The skin, comprising of three strata’s, encases most of the human body, rendering it the greatest bodily organ. The stratum corneum is the exterior layer of the epidermis, engendering it the initial interaction for the external environment. The stratum corneum operates as a penetrable yet defensive layer against external compounds, and also inhibits the loss of bodily fluids and electrolytes in order to ultimately guarantee the retainment of vital moisture and hydration within the epidermis. Though, the effective performance of the stratum corneum relies wholly on the integrity of its physiological constituents, and the colder months can have immense damaging impacts on these physiological components and hence the skin’s complete functionality and integrity can be destructively influenced, which highlights the gravity of prevention, protection and management of skin barrier elements in the colder seasons.
The bearing effects of winter on the skin
The winter season entertains an unforgiving impact on the skin’s typical integrity and health, irrespective of age or genetic predisposition. While research states the impediments may not be serious, a sizable emphasis has been placed on winter’s undesirable capabilities to diminish water retentive competencies and hydration levels within the skin, which conclusively pilot a reduced functioning stratum corneum. Consequently, the skin can befit as dry, irritated, erythematous, inflamed, cracked, blistered and pruritic, and what is more, in further unyielding cases where the skin has fissured, secondary bacterial infections may extant. Namely, research has offered numerous considerable causative factors donating to the skins compromised integrity when colder temperatures present, these involve;
-Central heating, such as wood burning stoves, fireplaces and heating units which power hot, dry air into the environment and then ensue lowered humidity levels
-Tight and restrictive clothing which may foster abrasive friction on the skin’s exteriors
- And finally, bathing and showering, as extreme hot water contact with the skin for extended periods of time can disrupt lipid barriers and instigate moisture loss within the skin.
Indications of winter’s influence on the skin’s integrity
While undoubtedly the exhibition and anatomical locality of Xerosis may diverge among age groups and individual health status’s, the central indicators encompass;
- Sensations of pruritis, tautness, stinging, tingling, burning and discomfort, and excoriations may also extant resultant of the sufferer scratching and rubbing with the purpose of easing the related itching and irritation
- The sufferer’s skin may lack lustre and bestow as thinner with associated erythema, inflammation, blisters, cracks, scaling, peeling and fine lines
- The subject's skin may also be rough, uneven, withered, and dry to palpate
- And lastly, it is noteworthy to also declare in more ruthless circumstances accompanying bleeding and secondary infections may display consequential of deep fissures that have reached the dermal capillaries.
Winter’s impact on already existing skin conditions
Studies propose winter, owing to its aptitude to impair the skin’s barrier, can either exacerbate already existing skin conditions or stimulate their onset. Research states both Eczema and Atopic Dermatitis, chronic inflammatory skin disorders, have the potential to intensify in winter. Both skin aberrations are depicted by dry, pruritic and inflamed skin, and fascinatingly both occupy an advancing incidence in countries distant from the equator, and what’s more, studies have also proposed a notable increase in their prevalence’s among children born during the colder seasons.
Further to this, skin conditions exclusive to winter can also develop, for instance Chilblains, which foster on the skin subsequent to exposure of cold climates. Chilblains universally emerge on extremities such as the nose, ears, fingers and toes, and are distinguished by minor, erythematous, pruritic and painful swellings which may blister or ulcerate. Chilblains consequentially appear due to small blood vessel restriction, once the skin reheats again the fluid from the blood vessels escapes into the tissues, ensuing both swelling and inflammation on the skins surface.
Prevention, protection and management for patients
It is essential to acknowledge that the damaging effects of winter on one’s skin can momentously influence the sufferer’s quality of life and pose limitations on their mundane affairs. Though fortunately, as Dermal Clinicians there are various ways to work collaboratively with patients to assist in the management, prevention and protection of their skin’s integrity during the colder seasons. The recommended preventative and management methods that patients can employ are outlined below;
- Avoidance of excessive bed clothes and electric blankets
- Avoidance of wearing wool and other irritating and abrasive fabrics, alternatively loose cotton and linens should be introduced
- The installation of a humidifier set at sixty degrees Celsius
- Avoidance of extended, hot showers, rather showers should be two-three minutes long and it is suggested the water temperature is to be tepid
- Avoidance of extended hot bath soaks
- Avoidance of rough bathing sponges, scrub brushes and washcloths that may trigger friction and irritation
- Avoidance of vigorous rubbing post shower or bathing, preferably the skin should be softly patted dry
- Avoidance of soaps, rather a pH balancing wash should be introduced
- Application of a moisturiser containing both humectants (ceramides, glycerine, sorbitol, hyaluronic acid and lecithin) and emollients (linoleic and lauric acids) to attract and enclose moisture within the skin
- Moisturiser should be applied generously and immediately after bathing or showering
- Application of a lip balm throughout the day and before bed to repair and hydrate
- Application of keratolytic’s such as salicylic acid, lactic acid or glycolic acid if there is extreme flaking
- Administration of oral antihistamines to control and lessen accompanying pruritis
- Avoidance of scratching and rubbing affected areas
- Avoidance of sweat inducing activities
To finish, it is profound to express that research affirms the devising of a prevention and management plan must convene to the individual needs of each sufferer and their distinctive offerings.
