sensitive skin

Sensitive Skin

Dermatologically, there is no actual definition for sensitive skin. Sensitive skin is a layman phrase used to describe the skin conditions of people with generally low tolerance to cosmetics and personal care products or the environment as they easily break out in rashes or get blotchy, itchy or a stinging pain from using or applying such products.

CLINICAL FEATURES

Sensitive skin can appear in several different forms such as:

  • Stinging, itching, or a burning sensation. However, these symptoms are subjective and not everyone has them.
  • Visible skin changes such as redness, bumps, hives, peeling skin, dryness and scaling.

Usually, most complaints of sensitive skin are in regard to the facial area and hands, since the eyes, nose and mouth are areas that are more sensitive, and the hands are most often exposed to overwashing and more harsh chemicals. However, other parts such as the armpits, groin and genital area may also be sensitive as these areas have slightly thinner skin around them.

CAUSES OF SENSITIVE SKIN

The outermost layer of your skin, also known as the epidermis, is a protective barrier that helps keep harmful substances out and most importantly- locking moisture in. Sometimes, however, this protective barrier may be weakened, hence, leaving your skin susceptible to external irritants that may cause a reaction on your skin.

There are several recognised medical causes of sensitive skin such as:

  • Irritant contact dermatitis
  • Allergic contact dermatitis
  • Contact urticaria
  • Rosacea
  • Physical urticaria and dermographism
  • Aquagenic pruritus
  • Dry skin
  • Eczema/dermatitis of any type
  • Photodermatoses
  • Cutaneous mastocytoses
  • Carcinoid syndrome
  • Irritant contact dermatitis (ICD)
  • Excessive exposure to skin-damaging environmental factors such as the sun, wind or even excessive heat or cold temperatures.
causes of sensitive skin

Let’s go into a bit more detail on the more common among these conditions.

Usually, where sensitive skin is concerned, it most often refers to a form of irritant contact dermatitis (ICD). This happens when the skin has developed and inflammatory reaction to and externally applied agent which has not had prior sensitisation. Some examples of such agents are:

  • Skin irritants such as detergents and solvents, very commonly seen in people who have to wash their hands a lot, such as nurses, hairdressers, bartenders, cooks, cleaners, etc
  • Body fluids such as sweat, urine and faeces.
  • Environmental factors such as heat, cold, low humidity and ultraviolet light.
  • Mechanical factors such as friction, pressure, vibration and occlusion.
  • However, host factors such as age, sex, skin site and history of eczema may also trigger ICD

There is another form of contact dermatitis called allergic contact dermatitis – for example nickel and rubber, which develops as an allergic reaction to contact with the substance. The cause for this is unknown.

ICD tends to happen more frequently in people who have eczema, asthma and hay-fever, and this trait tends to run in families (that is, it is inherited in your genes).

The appearance of ICD is a rash that is red, flaky and dry – very like eczema, except that it is most commonly found on the hands, face, neck, etc, areas most likely to be in contact with irritants. There may also be blistering and weeping. Itch is the major symptom, and it can be very intense and hard to bear.

HOW IS SENSITIVE SKIN DIAGNOSED?

Usually, the cause of sensitive skin may be diagnosed based on the history of the condition, and the clinical examination by your dermatologist.

Generally, a doctor will look for an underlying diagnosis, such as eczema, or irritant contact dermatitis, or allergic contact dermatitis.

The doctor may recommend several tests such as s skin biopsy or patch tests, depending on the history of the condition and examination, and it is good to discuss with your doctor the needs of testing, and what it can and cannot diagnose.

HOW IS SENSITIVE SKIN TREATED?

Treatment is usually aimed at the underlying cause and condition one has. For eczema, please see our article that goes into depth about how to manage your eczema. ICD is typically managed by reducing or managing exposure to the irritant(s), such as wearing gloves or using less irritating detergents, and by moisturising effectively to repair the skin barrier. Sometimes a course of topical steroid cream is required to get a flare-up under control, though this isn’t typically required for the maintenance of sensitive skin.

For people with sensitive skin and for which no underlying cause can be found, or who need to maintain their skin condition in remission, a good skincare routine is recommended, by which you can protect your skin from irritation.

Our top tips for your skincare routine are:

  • Confirm your diagnosis with your doctor – if it is not improving, or getting worse, then you need to seek advice and maybe look for alternatives or rarer diagnoses.
  • Be aware of any triggers and avoid them.
  • Avoid scratching.
  • Be sure you know what you are applying on your skin is safe.
  • Use soap-free cleansers.
  • Keep your skin hydrated! Use an itch-relieving moisturiser such as Suu Balm™ and be sure to moisturise frequently throughout the day – meaning 3-4 times at a minimum!
  • Use sun protection.

HOW TO CHOOSE A MOISTURISER?

There are many different moisturisers on the market, and it can be very difficult to understand which is right for sensitive skin. Generally, moisturisers are either creams, which are mixtures of oils and water, though some are based on paraffin, and are called ointments (these are typically thicker and greasier).

Firstly, you need to apply the moisturiser frequently, so you need to choose one that you are comfortable applying frequently; for example, some people find thicker products difficult to use, because it is unpleasant to get dressed afterwards, or go out in hot weather after applying. Therefore, try out a cream and find one that goes on easily, so that you can get on with your day, and so that you will actually apply it as often as you should!

Secondly, you need to consider the ingredients: there are many potentially irritating ingredients used in cosmetic products (moisturisers are generally considered cosmetics from a product regulation perspective). Some preservatives, including some parabens, fall into this category, as well as ingredients to adjust the acid / base balance of the cream, for example sodium hydroxide. People with sensitive skin also need to be careful with plant extracts, some of which can be irritating to the skin, and which are often contained in products to give them a “natural” image, or because they are organic in origin. On the other hand, there are ingredients that are beneficial, such as ceramides and filaggrin breakdown products, which aim to repair the damaged skin barrier and restore its normal function, thereby improving moisture retention in the skin.

Finally, consider if there are additional benefits to the moisturiser, such as itch relief. Menthol in small amounts is very effective at relieving itch associated with eczema, ICD, and other conditions that can underlie sensitive skin.

HOW TO CHOOSE A CLEANSER?

The single most important aspect of the cleanser that you choose is that it is soap free. You will see a lot of products that are marked Soap Free yet contain soap like ingredients (they are classed as detergents, that is ingredients that help break down oils to allow the water to wash them away) that are potentially irritating to sensitive skin. The most frequently used of these are Sodium Lauryl Sulfate (SLS) and Sodium Laureth Sulfate (SLES).

The notes on ingredients mentioned above in the section on “How to choose a moisturiser” apply also to cleansers. Note that fragrances and colours should also be avoided.
If your hands are really dirty, or covered in oil, then you will need to use a little bit of soap – so choose an unperfumed gentle soap sparingly, then dry the skin well, and moisturise straight away.

HOW TO PROTECT YOUR HANDS FROM CONTACT WITH IRRITANTS?

  • Try to avoid laundry and dish washing detergents by using gloves.
  • Try to avoid getting your hands very greasy or dirty, to reduce the amount of soap you need to use.
  • Foods can irritate the skin (things like potatoes, chilli, citrus fruits are some examples). So again, use gloves or get help!
  • Gardening again exposes the hands to potentially irritating plants, so get help or use a pair of good, tough gardening gloves.

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