 

• Strength: The appropriate potency is based on the severity and location of the eczema.² 

• Duration: Educate patients on the correct duration of use to prevent potential side effects, such as skin thinning.² 

3. Topical calcineurin inhibitors

For sensitive areas, such as the face and intertriginous zones, where corticosteroids might not be suitable, topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) can be effective. Advantages include:^2,4 

• Less risk: Lower risk of skin thinning compared to corticosteroids.^2,4 

• Long-term use: Suitable for long-term management of eczema.² 

4. Wet wrap therapy

For severe eczema flare-ups, wet wrap therapy can be beneficial. This involves applying emollients and wrapping the affected areas with wet bandages to enhance moisture retention and absorption of topical treatments.² 

PHARMACIST'S ROLE 

• Patient education: Pharmacists should educate patients on the importance of adherence to treatment regimens, proper application techniques for topical medications, and strategies to minimise triggers. 
• Monitoring and follow-up: Regular follow-up with patients is essential to monitor the effectiveness of treatment, manage side effects, and make necessary adjustments to the therapy plan.² 
• Collaboration with healthcare providers: Pharmacists should work collaboratively with dermatologists and primary care providers to ensure a coordinated approach to the management of eczema, particularly in complex or severe cases. 

Eczema management in winter poses unique challenges due to environmental factors that exacerbate symptoms. Pharmacists, equipped with comprehensive knowledge of treatment strategies and patient education, play a vital role in alleviating the burden of this chronic condition. By implementing effective management plans and providing continuous support, pharmacists can significantly improve the quality of life for individuals suffering from eczema during the winter month. 

REFERENCES 

1. Jonathan Chan, Stephanie J MacNeill, Beth Stuart, Y T Eunice Lo, Amanda Roberts, Dann Mitchell, Matthew J Ridd, Do temperature changes cause eczema flares? An English cohort study, Clinical and Experimental Dermatology, Volume 48, Issue 9, September 2023, Pages 1012–1018. Available from: https://doi.org/10.1093/ced/llad147 
2. Sroka-Tomaszewska J, Trzeciak M. Atopic dermatitis – intensification of skin ailments in autumn and winter. Lekarz POZ. 2020;6(5):259-264. Available from: https://www.termedia.pl/Atopic-dermatitis-intensification-of-skin-ailments-in-autumn-and-winter,98,42946,1,1.html 
3. C. Green, J.L. Colquitt, J. Kirby, P. Davidson, Topical corticosteroids for atopic eczema: clinical and cost effectiveness of once‐daily vs. more frequent use, British Journal of Dermatology, Volume 152, Issue 1, 1 January 2005, Pages 130–141. Available from: https://doi.org/10.1111/j.1365-2133.2005.06410.x 
4. H.C. Williams, Preventing eczema flares with topical corticosteroids or tacrolimus: which is best?, British Journal of Dermatology, Volume 164, Issue 2, 1 February 2011, Pages 231–233. Available from: https://doi.org/10.1111/j.1365-2133.2011.10205.x