Educate patients on winter skin care

New York - As winter exacerbates existing skin problems and precipitates new ones, many patients benefit from practical advice on changing their skin care regimens to fit the season, according to Chérie M. Ditre, M.D.

Discussions should cover moisturizers, sunblock, proper clothing and bathing habits, says Dr. Ditre, director, Skin Enhancement Center and Cosmetic Dermatology, University of Pennsylvania, Philadelphia.

"We have a lot of patients coming in and complaining of winter itch," Dr. Ditre said at an American Academy of Dermatology (AAD) press conference. "And in patients with diabetes or other conditions, the skin is a barrier for other problems or organisms ... If we can help them protect their skin, we can really make a difference.'

Likewise, patients should avoid prolonged hot showers and baths, which they may feel can "invigorate" their skin. Instead, the clinician can suggest bathing in lukewarm water to avoid evaporation of moisture on the skin. Use of emollients in the bath can be recommended.

"Something as simple as putting a quarter-cup of mineral oil in the bath can help," Dr. Ditre says. "This is very inexpensive to get over the counter." Patients prone to extremely dry skin can take Vaseline baths, after which they should lightly pat the skin dry, then immediately apply moisturizer.

When going outside, patients should wear appropriate clothing, especially over the extremities, and should be alert to the signs of frostbite (numbness and tingling) as a clue to get back indoors, Dr. Ditre says.

Before bed, patients should again apply moisturizers to the hands, feet and other exposed areas.

"I tell them to keep their bottle of moisturizer on their pillow," Dr. Ditre says. Light cotton socks or gloves can be worn to bed, especially if the patient has cracked or peeling skin on the extremities. In addition, electric blankets should be avoided: "This is a real problem," Dr. Ditre says. "We need to tell patients who have a tendency toward dry skin not to use them."

Products to use, or avoid Patients should limit use of soaps, and should be sure to avoid gels and degreasing agents. "I prefer bath lotions, because bar detergent soaps can really strip more moisture away from skin," Dr. Ditre says.

The clinician might want to recommend cleansers with moisturizers added to them, such as Aveeno Skin Relief.

"I tell my patients to get into the habit of reading the ingredients on the back of the label, like they do their fat grams or carbohydrates," Dr. Ditre says. "They should look for ingredients such as glycerine, dimethicones and cyclomethicones, and if they are really dry, petrolatum." Vanicream or other fragrance-free products for patients with sensitive skin can be recommended.

Generally, "less is more" when picking a moisturizing or cleansing product, Dr. Ditre says, advocating a "rule of 10": "More than 10 ingredients in the bottle, I think, becomes frivolous," she says. One such 10-ingredients-or-less product is TriXera (Avene) emollient cream.

Many patients aren't aware that sunscreens are important in winter as they are in summer. During outdoor winter sports such as skiing, a product with an SPF of at least 30 should be used, and should be reapplied every 90 minutes. Patients should look for specific ingredients, including physical blockers such as zinc oxide and titanium dioxide, and chemical blockers such as avobenzone or Parsol 1789.

"Many times, the physical blockers are separate from the chemical blocker, so I have the patients buy two products," such as Neutrogena's Healthy Defense sunblock lotion and Aveeno Positively Radiant Daily Moisturizer with Parsol 1789, Dr. Ditre says.