One in 10 adults in the UK is affected by eczema. Also known as dermatitis, the condition can be difficult to manage. There are several different types of eczema, and symptoms vary in severity. One symptom that is common to all types is dry, itchy skin that may also be red, sore and raw, and may bleed. 

There is no one cause or treatment for all types of eczema, so it’s important that pharmacy teams make sure that anyone who is concerned about their symptoms is signposted to their GP if they haven’t already been diagnosed. This is especially important with children. 

The National Eczema Society (NES) advises that a good skincare routine is vital in managing and preventing eczema flare-ups, because while most people know what causes their own flare-ups, there is very little clinical evidence.

Weleda recommends passing on the following advice to people with eczema:

• Avoid long, hot baths or showers; stick to lukewarm water instead
• Cleanse the face and body with a cool compress or shower spray
• Apply creams and lotions with a gentle pressing action, rather than sweeping or circular ‘rubbing in’ movements
• Keep emollients on hand to reapply regularly
• Protect hands with moisturiser and gloves when doing household chores
• Avoid tight clothing and synthetic fabrics
• Adopt a healthy sleep rhythm, and nightly routine
• Avoid household cleaners containing harsh synthetic components and opt for natural alternatives
• If environmental factors such as dust and pollen or certain foods trigger eczema, it can be useful to test for food intolerances and allergies.

Potential triggers for eczema

Experts agree on some of the causes of eczema. If the neck or face are affected, airborne allergens such as house dust mites, pollen or perfume might be the culprit. Otherwise:

• Wool and synthetic materials that cause overheating and sweating (like polyester) can cause irritation
• Some people notice that their skin deteriorates as the weather gets colder. This can be climate-related, or because of central heating, exposure to dust mites and inadequate ventilation
• Allergies to pets can cause eczema
• Chemicals, including detergents, laundry products and household cleaners can trigger symptoms.

Even stress can lead to a bout of eczema. In a 2020 patient survey by the NES called Eczema Unmasked, stress was reported to be the single biggest trigger. There was a gender imbalance in symptoms too, with 57 per cent of women stating that stress triggered their flare-ups, compared to 41 per cent of men. It makes sense: stress can cause or increase inflammation throughout the body and is also known to affect the skin’s natural repair function.

Weleda skincare expert Elizabeth King agrees that stress and exhaustion – both mental and emotional – can trigger eczema breakouts, but adds that the cause may lie in the gut. “Eczema is often associated with the imbalance and weakness in the gut, where food is not properly broken down with the help of digestive juices,” she says.

The NES produces a guide to eczema management designed specifically for healthcare professionals, which can be ordered from the NES website. The site also has free downloadable resources for customers.

Cathy Crossthwaite, OTC business development executive at Numark, suggests emollients as a first line of defence. “The main treatment for eczema is emollients – moisturisers often recommended for daily use to stop the skin from becoming dry,” she explains. “For more severe cases or flare-ups, patients may be prescribed topical corticosteroids to tackle redness and reduce swelling.”

Ms Crossthwaite believes the focus for pharmacy teams should be making sure that customers have the right products to suit their needs. They should also explain how to use products properly so that they deliver the full benefit. “Emollients often aren’t used to their full extent to help combat symptoms, and guidance is needed for customers to ensure they’re using products appropriately,” she says. “Pharmacy is in an ideal position to offer education and support to customers in need.”

Ms King suggests avoiding synthetic ingredients that may irritate and further dry the skin. These include sodium laurel sulphate, which is commonly used for its cleansing and foaming ability. Synthetic preservatives such as the petrochemically-derived phenoxyethanol and polyethylene glycols (PEGs) are used as thickeners, softeners and moisture carriers, but can cause skin irritation. “Reducing water loss is also key,” Ms King adds. “That’s why mineral oils/petroleum jelly are often recommended by dermatologists. However, natural components like white mallow extract and almond oil are also effective at controlling water loss as well as being more ecologically sustainable and planet friendly.”

Laura Ball, MooGoo UK marketing manager agrees, adding: “Using harsh detergents can strip skin of natural oils, keeping it in a constantly irritated state, causing persistent skin problems that keep returning. We recommend cleansing the skin with a natural, gentle wash that works without the unnecessary trauma. Also, moisturise skin within three minutes of bathing as this is when skin absorbs moisture best.”

