Sensitive skin is not an uncommon problem. It is almost always a problem of facial skin, but can occur anywhere or everywhere on the body. The most common complaint is that facial products start to burn, tingle or sting when applied. The product often needs to be washed off quickly to relieve the sensation.
Sensitive skin is a symptom. It is not a specific disease, like asthma. Therefore, the question to ask when you have sensitive skin is: “What is the underlying condition that is causing the sensitive skin?”
From a purely anatomical or physiological perspective any condition that can disturb the epidermis, which is the top layer of the skin, can lead to a sensitive skin. Nerve fibres terminate in the epidermis, so any condition that disturbs the area around a nerve fibre can result in that nerve fibre becoming too easily stimulated. This over sensitivity of nerve fibres is experienced by the patient as sensitive skin.
Atopic Dermatitis is a genetic condition that results in many different signs and symptoms, but a tendency to dryness is perhaps the most common symptom. Dryness leads to an abnormal epidermis, disturbs the environment of the epidermal nerve endings and opens the door for sensitive skin to develop. Because dryness is the primary problem, the cornerstone of the treatment of Atopic Dermatitis is moisturisers and the avoidance of products that can dry the skin even more, like regular soaps and cleansers. Over time, this will improve the epidermis, normalize the area around the nerve fibre and result in less sensitivity. In many patients Atopic Dermatitis only manifests later in life.
Irritant dermatitis is caused by exposure to irritants. These irritants are most often soaps, cleansers, toners and other cosmetic preparations. Very often these products are advertised as mild, natural and non-irritant. The cornerstone of the treatment if Irritant Dermatitis is to avoid the irritant. With complete avoidance of the irritant and other supplementary measures, the skin sensitivity will gradually subside over a period of weeks to months.
Irritant dermatitis can often be superimposed on Atopic dermatitis. The patient with Atopic dermatitis already has an abnormal epidermis and is therefore already much more sensitive to the potential irritant effects of soaps and other cosmetic products. Patients often find it difficult to believe that their facial products or facial cosmetic routine can play a role in their sensitive skin. “Doctor, but I have used those products for years”, is a common explanation for why the facial products cannot possibly play a role. But, it can.
There are two possible explanations why an existing product can suddenly start stinging. Either the person himself/herself has changed or the product ingredients or way of use have changed.
Here are some examples of the “person has changed” scenario:
- Perhaps an oral medication was started that makes the skin drier. Statins, used to treat elevated cholesterol levels, often leads to dry skin and then increased skin sensitivity.
- Perhaps the work or home environment changed. Air conditioners can sometimes tip the scale towards dryness.
- Perhaps a Contact dermatitis has developed. Contact dermatitis is a type of skin allergy that can be investigated by doing an allergy tests, called patch tests.
- Stress has been showed to influence the epidermis in dramatic ways.
- The thyroid gland might have become under active, leading to a disturbed epidermis and increased skin sensitivity.
- The normal ageing process and sun damage leads to increased skin dryness that can then lead to sensitive skin.
- After the menopause the skin becomes significantly drier and prone to sensitivity
To figure out what exactly tipped the scale towards a sensitive skin and to treat sensitive skin will often require the help of a dermatologist.