The words “sensitive skin” can be found pretty much in every blog post on my blog. Mainly because I find my skin highly reactive to a variety of things, e.g. physical manipulation with fingers or brushes (see it happen here), sunlight, heat, cold, certain skincare products, alcohol consumption, emotional excitement/discomfort and the list goes on – all thanks to my rosacea.

But what is ‘sensitive skin’ exactly?

The current status of my skin. A little more reactive these days, probably due to my pregnancy.

The current status of my skin. A little more reactive these days, probably due to my pregnancy.

Sensitive skin – the terminology

If you go to your GP (general practitioner) and consult her about your sensitive skin, she might not know exactly what you mean, as it isn’t an actual medical term. ‘Sensitive skin’ is layman’s term and essentially a self-diagnosed condition[1]. Among dermatologist it’s synonymous with ‘reactive skin’, ‘hyperreactive skin’ or ‘hyperirritable skin’.

As it is a self-diagnosed condition, studies based on questionnaires among people with sensitive skin, has come to the definition that sensitive skin is a reduced tolerance to cosmetics and toiletries [5].

The symptoms

The symptoms typically occurs after application of either makeup or skincare products followed by onset of erythema (skin redness), prickling, burning, tingling, tightness sensations, sometimes itching and even pain. These symptoms often have a rapid onset, within minutes, but can in some cases be experienced hours later. Besides the redness, the objective signs of sensitive skin can be hardly recognizable or absent altogether. This makes the diagnostic process even more complex if you would consult a doctor.

What causes sensitive skin?

The French dermatologist, MD Annick Pons-Guiraud, defines it as a multifactorial syndrome: This hyperreactivity of the skin is a non-immunologically mediated skin inflammation.”[1] The cause of sensitive skin is multifactorial and thought to be due to both exogenous factors and endogenous features (listed below), which in combination are responsible for the hyperactivity in the skin.

The sensitive skin has an impaired barrier function making it more susceptible to potential irritating substances. It’s characterized by a thin stratum corneum (the outmost layer of the skin) which is more permeable, ie. making it easier for product to penetrate[2], which in turn can lead to an inflammatory reaction.

 

The thin and dry stratum corneum increasing permeability of potential irritants

The thin and dry stratum corneum increases penetration of potential irritants

If you feel you have sensitive skin, you may recognize some of the listed factors to trigger your sensitivity symptoms.

Exogenous factors[1]: 
  • soaps, cleansing products 
  • sunscreens
  • chemical exfoliants e.g. resorcine, TCA (Tri-Chloro-Acetic), AHA (Alpha-Hydroxy-Acid)
  • Sunlight (UV-radiation), cold, heat, wind, pollution, air conditioning
  • product ingredients: alcohol, propylene glycol, butylene glycol, cocamidopropylbetaine, triethanolamine, SLS (sodium lauryl sulfate)
  • Foods & drinks: spices, alcohol, coffee, hot beverages (which all can lead to flushing)
  • Prolonged use of topical steroid cream leading to steroid dermatitis

Exogenous factors for sensitive skin

Exogenous factors for sensitive skin

Endogenous features:
  • Thin skin [2]
  • Dry skin: a high transepidermal water loss (see picture) makes the skin more susceptible to irritants [7]
  • Innervation: high number of sensory nerves in the skin increases sensitivity. [8]
  • Pre-existing skin conditions: seborrheic dermatitis, steroid dermatitis, atypical psoriasis, rosacea, (telangiectatic rosacea), perioral dermatitis, and atopic dermatitis [1]
  • Sex: women report sensitive skin more frequently than men [3]
  • Age: Young individuals have more sensitive skin than elderly [4]
  • Stress: self-reported feeling of stress is associated with sensitive skin [5]
  • Hormonal status promotes skin sensitivity [6]

 

Young individuals have more sensitive skin than elderly

Young individuals have more sensitive skin than elderly

Whom does it affect? 

The overall prevalence is unknown. However, a British study found (by asking a bunch of men and women) that approximately 52 % of the female respondents had self-reported sensitive skin compared to nearly 39% among the male respondents[3]. And we know that women with fair, dry and thin skin are more frequently affected[1]. Finally, atopic dermatitis (eczema) is thought to be a promoting factor for sensitive skin [3,6].

The three kinds of sensitive skin

Many classifications of sensitive skin has been proposed, however the following classification[1] is the most meaningful in my opinion. And as with any case of doctors trying to fit medical conditions into boxes, there’s an overlap of the clinical manifestations. You may find yourself nodding to one or more of these characteristics? 

  • Very sensitive skin: dry or fatty, reactive to both exogenous factors, i.e. cosmetic and skincare products, environmental factors and endogenous features. Symptoms can be both acute and permanent with a strong psychological component. 
  • Environmentally sensitive skin: often clear, dry and thin skin, essentially reactive to environmental factors e.g. heat and rapid temperature changes, with frequent flushing.
  • Cosmetically sensitive skin: transiently reactive to cosmetics and skincare. This intolerance is lighter and often limited to some identifiable cosmetic/skincare products.

In Conclusion

Wrapping this up: Sensitive skin is a layman’s term, and essentially a self-diagnosed condition, that covers a range of symptoms due to a reduced tolerance to cosmetics and skincare products. The etiology is believed to be multifactorial; skin thickness, hydration-level and innervation play a role; that is fair-skinned women, with thin and dry skin are more often affected. In severe cases it’s important to rule out a potentially overlooked skin disease. Patch-testing for standard allergens can be necessary along with patch-test to the specific cosmetics/skincare products the patient is using.

How to manage sensitive skin, the Do’s and Don’t’s, will be up in my next blog post, read it here

Hope you found this helpful – XO Caecilie

 

 

 

 

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References:

  1. Pons-­Guiraud A. Sensitive skin: A complex and Multifactorial syndrome. J Cosmet Dermatol 2005;3:145­8.
  2. Frosch PJ, Kligman AM. Method for appraising the stinging capacity of topically applied substances. J Soc Cosmetic Chemist 1977; 28: 197–209.
  3.  Willis CM, Shaw S, de la Charriere O, Baverel M, Reiche K, Jourdain Bastien P, Wilkinson JD. Sensitive skin: an epidemiological study. Br J Dermatol 2001 August;
    145 (2): 258–63
  4. Wöhrl S, et al. Patch testing in children, adults, and the elderly: influence of age and sex on sensitization patterns Pediatr Dermatol. 2003 Mar-Apr; 20(2):119-23.
  5. Farage MA. Perceptions of sensitive skin: Changes in perceived severity and associations with environmental causes. Contact Dermatitis 2008;59:226­30.
  6. Berardesca E1, Farage M, Maibach H. Sensitive skin: an overview. Int J Cosmet Sci. 2013 Feb;35(1):2-8.
  7. Lee CH, Maibach HI. The sodium lauryl sulfate model: an overview. Contact Dermatitis 1995;33:1­7.
  8. Marriott M, Whittle E, Basketter DA. Facial variations in sensory responses. Contact Dermatitis. 2003;49:227­31.