Sensitive skin deep dive part 2: the latest in treatment and management

Sensitive skin was initially believed to be an unusual reaction that occurs in only a small number of individuals, partly due to its subjective nature and lack of clearly visible symptoms [1,2].

However, over the last two decades, surveys on sensitive skin have been conducted in more than 20 different countries and across 5 continents, revealing that sensitive skin conditions may in fact affect more than half of the global population [1].

Although estimates vary across different geographies, up to 60–70% of women and 50–60% of men have reported having some degree of sensitive skin [1].

So, back in June, we published our ‘Sensitive Skin Deep Dive part 1’, highlighting current knowledge around sensitive skin conditions. We provided an overview of key triggers and physiological processes underlying sensitive skin conditions, and pondered how these factors could potentially interact with the skin microbiome.

To give you a more complete package, we now venture deeper into the symptoms and different types of sensitive skin, and the latest in treatment and management.

Read on to find out more…

What are the symptoms?

Sensitive skin is not a single condition but describes skin that is hypersensitive, resulting in abnormal sensory perceptions and low tolerance to an array of external factors – for instance, food products, chemicals found within household products such as washing detergent, and beauty and personal care products [3,4].

The symptoms can present in a variety of forms and vary from one individual to the next, but include [5,6,7]:

  • Itching, stinging, burning, prickling or tingling without a visible rash
  • Rashes that may itch, sting, or burn
  • Feelings of tightness or dryness
  • Patches of redness and inflammation
  • Hives
  • Sunburn and photosensitivity

The mechanics of sensitive skin are not yet fully understood [8], but a few different underlying processes have been identified that are thought to contribute to the various types of sensitive skin [9,10,11] – this includes disruption of out outer protective skin barrier and our neurosensory network, giving rise to a feeling of discomfort in our skin (find out more about the underlying causes in our Sensitive Skin Deep Dive part 1).

Sensitive skin types

With many underlying factors and triggers, sensitive skin is a complicated set of conditions and can manifest in different ways and at different severities.

For example, when it comes to disruption of the skin barrier, sensitive skin can be classified into three types [12]:

  • Type I: Low skin barrier function.
  • Type II: Normal skin barrier function with inflammatory changes.
  • Type III: Normal skin barrier function without inflammation but with reactivity problems.

In terms of the triggers that cause a reaction in sensitive skin conditions, again different categories can be assigned [9,10,11,12]:

  • High sensitivity: Reactive to a wide variety of both internal and external factors, and associated with acute or chronic symptoms with a strong psychological component.
  • Environmental sensitivity: Fair, dry and fine skin that has a tendency to blush and is reactive to primary environmental factors.
  • Cosmetic sensitivity: Skin that exhibits temporary reactivity to specific beauty and personal care products.

However, a fairly long list of triggering factors has been identified in those who self-perceive sensitive skin, making the use of such categories challenging. For instance, sensitive skin symptoms have been reported in association with external factors such as cold and windy weather, clothes and certain fabrics, as well as internal factors such as stress and pre-existing skin conditions. Meanwhile, self-reported skin sensitivity has been found to decrease with age, and proportionally more women report sensitive skin [13.

As the presence or absence of other skin conditions has been identified as a contributing factor, different categories have also been proposed here (more on this back in the Sensitive Skin Deep Dive part 1) [12]:

  • Primary sensitive skin: The affected person has no associated underlying disease.
  • Secondary sensitive skin: The affected person has another skin condition, such as seborrheic, atopic dermatitis, rosacea or acne.

So, the various types illustrate that sensitive skin is indeed very complex, with many different factors at play.

This means that treating and managing sensitive skin conditions is also complex…

Managing and treating sensitive skin conditions

The management and treatment of sensitive skin remains challenging, and no gold standard has been established [14].

However, as it is likely that patients will have flares due to certain triggers and unpreventable conditions, such as wet humid air, windy environments, stress and strong emotions, management techniques are key [5], and include the need for optimization depending on sensitive skin type and even the season [12].

Generally, management and treatment approaches should aim to [5,12]:

  • Restore skin barrier function: Repairing a weakened skin barrier should increase an individual’s tolerance threshold and restore the protection provided against all types of insults: physical, chemical, mechanical, immunological and microbiological.
  • Reduce neurosensory reactivity: Blocking exacerbated neurosensory activity will help to alleviate the sensory symptoms associated with sensitive skin.
  • Be safe for sensitive skin: The use of formulas with few ingredients is recommended for products designed for the treatment and care of sensitive skin to prevent chemical mediators or unwanted characteristics (for example a change in pH) that could aggravate sensitive skin symptoms.

Hygiene and personal care

Due to the diversity of factors that can trigger and worsen sensitive skin conditions, managing your day-to-day hygiene and personal care routine can help the care of sensitive skin – particularly as the use of inappropriate products could exacerbate symptoms.

