The Pharmacist September/October 2018 - Page 42

CLINICAL Also known as perniosis, chilblains are local inflammatory lesions induced by cold exposure and appear on the fingers, toes, nose and ears as oedematous Asteatotic eczema Although dry skin can affect people of all ages, it is most common in older patients. Older skin has fewer sebaceous and sweat glands, and cells are lost at a greater rate than they are replaced. The end result is thinner skin with a reduced capacity to hold water. Asteatotic eczema is common in the elderly on the lower legs and shins. Moreover, fissures can develop in the skin leading to ruptured dermal capillaries and resulting in bleeding. Asteatotic eczema occurs through excessive water loss from the skin and is worse in winter as older people spend more time in overheated, dry rooms, or sitting too close to fires or radiators. A further aggravating factor is excessive washing with soaps or detergents. Management of xerosis and asteatotic eczema Avoidance of soaps or detergents and the use of emollients will normally resolve both xerosis and asteatotic eczema. Bathing in hot water with soaps strips away the skin’s natural oils, provoking additional xerosis. Washing in warm – rather than hot – water with added emollients will clean the skin and spare the skin’s natural oils. Emollients should be applied to the skin within a few minutes of bathing or showering because this traps surface moisture on the skin, leading to rehydration. When applying an emollient, it is not necessary to rub into the skin until it disappears. Simply dotting the product onto the skin and spreading in a downward stroking motion is sufficient. Ointment-based emollients are more occlusive and provide greater hydration but are less cosmetically appealing. Alternatively, 42 | The Pharmacist | September/October 2018 creams that contain a humectant provide a similar degree of hydration and are more aesthetically pleasing. Xerosis can also be improved with a humidifier that increases the moisture content in the air. If avoidance of soaps and greater emollient use fail to improve xerosis and asteatotic eczema, or if the skin starts to bleed or exhibit signs of infection (ie inflamed and feeling hot), patients should be referred to the GP. Eczema Both adults and children with eczema often notice that their condition worsens during the colder months. Avoid