Sensitive Skin--No, You Are Not Crazy After All!
Posted: Wednesday, August 02, 2006
by Nelson Lee Novick
Nelson Lee Novick, M.D.
You’ve all heard the term so many times, in so many print ads and T.V. and radio commercials. You may yourself complain of it, and it’s been driving you crazy, and what’s even worse you already have begun to think of yourself as nut. I’m referring to the complaint of “sensitive skin," a condition in which just about every soap, makeup or toiletry product you apply to your skin makes it feel tight, tingle, itch, sting or burn, in the absence of any rash or anything else you could point out to your doctor whom you are sure must be convinced that you’re just a wacko.
Be of good cheer, however. That may be the way things were until relatively recently, but a closer investigation has revealed an entirely different picture of this troublesome problem for which new strategies have been devised to help sufferers deal with it.
Sensitive skin, also called the “irritable skin syndrome," “status cosmeticus," the “cosmetic intolerance syndrome" (CIS), or “chemosensory irritability," is estimated to affect an estimated between 1 percent and 10 percent of facial cosmetic users according to surveys done by cosmetic manufacturers.
Although the precise cause(s) of sensitive skin awaits further elucidation, speculation has led to several different theories. One hypothesis suggests that there is a higher density of nerve endings in the skin of these individuals. Another contends that it results from an increase in the release of nerve ending transmitter substances (the chemicals responsible for communication between nerve cells). A third model suggests that sensitive skin results form chronic trauma to the nerve endings. Still another attributes it to an abnormally slow removal of nerve ending transmitter substances, which might explain the persistence of the unpleasant sensations. Another theory suggests that the root of the disorder is an exaggerated and prolonged immune system response to common skin stimuli.
Finally, a somewhat unifying theory attributes the condition to the presence of a disabled or dysfunctional skin barrier (at the level of stratum corneum, the horny layer). According to this model, a barrier disturbance would not only allow more potential irritants to reach delicate nerve endings below the surface, but would also expose them to a increasing degree of stimulation by the environment.
Approximately, 50 percent of persons with sensitive skin have one or more of the above symptoms WITHOUT ANY VISIBLE SIGN OF A RASH, which makes the diagnosis particularly challenging and which even in the not-to-distant past often led to a misdiagnosis of psychogenic illness. The other 50 percent can present with skin lesions that can run the dermatologic gamut from redness, scaling and blisters to pimples, pustules and hives. Symptoms may occur immediately after applying a product or minutes, hours or even days later. Occasionally, the interaction of more than one product is necessary to provoke the reaction.
In making the diagnosis, the dermatologist must rule out the presence of other common disorders whose symptoms may mimic those of CIS. These include atopic dermatitis, seborrheic dermatitis (insert link to article on seborrheic dermatitis), psoriasis, contact dermatitis and photocontact dermatitis. Through the years a variety of tests have been devised to verify the diagnosis. The most common one is the lactic acid stinging test, in which a lactic acid 10 percent solution is applied to the cheek or the fold between the nose and the cheek and left for ten minutes. A stinging reaction during the test indicates sensitive skin.
Once the diagnosis is made, finding suitable cosmetic and toiletry products can be tricky and often requires a careful examination of product ingredient labels and often much trial and error. Simple products containing ten or fewer ingredients make wise choices, since fewer ingredients means less chance of developing an untoward reaction. In general, products containing milder paraben preservatives are preferable to those containing other preservative agents. Likewise, skin hygiene products employing mild surfactants (emulsifying agents used in cleansers and shampoos), such as sarcosinates, glutamates, isoethionates, sulfosuccinates, betaines and amphoterics make prudent choices.
In an attempt to break the sensitive skin cycle, some investigators have suggested a calming down period of at least two weeks in which only a mild, sensitive skin cleanser (eg. Formula 405 AHA Facial and Body Cleanser, Moisturel Sensitive Skin Cleanser) and a bland emollient (eg. Acid Mantle Cream, Aquaphor) should be used. Following this, other skin care products and makeups may be added one at a time-- adding one each week, and then only after testing a dime-sized amount of it to the side of the eye for five consecutive nights to reduce the likelihood of irritation when it is applied to a larger area.
Research has suggested that the following ingredient categories and offending agents be AVOIDED by sensitive skin sufferers: solvents (eg. ethanol, acetone, SD alcohols) aromatics (menthol, benzyl alcohol, cinnamates) penetrants (propylene glycol, butylene glycol, AHAs) surfactants (sodium lauryl sulfate, quaternary ammonium surfactants) biocides (sorbic acid, formaldehyde releasers) chemical sunscreens (PABA, benzophenones, cinnamates) abrasives (polyethylene beads, bismuth oxychloride, mica, silica).
The take home message is that you need no longer be tortured by the vagaries of sensitive skin. With a bit of work and a little luck, you can find products right for you. And, if trial and error don’t work, see your dermatologist.
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