Dr Donna Cosgrove PhD MPSI synopsises skin conditions, one of the most common reasons patients seek advice in community pharmacies
Several observational studies have found skin conditions to be one of the most common conditions for which advice is sought in pharmacies.1 Exact estimates vary depending on study design, with one study identifying skin conditions as the second most common (23.1 per cent) symptom-related category (rashes, bites, verrucae). Another study found that skin conditions accounted for 12 per cent (urticaria, acne, eczema, moles, sunburn) of requested consultations, with a third survey concluding that over a third of symptomatic advice in the pharmacy is sought for skin conditions (38 per cent).2
An online survey among pharmacists in the UK (n=780) reported that dry skin (78 per cent) was perceived as the most common skin condition for which advice was sought on a weekly basis, followed by eczema/dermatitis (72 per cent) and thrush (66 per cent).
A significant proportion of all OTC sales in the UK are for skin care products.1 Pharmacists have an important role in facilitating self-care of skin problems, especially since many patients with skin issues choose to manage their condition through self-care rather than seeking medical treatment from a GP.
It has been shown that patient education from pharmacists about dermatological treatments is beneficial? advice on the appropriate use of emollients in eczema can reduce symptom severity in children and common patients’ concerns relating to the use of topical steroids are adequately addressed through verbal interventions by pharmacists.
A larger role for the pharmacist in optimising management of chronic conditions such as psoriasis, eczema and acne may support patients in getting the best out of their treatments.2
On the other hand, research findings indicate that time constraints and lack of in-depth training in dermatological conditions can limit the amount of useful advice available from pharmacists.
A survey of pharmacists in the UK identified the absence of reliable, high quality, and evidence-based resources as a barrier to more effectively responding to queries and questions about skin conditions.
Furthermore, the nature of community pharmacy can also mean that there is a lack of post consultation feedback on the advice given or products recommended, so there may not be any knowledge of the ultimate outcome of the skin condition. A summary of some of the more commonly encountered
skin conditions and their treatments is available below.
Management of common skin conditions
Emollients for dry skin
A Cochrane review (of 77 studies) which compared moisturisers for use in managing eczema found that the use of moisturisers:1
- Reduced the number of flares;
- Prolonged the time between flare-ups; ?Reduced the rate of flare;
- Had a significant beneficial effect on itch;
- Reduced the total amount of topical steroids that would have been needed to reduce the flare.
Moisturisers do improve disease severity, however, there was no clear superiority identified among products. Evidence also showed that topical steroids were more effective at improving eczema when used in conjunction with a moisturiser rather than when used alone.
The review was unable to identify any specific moisturisers or ingredients that are significantly better than others due to insufficient number of published research studies on the topic. For children under 12, National Institute
for Health and Care Excellence (NICE) guidance3 recommends unperfumed emollients for everyday moisturising, over the whole body, 250g to 500g per week in children with widespread eczema, even when the skin is clear.
Dermatitis
Dermatitis is an umbrella term for a wide range of inflammatory skin conditions of varying aetiologies. Symptoms include erythema, scaling, vesicles, itching, or lichenification in more chronic cases. Atopic eczema and contact dermatitis are among the most common inflammatory skin conditions encountered, while fungal infections are another frequent category of skin queries encountered in community pharmacy.
Eczema (atopic dermatitis) is a chronic relapsing skin condition, characterised by dry, pruritic skin, with genetic and environmental factors influencing development.4 Typically, eczema leads to erythema, scaling, and vesicles in skin flexures ? ie, skin folds like the knee or elbow joints, or around the neck. Liberal emollient use is an essential part of daily skin care for all patients, even when
Dermatitis is an umbrella term
for a wide range
of inflammatory skin conditions of varying aetiologies
asymptomatic. Emollients may contain a humectant (glycerol or urea) and/or an occlusive agent (petrolatum) that reduces evaporation, in turn improving symptoms of itch and pain and reducing skin exposure to bacteria.
Patients inadequately controlled on emollients are started on low (hydrocortisone) to medium potency topical corticosteroids, and may only require intermittent use. Higher potency steroids (mometasone, betamethasone, and clobetasol) are required when milder steroids are not sufficient for symptom control.
The potency of the steroid should be tailored to the severity of the symptoms and body site, with lower potencies used when possible during flare-ups on more delicate areas such as the face and neck. Short courses of moderate- potency topical corticosteroids are often required for flare-ups, typically ranging from three to five days in sensitive areas to up to one to two weeks depending on severity and body site.
Children are more at risk of systemic adverse effects (eg, HPA axis suppression, reduction in linear growth rate, Cushing syndrome, and reduced bone density) due to their increased body surface area to weight ratio, and for this reason lower potency options are preferred when treating children with eczema. Some of the most common ADRs of topical corticosteroids include skin atrophy, hyperpigmentation, striae, and purpura (easy bruising/purple patches).
Skin atrophy is the most concerning and is more likely to occur with higher potency preparations, occlusion, use on thinner skin, older age, and longer use. A topical calcineurin inhibitor (tacrolimus) can be used instead of or in conjunction with topical corticosteroids, particularly in facial eczema/eyelid involvement.