Moogoo has recently launched 2.5 litre refill packs for some of its best-selling products, adding to an existing bulk size offering of 500g, one litre and five litres. 

Tracey Ryan, scientific skincare advisor at Skin Trust Club says: “A common misconception about dry skin is that heavy, oil-based moisturisers and balms add moisture to skin. Oils cannot add moisture, but are wonderful at sealing moisture in. Hydration is added by using humectants like glycerine or hyaluronic acid, which draw water in and retain it.”

A study by Skin Trust Club revealed that 63 per cent of women wrongly diagnose their own skin type, which could cause problems if they go on to use inappropriate skincare products. If surfactant-based cleansers are used on dry skin, for example, it could strip away sebum, further drying the skin and exacerbating eczema. Alternatively, someone with oily skin using rich oil-based moisturisers runs the risk of overloading their face with oil, creating an environment where bacteria such as cutibacterium acnes thrive and potentially cause acne.

Skin Trust Club is a web-based platform and app that allows people to have their skin analysed and then choose from a range of appropriate products. “Skin microbiomes change with certain conditions, such as atopic dermatitis, psoriasis, acne, rosacea or seborrheic dermatitis,” says head of R&D Dr David Caballero-Lima. “Some changes in the microbiome are the cause of the conditions, others are just a consequence of physiological changes linked to those conditions. In both cases, the microbiome could be used as a biomarker to create a diagnostic and prognostic tool, helping doctors find the most effective treatment.”

An eczema red flag

One red flag to be aware of is the rare condition eczema herpeticum, a serious skin infection caused by the herpes virus. The virus is normally caught from somebody with cold sores or similar and can take up to 12 days to develop following contact with an infected person.

Eczema herpeticum usually appears as painful blisters in children with existing eczema, although it can also affect adults. The rash worsens rapidly, leading to clusters of blisters and painful red spots, usually in places where eczema is already present. The spots will spread to other areas if not treated quickly. 

If pharmacy staff suspect eczema herpeticum, it’s important that the patient is advised to see a doctor as soon as possible as there can be complications if it’s left. They will be able to prescribe antiviral medicine and give medical advice.

Views of the P3pharmacy category panel

“There’s been a uptick in interest in products like Acnecide and Zerodouble Gel. We get asked about treating dry skin and scalp conditions without steroids. Our best sellers are Oilatum, Head & Shoulders and Neutrogena T/Gel. Steroid withdrawal has been a bit of a hot topic; many people are not wanting to go down that route due to possible uncomfortable and drawn out withdrawal after long-term use. An explanation of ingredients can be helpful when recommending products.”

Marisa Maciborka, Well Pharmacy, Tonteg, South Glamorgan

“This is a successful category; there’s always a demand. Aveeno does really well as people want more natural products these days and it suits most skin types too. We stock the whole range. Other good sellers are Oilatum and Diprobase. Hand creams are popular; our best sellers are Neutrogena and O’Keefe’s. Customers will ask us what their rashes might be caused by; adults who suffered with eczema in childhood want to know if it has recurred. This seems to be happening more frequently.”

Hardik Desai, Ticehurst Pharmacy, East Sussex

“This is a really important category for our pharmacy – we devote three bays to it. The main concerns of our customers include acne, pigmentation, dry skin and eczema. They tend to prefer natural products, so we cater for them by offering ranges such as Caudalie. Eucerin is a really good seller as it is suitable for many different skin types and problems. Other popular brands include E45, Doublebase, Dermal, Cetraban and Cerave. We site small items such as lip balm on the counter for impulse purchase.”

Sarina Mughal, Day Lewis, Knightsbridge

The category

The skincare category covers a wide range of products and subcategories. Within pharmacy, Numark data suggests it holds approximately 7 per cent of space, with treatment products accounting for approximately 42 per cent of this. 

Numark also points to certain trends that have started to trickle into the pharmacy offering. For example, there is a general trend across health and beauty categories for eco-friendly properties and more natural ingredients. Skincare is no exception, as customers focus on environmental impact and how harsh chemicals affect their skin.

Face masks have seen a significant rise in popularity in recent years, with various options available for home pamper sessions. This trend was probably supersized through lockdown as people couldn’t access beauty treatments in salons and spas, so turned to home pampering.

Lastly, marketing has become more focused around inclusion of different skin types, tones, and ages to ensure all needs are met. This has been seen across cosmetic beauty as well as medicated skincare options.