In this episode of Topical Conversations, Charlie Dunn, MD, shares timely and practical tips for dermatologists to counsel their patients through the winter season. With stress, cold weather, indoor heating, and disrupted routines taking a toll on skin health, Dr Dunn outlines his top 3 counseling pearls dermatologists can share with patients to help them proactively manage common seasonal challenges. 

1. Proactive treatment for winter flare-ups: Dr Dunn highlights the importance of proactive care for conditions that frequently flare during the winter, such as rosacea, atopic dermatitis (AD), psoriasis, and Raynaud's phenomenon: 
   1. Rosacea: Since triggers like cold weather, stress, alcohol, and hot drinks may be difficult to avoid for some patients, Dr Dunn recommends augmenting treatment plans with systemic therapies, such as oral doxycycline, to maintain control 
   2. AD and psoriasis: Preventative topical anti-inflammatory therapies, such as steroids, applied to commonly flared areas—even if they appear clear or in the very early stages of a flare—can help prevent progression. He suggests a Monday-Wednesday-Friday application schedule for ease of adherence. 
   3. Raynaud’s phenomenon: For patients who are hesitant about oral therapies, Dr Dunn discusses topical options, including 5% sildenafil cream, citing a 2018 JAAD study showing improved blood flow and vessel diameter,1 in addition to practical measures like hand warmers, gloves, and socks for warmth 
2. Passive and active skin hydration: To combat winter dryness, Dr Dunn advises dermatologists to provide actionable hydration strategies and provides an easy-to-remember system to share with patients: 
   1. Passive hydration: Encourage patients to use cool-mist humidifiers, drink more water, reduce indoor thermostat temperatures, and minimize irritants like retinol. 
   2. Active hydration: Dr Dunn introduces the 4 C’s of moisturization: 
      1. Cream: Switch from lotions to thicker creams 
      2. Cover: Use gloves or socks after moisturizing 
      3. Clean skin: Moisturize after showers and handwashing 
      4. Chapped lips: Be proactive with lip balm before lips become cracked 
3. Don’t neglect sun protection: Dr Dunn reminds dermatologists to emphasize to their patients that UV exposure remains significant in winter, particularly for patients with photosensitive conditions like melasma. Snow can reflect up to 80% of UV rays, far more than sand or sea foam.2 He emphasizes year-round sun protection to his patients, including broad-spectrum sunscreen, protective clothing, sunglasses, and shade-seeking behaviors. 

These 3 pearls offer dermatologists actionable tools and patient-centered strategies that are easy to implement to help guide patients through the challenges of the winter season. By taking a proactive approach to flare prevention, emphasizing both passive and active skin hydration, and reinforcing year-round sun protection, dermatologists can help patients maintain healthy skin and minimize seasonal exacerbations.