Healthy Skin: How Pharmacists Can Help

Billions of dollars are spent annually for skin care products by individuals seeking to prevent or treat skin damage caused by aging, ultraviolet radiation (UVR), and other environmental factors such as seasonal changes or pollution.^1,2 Approximately 40% to 60% of adults have sensitive skin.^2-5 Not surprisingly, then, pharmacists frequently are questioned by people who want to improve their skin health and appearance. Therefore, they should be prepared to provide well-informed recommendations.

Role of Pharmacists in Skin Management

Pharmacists are in a position to augment patient understanding of appropriate skin care; to raise awareness of how practicing or omitting certain daily routines can influence skin health and appearance; and to alert patients to the irritating ingredients and conditions or prescription treatments that may predispose the skin to sensitivity. Following a brief review of relevant skin physiology, this article gives recommendations that pharmacists can offer to patients.

Structure and Function of the Stratum Corneum

The stratum corneum (SC) is the selectively permeable, enzymatically active outermost layer of the epidermis that protects against desiccation and environmental challenge through closely controlled homeostatic mechanisms.^6,7 The SC corneocytes are embedded in a continuous extracellular matrix of lipids and proteins.⁸ The corneocytes, lipids, and proteins function synergistically to reduce the rate of water flux and also retain atmospheric water.⁸ Suboptimal hydration may impair SC function, which may lead to the development or exacerbation of various cutaneous disorders.⁹

Barrier Dysfunction and Sensitive Skin Conditions

Disrupted barrier integrity causes increased transepidermal water loss, resulting in sensitive or easily irritated skin.⁶ Common skin disorders linked to barrier dysfunction include xerosis, psoriasis, atopic dermatitis, acne, and rosacea.⁶ Symptoms of sensitive skin include tightness, burning, itching, stinging, irritation, dryness, flakiness, inflammation, rashes, redness, blemishes, breakouts, and erosions.^2,4,10

Pharmacist Recommendations for the Optimal Care of Skin

As outlined above, avoiding barrier dysfunction is essential to healthy skin. Multifactorial skin care designed to maintain the integrity of the SC should include a daily regimen of mild cleansing, moisturizing, and protection from UVR.¹¹

Advocate Mild Cleansing Proper cleansing of the skin is essential. Soap-based alkaline cleansers contain harsh surfactants that interact with SC lipids and proteins, compromising the skin's hydration and integrity.¹² Cleansing with common soap-based products exacerbates most skin disorders.¹²

A common point of confusion that pharmacists can help correct is that not all cleansing bars are soap-based. Synthetic detergent (syndet)-based cleansers such as sodium cocoyl isethionate provide effective but mild cleansing, with less interaction with SC, irritation, and potential damage to skin tissue¹² (Table).

Bathing always should be done in warm rather than hot water. After washing, patients should pat the skin dry rather than rubbing it dry. Any topical medication should be applied at least 5 minutes after cleansing.

Current skin cleansing technology has evolved to include mild bar and liquid cleansers that also incorporate moisturizing lipids, emollients, occlusives, and humectants.¹²

Promote Frequent Moisturizing Daily moisturizing supports optimal hydration of the SC.⁹ Effective moisturizers include humectants (eg, glycerin) that bind water, occlusive agents (eg, petrolatum) that trap water, and emollient lipids (eg, fatty acids) that promote barrier repair¹³ (Table).

Emphasize Adequate Daily UV Protection

Consistent UVR exposure over time disrupts SC homeostatic processes, damages dermal structure, and increases skin cancer risk. Pharmacists should recommend limiting sun exposure and using sunscreen daily. Sunscreen products containing at least sun protection factor (SPF)-15 (which absorbs or blocks 93% of UVR) should be recommended.¹⁴ Nonwaterproof broad-spectrum (blocking both UVA and UVB) sunscreen products containing zinc oxide or titanium oxide formulations are favored. Daily moisturizers frequently contain SPF, offering simultaneous incorporation of 2 fundamental skin care practices in a single product.

Recommend Products with Nonirritating Ingredients

Pharmacists can alert consumers and patients with sensitive skin to ingredients that may potentially aggravate their condition, including volatile solvents, penetrants, harsh surfactants, abrasives, and aromatic sunscreen ingredients.¹⁵ Some ingredients have the potential to cause irritation, particularly in individuals with sensitive skin. Whether ingredients cause irritation depends on their concentration, duration of skin exposure, and overall SC health.

Identify Conditions and Treatments that Predispose Patients to Sensitive Skin

Pharmacists see many patients with comorbid conditions and syndromes associated with sensitive skin, including diabetes, anemia, eating disorders, menopause, hypothyroidism, chronic renal failure, HIV, cholestasis, and lupus. In addition, treatments or agents that may sensitize skin include cholesterol-lowering agents, antibiotics, antifungal agents, anti-inflammatories, chemotherapy, immunosuppressants, and antimalarials. So, pharmacists can play a valuable role in reminding patients with these disorders about good daily skin care practices.^2,4,15-23

Encourage Skin-friendly Cosmetic Use

Generally, based on clinical experience, the following guidelines are important²⁴:

• Use powder cosmetics
• If liquid facial foundations are used, choose silicone based on cyclomethicone or dimethicone
• Avoid waterproof products
• Replace cosmetics every 3 to 6 months
• For eye cosmetics, black colors generally are better tolerated
• Use pencil forms of eyeliner and eyebrow cosmetics; use light earth tone colors for eye shadows (vs shiny colors or deep colors such as blue, purple, or green)

Summary

Pharmacists are in a key position to educate people on factors that can contribute to skin problems, as well as to remind them to incorporate an appropriate skin care regimen into their daily routine for the overall health of their skin. Individuals who are visiting their pharmacists can benefit from simple recommendations they receive for everyday skin care.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Va.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Stahl, Pharmacy Times, 241 Forsgate Drive, Jamesburg, NJ 08831; or send an e-mail request to: astahl@ascendmedia.com.