Sensitive skin

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Sensitive skin affects millions of people, but the exact definition varies depending on who you ask. Dermatologist Leslie Baumann, MD, FAAD, director of the University of Miami's Cosmetic Medicine & Research Institute and professor of dermatology at the University of Miami Miller School of Medicine, reports that in her practice up to 50 percent of patients have some form of sensitive skin. According to Dr. Baumann, there are four distinct types of sensitive skin — acne, rosacea, burning and stinging, and contact dermatitis (allergies and irritants) — and they all have one characteristic in common: inflammation.

Background on Skin Care Products for Sensitive Skin

  • Skin care products marketed for sensitive skin do not specify for which type of sensitive skin they work best — such as acne or rosacea.
    • For example, a product for an acne patient is very different from a product for a rosacea patient. But, both products will be labeled for use with sensitive skin.
    • Manufacturers of skin care products cannot make any specific drug claims for treating conditions such as acne or rosacea. Therefore, "sensitive skin" has become a "catch-all" category for these products.
  • The U.S. Food and Drug Administration (FDA) issues monographs for ingredients used in products that allow manufacturers to make certain claims, but not every ingredient will benefit every type of sensitive skin.
    For example, the FDA monograph that covers oatmeal allows the manufacturer to claim that this ingredient protects and soothes skin. However, Dr. Baumann reported that oatmeal would not be the best treatment for all types of sensitive skin, but can help contact dermatitis.

Acne

  • Acne is caused by oily skin and high levels of the bacteria P. acnes.
  • Some skin care products can clog pores, leading to whiteheads and blackheads.
  • Treatments for acne involve anti-inflammatory ingredients and anti-bacterials, including antibiotics, benzoyl peroxide, salicylic acid and retinoids.
  • One natural ingredient that is used to treat acne is tea tree oil.
  • Other natural ingredients, such as coconut oil and avocado, can cause acne outbreaks.
  • Dr. Baumann cautioned acne patients to be careful when selecting products labeled "natural" or "organic," and to ask your dermatologist if you have questions as to whether an ingredient will help your particular type of sensitive skin.

Rosacea

  • Rosacea is a common skin condition commonly marked by facial flushing, pimples and broken blood vessels on the face.
    • The cause of rosacea is not completely known, but theories range from bacteria, genetic causes, side effects of sun exposure and vascular instability.
  • Anti-inflammatory ingredients that do not cause irritation are the mainstay of treatment for this difficult condition. They effectively reduce the redness and inflammation caused by rosacea and prevent facial flushing.
    • These ingredients include caffeine, sulfur, sulfacetamide, various antibiotics and natural ingredients such as feverfew, chamomile, green tea and licorice extract.
  • Dr. Baumann advised that skin care products containing vitamin C and alpha hydroxy acids (AHAs) should be avoided, as they are acidic and can cause stinging.

Burning and Stinging

  • The cause of burning and stinging is unknown.
  • Dr. Baumann noted that there are no products that help burning and stinging sensations. That's because the mechanism of why they occur — such as what nerves or skin components are involved — has not been determined through scientific research.
  • Ingredients that are known to cause stinging are lactic acid, azaelic acid, benzoic acid, glycolic acid, vitamin C and AHAs.
  • Dermatologists gauge whether a person has this form of sensitive skin by taking a medical history of the patient, and certain tests can be performed to see if a patient has a positive reaction to the known stinging ingredients.
    • For example, the lactic acid stinging test can be conducted to determine if a patient feels lactic acid when a small amount is placed on the skin. However, this test is complicated by the fact that not everyone stings to lactic acid. For example, some patients who test negatively to lactic acid may sting to benzoic acid.

Contact Dermatitis (Allergies)

  • There are two main types of skin irritations in this category.
    • The first is allergens, which is when you are allergic to an ingredient. For example, when you are allergic to something, your immune system is making antibodies against the thing to which you are allergic and causing the allergic reaction.
    • The second is irritants, where an ingredient is irritating but you are not truly allergic. For example, if bleach is poured on your skin you will get an irritation from that chemical — but it doesn't mean you are allergic to it.
  • People who complain of frequent rashes to specific skin care products are most commonly allergic to fragrance, preservatives, colors or formaldehyde.
  • Dr. Baumann noted that it is difficult to predict who will be allergic, and dermatologists gather clues and make a diagnosis by asking patients questions as to when they notice the appearance of a rash.
    • For example, a patient may report that she notices a rash whenever she wears eye shadow.
  • In order to be certain of an allergy to an ingredient, patch testing must be done.
    • Dermatologists perform patch testing by applying a certain ingredient to the skin and look for a rash to develop within 24 to 48 hours.
  • Impaired skin barrier (or defects in the protective outermost layer of skin) may increase susceptibility to skin allergies and irritations.
  • Many organic products lead to contact dermatitis, because they contain essential oils and fragrances that can cause allergy.
    • For example, patients with a ragweed allergy could develop rashes to organic products that contain chamomile, calendula (marigold extract) and feverfew — as these ingredients are cross reactive ragweed allergies.
    • Dr. Baumann said that it is a misnomer to call organic products healthier and advised patients to use caution before using products labeled natural or organic.
    • Dr. Baumann anticipates seeing occasional cases of contact dermatitis to some botanicals found in skin care products.

See your dermatologist for successful diagnosis and treatment of skin, hair and nail conditions.

Find a dermatologist by visiting the American Academy of Dermatology's website at www.aad.org.