How To Manage Sensitive Skin

As a sequel to my What Is Sensitive Skin blog post I’m here going into detail about how to manage sensitive skin, the Do’s and Don’t’s.

To determine why your skin is reactive to certain cosmetics or skincare products, whether it’s due to an undiagnosed skin disease or the fact that your skin is “just” sensitive, the following regime is recommended [1-3] (here comes the Do’s). 

  1. Discontinuation  
  2. Clinical assessment
  3. Dermatological testing
  4. Slow reintroduction

 

Discontinue use of all cosmetics and skincare products

Discontinue use of all cosmetics and skincare products

Discontinuation

Discontinue use of all cosmetics and skincare products – a full-on cold turkey. The only product allowed at this stage are the so-called syndets (synthetic detergents, such as La Roche-Posay Lipkar Syndet or the Decubal Face Wash) for daily cleansing. Avoid skin friction from face cloths, clothing and bed linens. This step is simply meant to let your skin reset and it is recommended to last a minimum 2 weeks and in severe cases up to a whole year [1,2] – good heavens!

 

Clinical assessment at your dermatologist to identify the cause of your sensitive skin

Clinical assessment at your dermatologist to identify the cause of your sensitive skin

Clinical Assessment

The whole point of this step is to rule out any underlying skin disease, that might have been overlooked and undiagnosed for years. Eczema, atopic dermatitis, and rosacea are believed to be the most common skin conditions to promote sensitive skin[4]. 
So after a minimum of two weeks of discontinuation – the so-called ‘washout period’ – you can consult your dermatologist for her/him to assess your skin. And at this step is the time for you to evaluate: How’s your skin behaving now? Just as ridiculous or in a state of relief?
The dermatologist will obtain your medical history (concerning your skin), obtain information on your makeup product and skincare regime, noting know irritants (see list below under Ingredients To Avoid). 
If no skin symptoms have emerged at this point, then it’s time for the next step; testing your skin systematically.

 

Patch testing for allergic contact dermatitis

Patch testing for allergic contact dermatitis

Dermatological Testing

To identify if and/or what your skin is intolerant to, patch test for standard allergens should be the first thing done[1-3]. This way substances that could cause an allergic contact dermatitis in your skin can be identified and to be avoided in the future.

Provocative use test [2,3] is something you can do at home, testing your own makeup items to identify any culprits in your makeup stash. If any reaction occurs then bring the item to your dermatologist for further testing. To test your tolerability you must:

  • test one product at a time
  • apply it to a 2 cm area in your temple
  • five nights in a row to monitor for any skin reaction

The order of the tested makeup should be: mascara, eyeliner, eyebrow pencil, eyeshadow, foundation, primer, blush, contour/highlighter.

Next up is photopatch test [2,3] where duplicate sets of suspected allergens (your own cosmetics and skincare products and known irritants) are applied to the skin on your back, then one set is exposed to UV-light, to see if it triggers a photo allergy response. The other set is protected from the UV-light and used as a reference to test for a regular allergic (type 4) reaction. Substances in cosmetics and skincare that could give a photo allergy response are: certain balms, citrus, fragrances, preservatives and sunscreens.

At this point your dermatologist has either found an underlying skin disease, an allergy or none of the above, the latter indicating that you have sensitive skin, also referred to as the Cosmetic Intolerance Syndrome[5].

Slow Reintroduction

Slowly reintroduce a mi-ni-mal(!) amount of cosmetics and skincare products of low-allergenic-potential (often labeled as hypoallergenic) to your skin[1], using the same approach as the ‘provocative use test’ (one product at a time – applied to your temple – five nights in a row). This will allow you to handpick the products that you’ll be able to tolerate. After you’ve reintroduced your chosen cosmetics you move on to testing your new skincare products.

This is a time consuming and exhausting process, however meaningful if you wish to identify your future holy grail makeup and skincare items.

