Sensitive skin

It is a condition that is often little recognized but very frequent, especially in women, and in some age groups: childhood and menopause.

Sensitive skin is skin that has already lost its state of balance, but is not yet diseased.

In a 2001 British study it was highlighted that 62% of women subjected to assessment said they had sensitive skin or had had at least one episode or period of increased skin sensitivity. In another study, conducted in France, approximately 50% of individuals (59% women and 41% men) declared they suffered from it.

Sensitive skin is commonly associated with unpleasant subjective sensations of stinging, heat, burning, itching, or even pain. All these are typical symptoms of irritation and inflammation that can be accompanied by another fundamental sign of inflammation, erythema or redness, although this does not always occur.

Its rather paradoxical characteristic is that it can manifest itself at particular moments and periods without any apparent warning, or it can be a constant and constitutional condition.

Another interesting and mysterious aspect of sensitive skin is that the stimuli that trigger its manifestations are varied and numerous. Precisely because of this complexity and unpredictability, sensitive skin has also been defined as reactive or intolerant skin, and, until a few years ago, there were difficulties in classifying it and framing it as a clinical condition in its own right.

The 5 paradoxes of sensitive skin:

• episodic and/or constant condition
• extreme variability of manifestations
• various and numerous triggering stimuli
• apparently healthy or pathological skin
• oily, normal or dry skin

Skin has always been classified into three types: oily, normal and dry.

Sensitive skin can be of any type.

Contrary to what you might think, greater skin reactivity does not only concern dry skin, but can also be present in the case of normal or even oily skin. Yes, it may seem rather strange, but even well-hydrated robust skin such as oily skin can be or become hypersensitive and intolerant.

According to research carried out recently, the part of the body most affected in 70% of cases is the face.

How can we define sensitive skin?

Sensitive, reactive, intolerant, irritable skin is characterized by the occurrence of sensations of stinging, tingling, burning, heat, itching or pain (with or without redness, with or without dryness and flaking), in response to various physical stimuli. (heat, cold, ultraviolet rays, wind), chemical (cosmetics, water, pollutants), psychic (stress) or hormonal (before the menstrual cycle, during menopause).

In most cases the skin appears healthy, although a sensitive or reactive skin condition can be found in individuals who already suffer from other skin diseases such as atopic dermatitis, rosacea and seborrheic dermatitis.

In all cases, at the basis of sensitive skin there is a high reactivity due to various causes and mechanisms, certainly not immunological or allergic. There is a particular sensitivity towards external physical agents (such as UV) and chemical agents (such as substances present in cosmetics), and a greater vulnerability to pathogens.

We can classify sensitive skin like this:

1. Sensitive skin with obvious skin pathologies (atopic dermatitis, seborrheic dermatitis, rosacea, ichthyosis and similar)
2. Sensitive skin with previous skin pathologies (sunburns, allergic contact dermatitis, irritant contact dermatitis) or latent, non-manifest ones
3. Sensitive skin that tends to be dry (high TEWL* and flaking)
4. Sensitive skin that tends to be normal or oily (TEWL* normal)

TEWL (trans-epidermal water loss): loss, passage or evaporation of water through the epidermis. When it is high, there is an alteration of the skin barrier so that the water present in the dermis and epidermis passes more into the external environment and the skin dehydrates, becoming dry and irritable.

Upon examination of the skin, it is characterized as follows:

Subjective feeling:

• stinging, tingling, burning, heat, itching, tightness or pain

Touch test:

• rough, thin, dry
• smooth, unctuous
• mild or no flaking

Visual exam:

• opaque, pinkish-greyish
• uneven complexion with red areas
• presence of vasodilation and telangiectasias (dilated capillaries: couperose)
• appearance of abnormal redness following mild mechanical stimulus
• invisible or enlarged pores with comedones
• wrinkled, flaking

Sensitive skin is a source of stress and can develop into couperose and rosacea, highly unsightly pathologies. In the diagnosis of sensitive skin, it is essential to evaluate the history, in particular the moments of onset of sensations and manifestations, in order to identify any triggering stimuli and underlying causes. The goal is to gradually reduce skin reactivity.