Recommendations for those prone to sensitive skin conditions include [5,12,14]:

  • Maintain high skin hydration to reduce susceptibility to irritation and to restore the integrity of the stratum corneum (the outermost layer of the skin) to support the skin barrier. Skin routines can include ‘passive’ moisturizers (such as silicones) to reduce transepidermal water loss and balance the skin’s acid mantle, and ‘active’ moisturizing or hydrating products that retain water in the stratum corneum (such as glycerol, hyaluronic acid and filaggrin derivatives)
  • Use a gentle cleansing routine and avoid scrubbing the skin with mechanical devices or exfoliating products
  • Use beauty and personal care products that have been shown to improve skin barrier function, sticking to simple formulas containing very few ingredients and minimal concentrations of preservatives and surfactants to help avoid irritants, sensitizing agents and sensory stimulants
  • Use products with a pH in the normal skin range (5.5–6.0) and avoid products that have a high pH that could damage the skin or mucous membranes (read more on skin pH)

When it comes to the active ingredients, ceramides are one example that may help sensitive skin conditions. Ceramides key skin lipids that hold skin together and form a protective layer to help prevent moisture loss and visible damage from environmental stress, and so topical application has been recommended [16].

Another active ingredient of interest is nicotinamide, which helps to restore barrier function by increasing the synthesis of ceramides and other skin lipids to again help reduce water loss. Nicotinamide also reduces inflammation and itching, and has been observed to have probiotic properties, supporting our skin microbiome [12].

Therapeutic treatments

For more acute cases of sensitive skin, certain substances have been identified that can help alleviate the symptoms. For instance, molecules that inhibit the activity of the protein ‘TRVP1’ are recommended, as TRVP1 plays a key role in neurosensory disruption (as covered in our Sensitive Skin Deep Dive part 1). ‘Pimecrolimus’ is one example used (currently used in pharma for the treatment of atopic dermatitis and neurodermatitis), as it targets TRPV1 and has been shown to improve the symptoms of sensitive skin in a clinical study [5.

Positive results have also been achieved with ‘neurosensine’, a molecule naturally found in the human body that consists of two amino acids (arginine and tyrosine) and is involved in pain regulation. Neurosensine stimulates the production of hormones such as endorphins and related molecules in skin cells and contributes to the creation of a barrier that protects nerve fibres, reducing neurosensory stimulation and the activity of TRPV1 and other inflammatory agents, helping to reduce sensitive skin conditions such as burning, heat, itching and stinging [12].

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References

  1. Farage, M. A. The prevalence of sensitive skin. Front. Med. https://doi.org/10.3389/fmed.2019.00098 (2019).
  2. Misery L. Irritated Skin Is Not Sensitive Skin. JID Innov. 2021;1(3):100031.
  3.  Do, L. H. D. et al. Sensitive skin syndrome: an update. Am. J. Clin. Dermatol. 21, 401-409 (2020).
  4. Chen L, Zheng J. Does sensitive skin represent a skin condition or manifestations of other disorders? J Cosmet Dermatol. 2021;20(7):2058-61.
  5. Misery L. Irritated Skin Is Not Sensitive Skin. JID Innov. 2021;1(3):100031.
  6. Do, L. H. D. D. et al. Sensitive Skin Syndrome: An Update. Am. J. Clin. Dermatol. 21:401–409 (2019).
  7. Farage, M. A. Understanding the Sensitive Skin Subject to Achieve a More Holistic Diagnosis. Cosmetics 8, 81 (2021).
  8. https://www.medicalnewstoday.com/articles/sensitive-skin#causes
  9. Raj N, Voegeli R, Rawlings AV, Doppler S, Imfeld D, Munday MR, et al. A fundamental investigation into aspects of the physiology and biochemistry of the stratum corneum in subjects with sensitive skin. Int J Cosmet Sci. 2017;39(1):2-10.
  10. Misery, L. et al. Sensitive skin: psychological effects and seasonal changes. J. Eur. Acad. Dermatol. Ven. 21, 620-628 (2007).
  11. Misery, L., Loser, K. & Stander, S. Sensitive skin. J. Eur. Acad. Dermatol. Ven. 30, 2-8 (2016).
  12. Jiang W, Wang J, Zhang H, Xu Y, Jiang C, Yang J, et al. Seasonal changes in the physiological features of healthy and sensitive skin. J Cosmet Dermatol. 2021.
  13. https://www.dovepress.com/a-survey-to-identify-determinants-that-influence-self-perceived-sensit-peer-reviewed-fulltext-article-CCID
  14. Guerra-Tapia, A. Diagnosis and Treatment of Sensitive Skin Syndrome: An Algorithm for Clinical Practice. Acta. Dermo. Sifilo. 110, 800-808 (2019).
  15. Misery L, Weisshaar E, Brenaut E, Evers AWM, Huet F, Stander S, et al. Pathophysiology and management of sensitive skin: position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI). J Eur Acad Dermatol Venereol. 2020;34(2):222-9.
  16. Wu Y, Wangari-Olivero J, Zhen Y. Compromised Skin Barrier and Sensitive Skin in Diverse Populations. J Drugs Dermatol. 2021;20(4):s17-s22.

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