Help Patients Manage Winter Eczema and Other Skin Conditions

Pharmacy Times, January 2022, Volume 88, Issue 1

Pharmacists can field dermatological questions and help provide relief for this uncomfortable ailment,

Many individuals experience skin discomfort, dryness, and itching during the winter. Eczema, or atopic dermatitis, is a common skin condition that causes dryness, inflammation, itchiness, and scaliness. In some cases, eczema can progress to extreme dryness, causing cracks in the skin. These cracks can lead to open wounds and bleeding. Eczema can affect individuals of all ages but usually begins during childhood.1

About 31.6 million Americans, including 9.6 million children, have some form of eczema.2

Approximately one-third of those children experience moderate to severe symptoms.2 Roughly 50% of children affected by severe atopic dermatitis develop asthma, as both conditions are linked to chronic inflammation.2 The symptoms, which can interfere with daily activities for many patients, affect a similar number of girls and boys but are more common in women.2 Although study percentages vary, adults who are multiracial or White tend to have the highest prevalence of atopic dermatitis.2 Black and Hispanic children tend to have more severe atopic dermatitis compared with White children.2 Approximately 15% to 30% of patients report sleep issues— including daytime drowsiness, fatigue, and insomnia—related to eczema.2

Eczema occurs more often in cold weather because the air is drier. Absence of humidity affects all body organs and especially the skin, which is the first line of defense. The dryness is exacerbated by indoor heat. Dryness in the air can lead to dry or scaly patches, raised or small bumps, and itching, especially at night. For some patients, the skin becomes cracked, dry, raw, scaly, and sensitive to the touch, which makes daily activities harder and more uncomfortable.

Eczema often first appears in children by aged 5 years.3 Approximately 10% to 20% of children around the world have eczema, although some outgrow the condition by adulthood.3 Eczema can appear in many places on the body, including the arms, backs of the knees, or legs.

Aside from cold weather, other causes of eczema can include allergens such as pollen, or it can be genetic. Triggers include asthma, food allergies, and hay fever. One school of thought is that patients with eczema lack certain proteins in their skin, which can lead to greater skin sensitivity.

Environmental factors also play a role in eczema. Those who spend a lot of time outside in cold weather or wash their hands multiple times a day are more susceptible to skin cracks, dryness, inflammation, and sensitivity. Other risk factors include being older than 40 years, having an infection, or having other skin conditions.3

The results of a recent study of adults with moderate to severe atopic dermatitis showed that 70.5% reported having a severe, unbearable itch for the prior 2 weeks, 85.8% reported having a daily itch, and 62.8% reported feeling itchy for at least 12 hours per day.4

Treatment Options

There is no cure for eczema. Pharmacists can first recommend that patients try nonmedication treatment options, such as avoiding materials that cause flare-ups, skipping hot baths and showers, and using gentle soap and other cleansing agents.5

Using thick moisturizers several times a day, especially after handwashing or showering, can also help avoid eczema or soothe affected areas of the body, allowing them to heal faster.5 Patients should also stay hydrated by drinking plenty of water, which can keep skin moist.5 Pharmacists can also recommend that patients use humidifiers while they sleep to keep the air moist.5

Pharmacists should advise patients with serious cases of eczema, including contact dermatitis, to contact their physicians. Warning signs that a patient may need to visit a physician include cases that do not improve even after various remedies have been tried, interference with sleep, large areas of peeling or scaling skin, open infections or sores from scratching, and redness. Many of these more severe types of eczema may require prescription treatments that include calcineurin inhibitors, lipids, or topical corticosteroids.5

Treatment On The Horizon

One approved treatment for atopic dermatitis is dupilumab (Dupixent), a monoclonal antibody blocking interleukin 4 and interleukin 13 used to treat eczema as well as asthma and nasal polyps that result in chronic sinusitis.

In addition, in August 2021, the European Commission approved upadacitinib (Rinvoq) as the first Janus kinase (JAK) inhibitor in the European Union for the treatment of adolescents and adults with moderate to severe atopic dermatitis.6 The FDA extended the review period for Rinvoq, which is being studied in several immune-mediated inflammatory diseases, so that the agency can review safety data for this class of therapies. The review was undertaken as a result of data released by Pfizer of a postmarketing study of a cardiovascular safety trial of its JAK inhibitor tofacitinib (Xeljanz).

Investigators found that use of JAK inhibitors may be associated with major cardiovascular adverse events and malignancies.6 As a result of an extended review, the FDA required warnings on the JAK inhibitors approved to treat arthritis and ulcerative colitis about the increased risk of serious heart-related events.6

Conclusion

Half of adults with moderate to severe atopic dermatitis experience a significantly limited lifestyle, and nearly 35% of adults with mild disease also experience some lifestyle limitations.7 Pharmacists can be instrumental in guiding patients toward OTC treatments for eczema or advising them to visit their health care providers if the skin condition is more serious. Colder weather can exacerbate these conditions, but getting the appropriate treatment can help patients have a better quality of life.

Saro Arakelians, PharmD, is vice president of pharmacy operations, population health management, and chronic health conditions in the Los Angeles, California, area.

References

1. Silver N. 7 treatments for winter eczema flare-ups. Healthline. Updated May 1, 2019. Accessed December 13, 2021. https://www.healthline.com/health/skin-disorders/ winter-eczema-treatment

2. Eczema stats. National Eczema Association. Accessed December 13, 2021. https://nationaleczema.org/research/ eczema-facts/

3. Managing eczema in winter and year round: a parents guide. Johns Hopkins Medicine. Accessed December 13, 2021. https://www.hopkinsmedicine.org/health/wellness-and-prevention/managing-eczema-in-winter-and-year-round-a- parents-guide

4. Simpson EL, Bieber T, Eckert L, et al. Patient burden of moderate to severe atopic dermatitis (AD): insights from a phase 2b clinical trial of dupilumab in adults. J Am Acad Dermatol. 2016;74(3):491-498. doi:10.1016/j.jaad.2015.10.043

5. Dry skin. Mayo Clinic. August 20, 2019. Accessed December 13, 2021. https://www.mayoclinic.org/diseases-conditions/ dry-skin/symptoms-causes/syc-20353885

6. European Commission approves RINVOQ (upadacitinib) as first JAK inhibitor in the European Union for the treatment of both adults and adolescents with moderate to severe atopic dermatitis. News release. AbbVie. August 24, 2021. Accessed December 13, 2021. https://news.abbvie.com/news/ press-releases/european-commission-approves-rinvoq-upa- dacitinib-as-first-jak-inhibitor-in-european-union-for-treat- ment-both-adults-and-adolescents-with-moderate-to-severe-atopic-dermatitis.htm

7. Silverberg JI, Gelfand JM, Margolis DJ, et al. Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Ann Allergy Asthma Immunol. 2018;121(3):340-347. doi:10.1016/j.anai.2018.07.006