A meta-analysis found calcineurin inhibitors like tacrolimus to be an effective topical agent to reduce eczema-associated pruritus. Systemic therapy options (immunosuppressants, corticosteroids, JAK inhibitors, and the interleukin-4 receptor alpha antagonist dupilumab), as well as phototherapy, are available for patients with treatment- resistant atopic dermatitis.
Contact dermatitis is an allergic (immunological) or irritant (non- immunological) skin reaction caused by an external agent.5
For allergic contact dermatitis (ACD), the main goals of treatment are avoidance of future allergen exposure and resolution of existing dermatitis. Topical corticosteroid preparations are used as the main treatment, with the type of vehicle dependent on the area treated; eg, liquid or gel for scalp and ointment for hands. The potency of steroids can be increased if necessary, similarly to treatment of eczema, and treatment escalated to calcineurin inhibitors if needed.
For irritant contact dermatitis (ICD), the irritant should be washed off the skin as soon as possible, and treated post-exposure with a thick barrier- protecting emollient. Avoidance of future exposure to the irritant where possible is important. Fragrance and urea free moisturisers without antibacterials are preferred on acutely inflamed
skin, as these substances may cause sensitisation. Topical corticosteroids are often used for ICD because treatment is often initiated prior to differentiation between ICD and ACD, but few studies have looked at the effectiveness of topical corticosteroids for ICD and results are unclear. Topical corticosteroids can be tried for ICD if emollients alone are ineffective.
Fungal infections
Pityriasis versicolor (tinea versicolor) is a fungal skin infection caused by the Malassezia yeasts.6 It manifests as hypo or hyperpigmented macular lesions on seborrhoeic areas of the trunk. There may be no itch or pain associated with the condition, although mild itch may occur. It is most common in summer months and in adolescents, often displaying a relapsing nature that requires frequent treatment/ prophylaxis, but is easily treated with selenium sulphide shampoo or azole class topical agents. Systemic therapy may be required for more extensive disease. Definitive diagnosis can be made through microscopical examination with potassium hydroxide if the diagnosis is uncertain.
Other fungal infections can also be diagnosed clinically based on symptoms, but fungal culture may aid patient care. Diagnosis of onychomycosis (fungal nail disease) and tinea capitis (scalp infection) should be confirmed prior to treatment where possible. Tinea corporis infection can usually be treated with topical therapy, whereas systemic therapy may be required for tinea capitis, tinea barbae (beard), tinea manuum (hands), and onychomycosis (nails).
Risk factors for dermatophyte (pathogenic fungi that infect humans) infections include exposure to infected people, animals or soil, or other contaminated items like hats, combs, furniture, etc. Chronic corticosteroid use (topical or oral) may also predispose people to infection. For tinea capitis, griseofulvin is the usual first-line treatment for Microsporum infections and terbinafine for Trichophyton infections.
Topical (selenium sulphide 1 to 2.5 per cent or ketoconazole 1-2 per cent) shampoo is useful to reduce the spread of infection to others. Systemic therapy is typically required for the treatment of tinea barbae or manuum in order to deliver effective antifungal concentrations to the hair shaft or thick skin on the palm of the hands, respectively.
Topical antifungal therapy is usually sufficient to treat dermatophytosis in superficial skin structures as in tinea corporis, tinea cruris, or tinea pedis. There is some evidence that favours the use of allylamines (terbinafine) in terms of efficacy. This should be applied once or twice daily until the infection has gone, and for one to two weeks after. In tinea pedis, disinfection or replacement of footwear may reduce recurrence.
Skin conditions are among the most common reasons patients seek advice in community pharmacies. Pharmacists play a key role in supporting self-care, particularly as many patients prefer to manage conditions such as dry skin, eczema, and fungal infections without visiting a doctor. Evidence shows that pharmacist-led advice ? such as guidance on emollient use or addressing concerns about topical steroids ? can improve treatment outcomes and patient understanding
in common skin conditions, despite existing challenges.
References
1. Tucker R and Duffy J. (2014). The role of community pharmacists in the management of skin problems. J Pharma Care Health Sys, 1(1), 105-8.
2. Harvey J, Shariff Z, Anderson C, et al. (2024). How can community pharmacists be supported to manage skin conditions? A multistage stakeholder research prioritisation exercise. BMJ Open, 14(1), e071863.
3. National Institute for Health and Care Excel- lence. (2007, updated 2023 and 2025). Atopic eczema in under 12s: diagnosis and management [CG57]. Retrieved April 14 2025, from www. nice.org.uk/guidance/cg57/resources/atopic-ec- zema-in-under-12s-diagnosis-and-manage- ment-pdf-975512529349.
4. Hebert A, Jafari A, and Dallo M. (2026 March 14). Eczema. BMJ Best Practice. Retrieved April 14 2026, from https://bestpractice.bmj.com/topics/ en-gb/87.
5. National Institute for Health and Care Excel- lence. (2018). Dupilumab for treating moderate to severe atopic dermatitis [TA534]. Retrieved April 14 2025, from www.nice.org.uk/guidance/ta534/ chapter/1-Recommendations.
6. Yu J. (2026 March 14). Contact dermatitis.
BMJ Best Practice. Retrieved April 14 2026, from https://bestpractice.bmj.com/topics/en-gb/90.
7. Tosti A. (2026 March 14). Dermatophyte infections. BMJ Best Practice. Retrieved April 14 2026, from https://bestpractice.bmj.com/topics/ en-gb/119.
