When we launched our Routine Finder for the Dr. Sam System two weeks ago, it was completed by over 3,000 of you and a whopping 70% of you said that your skin was sensitive. So I wanted to explore this topic. Are we really much more sensitive? Or are we missing a skin disorder where sensitive skin is simply a feature of its presentation? OR: are we doing certain things with our skincare behaviour that’s promoting a problem in the way our skin functions?
What is Sensitive Skin
So firstly, I want to eliminate the disorders of which sensitive skin is a part of. When I think about sensitive skin in context of disease, rosacea immediately comes to mind. The condition where it's almost an inevitability that there'll be intolerance to certain skincare ingredients, that there'll be stingy, burning sensations associated with skin changes. There'll be associated redness of the skin and maybe papules and pustules. There may even be dry, rough patches because barrier dysfunction is part of how rosacea manifests. And barrier dysfunction is something you're going see is a common theme as we talk through the different ways sensitive skin presents.
Other skin disorders that feature sensitivity as a prominent symptom include the different types of eczema, of which atopic eczema and seborrhoeic eczema are 2 of the most common forms which can affect the face. I’m going to exclude these disorders from the discussion here - they ae discussed in previous videos and require a specific therapeutic approach.
What we then are left with, which my feeling is from the Routine Finder that is the majority of the individuals that we're left with are those who experience a kind of a bucket of kind of subjective symptoms. They'll often complain of a tight feeling or a stingy feeling or a burny feeling of their skin. And from time to time, they will experience dry patches, redness, but typically, skin changes won't be consistent. They'll come and go and the skin may even look normal. So when I think of sensitive skin, I'm excluding the disorders we've left over here and I'm focusing in on this group who have normal to dry skin as their skin type but this is possible really in context of any skin type, any skin. You can have oily skin and still behave sensitively. But it is this kind of ragbag of symptoms and occasional signs on the skin. And I think it takes that group down a certain path where we start to really dig into their behavior.
Reducing Sensitive Skin
So these patients come into clinic with a huge bag of products, typically, that they haven't been able to use “because everything stings, doctor.” And oftentimes, as I've said, the skin can look normal. So I think one of the first things I make sure I'm not missing is subclinical eczema, where there's very little inflammation to see but there is evidence of barrier disruption as manifest by the fact that everything that you put on your skin irritates them. So a trial of topical anti-inflammatory treatment, using a mild topical steroid, alongside a product detox is something that's often worth trying, particularly if somebody's skin is really itchy.
If that isn't working out, or doesn't make a big difference, the next consideration is whether there is a contact sensitivity issue to a specific skincare ingredient? And I have a low threshold for sending those patients off to have patch testing, where we look at their skin's behavior in detail, following exposure to a barrage of common allergens, including things like fragrance and preservatives, which are common culprits in this situation. So those are two more exclusions in terms of whether an actual disease process is present here.
What Causes Skin Sensitivity?
So, we’ve excluded those individuals who have a disease that needs a specific treatment approach. But we’re left with a big group who have ongoing symptoms. So what's actually causing the problem? In many of these instances, the primary problem is barrier disruption. Barrier disruption means that our complicated stratum corneum, the outermost layer of the epidermis, is no longer doing its magical thing of keeping all the bad stuff out. And that means that with ongoing use of our lotions and potions, ingredients are penetrating into the skin and potentially stimulating immune reactivity and triggering our nerve endings to release inflammatory mediators, both of which stack up to activate the inflammatory cascade and that's what we're seeing - this grumbling, low-level inflammation because our barrier is not intact.
So that's the simple thought process that I go through when I'm looking at someone who's complaining of sensitive skin. Is there a disorder? Is it part and parcel of their normal skin's behavior? Or is it due to skincare activity, like product hopping and how do we go about solving it?
Next week, I’m going to move on to product hopping because I really do believe that's the root cause in many, many instances. And that's a good thing because of course, that is eminently fixable with good skin behaviour.