Apollo Hospital dermatologist suggests 7 smart ways to manage winter skin flare-ups

Winter skin care: While this season typically brings cold temperatures and low humidity, those afflicted with chronic skin conditions, such as eczema, psoriasis, and dermatitis, often find that their symptoms flare up during this time. "Low humidity, abrupt temperature shifts, and indoor heating can all damage the skin barrier, thus increasing skin irritation and inflammation," say dermatologists.

Dr Inderpreet Kaur, a dermatologist at Apollo Clinic, has explained why winter exacerbates these conditions and how patients can better manage them.

Why do skin conditions get worse over the winter months?

For lots of people, winter is synonymous with dry, itchy, red and uncomfortable skin. Dr Kaur says that this has much to do with a dramatic drop in ambient humidity. Cool air can’t hold on to moisture, and as the humidity drops, the skin rapidly loses moisture.

In conditions like eczema, the skin barrier is already compromised. As the wind blows and humidity drops, the rate at which moisture is lost through the skin increases and further compromises the natural skin barrier. Winter can also exacerbate psoriasis because the sun is not out as much, and therefore, the body does not produce vitamin D naturally as much. The immune system is affected by Vitamin D, which also helps to reduce the production of excessive skin cells.

In winter, individuals with Atopic Dermatitis or Contact Dermatitis are more likely to experience itchiness and dryness due to cold weather, wool fabrics, hot showers and strong soaps, all of which can worsen their skin condition and irritate their skin.

The influence of cold temperatures and low humidity on the skin barrier

The skin barrier functions as a protective wall, helping to facilitate moisture retention and prevent irritating elements from entering the skin. During colder weather, that protective wall becomes compromised. When moisture levels drop significantly, the skin's natural moisture levels become depleted as the skin attempts to compensate by drawing moisture from the deeper layers of the skin. This causes the surface skin to dry, crack, and become inflamed.

Indoor heating (using blowers or heaters) serves to exacerbate the situation by further reducing indoor humidity. The cycle of exposing your skin to cold air outside and warm air inside creates an added burden on the skin barrier, particularly for individuals with skin conditions. For example, the normal activities of switching clothing, fragrances, or mild allergens can be visible irritants to their skin barrier.

Everyday plan for fewer winter flare-ups

Dr Kaur indicates that simple and consistent changes to your everyday life may improve the frequency and severity of flare-ups in the winter. She suggests:

• Use a gentle, fragrance-free cleanser to avoid drying out the skin (and shower) only with water rather than using soap.
• Use a thick ceramide-based moisturiser immediately after bathing to encourage hydration (this essentially means occlusive agents).
• Limit showering to between 5 - 7 minutes and use warm water (not hot water).
• Layering skin care products means: Use a hydrating serum directly onto the skin first, followed by an emollient, and lastly use occlusive agents, which will help keep the skin moisturised and hydrated.
• Wearing a base layer of soft cotton clothes under a woollen sweater will reduce the irritation caused by wool and will help to prevent any abrasions.
• In cold weather, patients with psoriasis should prioritise obtaining UV protection through daily use of sunscreen due to their condition.
• Simple life changes, such as drinking plenty of water during the day and in the evenings, minimising stress, and using a humidifier inside, will also help with skin health during the winter.

According to Dr Kaur, some products have specific benefits for individuals with stubborn skin issues. If you have either winter skin irritation or other chronic skin conditions, search for ingredients such as:

• Ceramides - which assist in restoring and preserving the skin barrier's function,
• Hyaluronic acid or glycerin, which assist in holding and restricting moisture,
• Colloidal oatmeal - which assists in addressing dry, itchy or irritated skin,
• Shea butter or squalane - which assist in nourishing, hydrating and softening dry skin,
• Salicylic Acid or Lactic Acid (for people with psoriasis) - will help lift the scales off and heal your skin.

For deteriorating skin, your dermatologist may recommend phototherapy, prescription creams, or biologic treatments. It is essential to develop a comprehensive treatment plan to address winter skin irritation, rather than providing temporary relief based solely on the skin condition.

Warning symptoms that require immediate medical attention

While it is common for flare-ups to fluctuate by season, there are some symptoms to consider as signs to seek medical care. Flare-ups often fluctuate with the seasons, but certain symptoms require medical attention.

• Seek medical attention or care if the rash is widespread or has rapidly spreading areas of redness, if you have itching which is so severe that it wakes you from sleep, if the rash is bleeding, if the rash has become weeping, or if the rash seems to be rapidly worsening.
• Additionally, you can seek medical attention from your dermatologist if you have larger areas of rash than you have previously had and if you are struggling to manage your skin pain.
• For patients who have psoriasis, any sudden changes to their skin can be an indication of a possible infection or flare-up due to stress or a new medication. Getting early medical care may help minimise possible complications and may provide management sooner.

In conjunction with the heater being on, you might have trouble avoiding the drying effects on your skin during colder months. Dr Kaur suggests the use of a humidifier to establish a healthier humidity level (45-55%). To maintain hydrated and healthy skin, try to keep the thermostat in the middle range, avoid being too close to the heater and use moisturisers on your skin regularly so that the skin has a continuous supply of moisture.

Add new habits to your routine, such as placing bowls of water near your heaters, moisturising before going to sleep each night, and avoiding irritating fabrics to help maintain the skin's moisture content.