References
Andriessen, A. (2013). Prevention, recognition and treatment of dry skin conditions. British Journal of Nursing, 22(1), 26–30. Retrieved from https://search-ebscohost-com.wallaby.vu.edu.au:4433/login.aspx?direct=true&db=c8h&AN=104409642&site=eds-live
Camargo, J. C. A., Ganmaa, D., Sidbury, R., Erdenedelger, K., Radnaakhand, N., & Khandsuren, B. (2014). Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children. The Journal of Allergy and Clinical Immunology, 134(4), 831–835. https://doi-org.wallaby.vu.edu.au:4433/10.1016/j.jaci.2014.08.002
Dyble, T., & Ashton, J. (2011). Use of emollients in the treatment of dry skin conditions. British Journal of Community Nursing, 16(5), 214–220. Retrieved from https://search-ebscohost-com.wallaby.vu.edu.au:4433/login.aspx?direct=true&db=c8h&AN=104663894&site=eds-live
Guenther, L., Lynde, C. W., Andriessen, A., Barankin, B., Goldstein, E., Skotnicki, S. P., … Sloan, K. (2012). Pathway to dry skin prevention and treatment. Journal Of Cutaneous Medicine And Surgery, 16(1), 23–31. Retrieved from https://search-ebscohost-com.wallaby.vu.edu.au:4433/login.aspx?direct=true&db=mnh&AN=22417992&site=eds-live
Hashiguchi, N., Hirakawa, M., Tochihara, Y., Kaji, Y., & Karaki, C. (2008). Effects of setting up of humidifiers on thermal conditions and subjective responses of patients and staff in a hospital during winter. Applied Ergonomics, 39(2), 158–165. https://doi-org.wallaby.vu.edu.au:4433/10.1016/j.apergo.2007.05.009
How to prevent and treat dry skin. Be proactive this winter by moisturizing often and avoiding hot water. (2015). Harvard Health Letter / from Harvard Medical School, 40(3), 7. Retrieved from https://search-ebscohost-com.wallaby.vu.edu.au:4433/login.aspx?direct=true&db=edselc&AN=edselc.2-52.0-84941770431&site=eds-live
Lodén, M. (2003). Role of Topical Emollients and Moisturizers in the Treatment of Dry Skin Barrier Disorders. American Journal of Clinical Dermatology, 4(11), 771–788. https://doi-org.wallaby.vu.edu.au:4433/10.2165/00128071-200304110-00005
Philpott, W. L. (2018). Chilling out Winter skin woes. Australian Journal of Pharmacy, 99(1173), 41–44. Retrieved from https://search-ebscohost-com.wallaby.vu.edu.au:4433/login.aspx?direct=true&db=edselc&AN=edselc.2-52.0-85047980363&site=eds-live
Sasaki, M., Yoshida, K., Adachi, Y., Furukawa, M., Itazawa, T., Odajima, H., … Akasawa, A. (2016). Environmental factors associated with childhood eczema: Findings from a national web-based survey. Allergology International, 65(4), 420–424. https://doi-org.wallaby.vu.edu.au:4433/10.1016/j.alit.2016.03.007
What to do about dry skin in winter. At this time of year, hands may be red, rough, and raw, and skin may feel itchy and uncomfortable. (2011). Harvard Women’s Health Watch, 18(6), 6–7. Retrieved from https://search-ebscohost-com.wallaby.vu.edu.au:4433/login.aspx?direct=true&db=edselc&AN=edselc.2-52.0-84989767485&site=eds-live
Zuccaroli, J. (2011). Dry skin, chilblains and other winter skin scourges. Professional Nursing Today, 15(4), 28–30. Retrieved from https://search-ebscohost-com.wallaby.vu.edu.au:4433/login.aspx?direct=true&db=c8h&AN=104143204&site=eds-live
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