Pharmacist Deborah Evans explains what is behind the dry skin that so many people experience and offers her advice for pharmacy staff on how best to support patients.

Dry skin may affect more people than we realise.  According to the British Skin Foundation, 60% of the UK population suffer with a skin condition every year and 70% have visible skin conditions that affect their confidence.¹ Despite hundreds of people going into a pharmacy every day, many people are still visiting a general practitioner with a skin problem, with common reasons being skin infection and eczema.

Identifying dry skin

Dry skin is another common condition which can lead to more troublesome skin complaints if left untreated. It’s usually caused by insufficient oil production in the skin, causing the top layer to dry out. This means that the natural barrier function becomes compromised resulting in moisture loss, which can lead to flaky, itchy or even cracked skin. In turn this can cause inflammation, irritability and potential infection as the skin’s ability to function as a barrier is compromised. The most vulnerable areas are those with fewer sebaceous glands – such as the hands, arms and legs. The ankles and soles of feet are also prone to dry skin.

It is usually straightforward to identify dry skin by its dull or red/pink colour, peeling, flaky texture and inflammation. If a person has repeatedly itched their skin it can appear thicker (lichenified) and may be darker or lighter than the surrounding skin.

Causes of dry skin

There can be a number of causes and these should be explored with the individual alongside a wider discussion on things for them to consider that might help to prevent the condition from returning.

Dry skin can be caused by both internal and external factors. These include:

• Lack of sebum on the skin; this is especially relevant with certain skin types (fair skin) and in the very young and as we get older
• Cold temperatures, heating, hot water, detergents, washing and bathing products, swimming in chlorinated or salt water, air travel
• Dehydration caused by not drinking enough water
• Health conditions that make people more prone to dry skin such as diabetes, hypothyroidism, menopause and hormonal imbalances, eating disorders and malnutrition, kidney disease, dialysis, atopic dermatitis, psoriasis, chemotherapy
• Medicines including diuretics such as hydrochlorothiazide or furosemide, retinol, cholesterol medication like pravastatin, simvastatin and Isotretinoin.

Questions to ask patients

When considering the most appropriate treatment for dry skin, healthcare professionals working in primary care, such as pharmacists and nurses, are well placed to support patients with dry skin by asking questions such as:

• What does your dry skin look like, (e.g. smooth or dry to touch/ what colour is it/ how does the dry skin appear – i.e. in patches)?
• How long have your been experiencing dry skin? Is this a long term problem or has there been a new trigger, i.e. medication or a certain product?
• How does your skin feel (e.g. does it feel itchy or tight?)
• Does your skin change after exposing it to certain situations, such as cleansing or washing?
• What makes your dry skin better?
• What makes your dry skin worse?
• When does your dry skin trouble you the most?

Considering your daily routine:

• How many glasses of water do you drink a day?
• What foods form a regular part of your diet?
• How often and for how long do you bathe or shower? What temperature is the water?
• What type of skincare products do you use (e.g. moisturising creams, soaps & shampoos)? Are they scented? Do they include ingredients such as SLS or alcohol/perfume?
• Do you have any pre-existing health conditions or are you taking any medications? If so, list them here.
• How long have you had dry skin and what do you think are the causes?
• How have you treated it previously?
• What would you like to try?

These questions help us establish more about the individual’s condition and what is likely to motivate them when managing it. Prevention and early intervention is critical to maintaining the integrity of the skin when it is prone to dryness, rather than waiting until things get really bad. This requires the individual to regularly and consistently apply skin products, even when their skin appears to be normal.

How to treat dry skin

There are three important aspects to consider when hydrating dry skin:
Treating dry skin, very dry skin and dry skin conditions requires a combination of particular components to hydrate skin optimally.

1. Occlusive agents – substances, such as oils and butters, which form a protective layer on top of the skin.²
2. Humectants – draw moisture into the skin. Glycerin is an example of a humectant.³
3. Emollients – help to improve the appearance of dry skin by filling in open spaces left by flaky skin cells, leaving it feeling smoother. ⁴

Self-care advice for patients

Alongside finding the right product or products for managing dry skin, the following advice can be very helpful to support your customer:

• Drink plenty of water throughout the day, avoiding too much caffeine and alcohol which can be dehydrating
• Give your body the right mix of vitamins and minerals for healthy skin (such as zinc, vitamins A and C) by eating a diet that is rich in green leafy vegetables, olourful fruit and seeds. Oily fish is also a rich source of omega-3 fatty acids which is necessary to keep skin thick, supple and moisturised. You could additionally consider a probiotic as there is an increasing link between gut health and the skin.
• Avoid extremes in temperature so wrap up warm in the cold and avoid ramping up the thermostat; avoid sitting close to heat sources such as open fires and fan heaters
• Use a product designed to support all elements of dry skincare at least twice a day and definitely after a shower or bath; use gentle circular motions when applying products
• Avoid products that are harsh on the skin, highly perfumed or contain sodium lauryl sulphate
• Try not to scratch as this disrupts the integrity of the skin and increases itching
• Recognise stress and anxiety and take steps to reduce these.

As pharmacists and pharmacy team members, we can play a significant role in supporting our customers to have healthy skin.

Resource to support healthcare professionals:

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 supporting healthcare professionals in their conversations with patients.

Download Dry Skin: Support and advice for healthcare professionals

Deborah Evans FFRPS FRPharmS FRSPH is Managing Director of Pharmacy Complete and a practising community pharmacist @pharmacycomplet @HLPharmacist. Deborah does not endorse any specific product or brand.

¹ https://www.britishskinfoundation.org.uk/

² Schandra Purnamawati et al. The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review 2017

³ Teresa M Weber et al. Treatment of xerosis with a topical formulation containing glyceryl glucoside, natural moisturizing factors, and ceramide. 2012

⁴ Runa Izumi et al. Efficacy of an emollient containing diethylene glycol/dilinoleic acid copolymer for the treatment of dry skin and pruritus in patients with senile xerosis