Ingredients To Avoid (the don’t’s)

The following list is a guide trough ingredients known to irritate sensitive skin. Firstly, the list isn’t complete and secondly it doesn’t mean that your skin is reactive to ALL of them. For instance, I know that my skin perfectly tolerates sodium lauryl sulfate (used in La Roche-Posay Lipkar Syndet) likewise lactic acid and urea (in my favourite acid toners) to name a few. 

  • Benzoic acid and benzoates (used in perfumes and as preservatives and pH-adjusters) 
  • Cinnamic acid compounds (anything ending in cinnam. Used in fragrance and as UV-filters) 
  • Quaternary ammonium compounds  (anything ending in (ammo)nium. Used as preservatives and surfactants)
  • Formaldehyde and formaldehyde-releasers (used as preservatives)
  • Lactic acid (used as exfoliant, humectant (attracts water to the skin) and pH-adjuster)
  • Triethanolamine (often abbreviated as TEA, used as an emulsifier, surfactant and pH-adjuster) 
  • Propylene glycol (used in fragrance, as a humectant and as a solvent that promotes skin penetration)
  • sodium lauryl sulfate, often abbreviated SLS (used in soaps to create foam and as a surfactant)
  • sorbic acid (a preservative)
  • urea (synonymous with carbamide, used as a humectant and pH-adjuster)
  • cocamidopropyl betaine (used as a surfactant)

What Makeup To Choose?

There’s a whole lots of don’t’s when it comes to sensitive skin, however there seems to be consensus[1-3,5] about which makeup products that are the smarter choice. 

  • Powder cosmetics in general (mineral powders are well tolerated and less allergenic, rather than liquid or gel formulations, as the latter contain more preservatives and ingredients in general = potential irritants)
  • Pencil eyeliners and pencil eyebrow products (contain fewer preservatives)
  • Cosmetics with less than 10 ingredients (fewer ingredients = fewer potential irritants)
  • Physical sunscreen agents (titanium dioxide and zinc oxide, they don’t penetrate the skin)
  • Fragrance free products (as fragrance can contain irritants and allergens)
  • Downsize your makeup stash and your skincare regime
  • Dispose old makeup and skincare products (notice the little period-after-opening symbol on the product. Bin the product if it smells funky)

 

Use powders, downsize your makeup and skincare products, choose fragrance free products, notice period after opening symbol, bin old products

Use powders, downsize your makeup and skincare products, choose fragrance free products, notice period after opening symbol, bin old products

In summary

  • Follow the 4-step management: discontinuation – clinical assessment – dermatological testing – slow reintroduction of products. 
  • Treat (if any) underlying skin disease
  • Avoid identified irritating substances (obviously)
  • Make a personalized list of known triggers 
  • “Green/organic/natural” cosmetics and skincare aren’t a guarantee for tolerability. The best thing you can do is to read the ingredients (using your personalized list) and steer clear of substances your skin reacts to.
  • Downsize not only the number of ingredients in each product, but also the total amount of makeup and skincare products you use.

In my next and final post on sensitive skin I’ll show you some of the products I use and tolerate and how to downsize your use of makeup and skincare.

XO Caecilie

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  1. Pons-­Guiraud A. Sensitive skin: A complex and Multifactorial syndrome. J Cosmet Dermatol 2005;3:145­8.
  2. Lev-Tov H, Maibach H. The Sensitive Skin Syndrome. Indian J Dermatol. 2012;57(6):419–423.
  3. Berardesca E1, Farage M, Maibach H. Sensitive skin: an overview. Int J Cosmet Sci. 2013 Feb;35(1):2-8.
  4. Draelos ZD. Treatments for sensitive skin: An update. In: Berardesca E, Fluhr Joachim W, Maibach Howard I, editors. Dermatology: Clinical and Basic Science Series, Sensitive Skin Syndrome. New York: Taylor and Francis Group; 2006. pp. 245–53.
  5. Maibach HI, Engasser P. Management of cosmetic intolerance syndrome. Clin Dermatol. 1988;6:102– 7.

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