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Dr Sarah Wakelin's Q & As for Sensitive Skin

Dermatologist, Dr Sarah Wakelin answers the key questions on Sensitive Skin.
10 Aug 2020

1. What is sensitive skin?

Nowadays, sensitive skin is an increasingly recognised and common complaint. Studies suggest that the majority of women and almost half of all men in developed countries are affected by sensitive skin at some time in life. Sufferers experience a range of unpleasant sensations ranging from tingling, prickling, itching and soreness, to burning and a tight feeling.  These are usually triggered by using cosmetics and toiletries (personal care products).  Although uncomfortable, the skin usually looks normal when these symptoms occur, but they can also be accompanied by mild redness

People who have eczema, rosacea and other inflammatory skin complaints are associated with increased skin sensitivity and this can cause problems with topical medication in addition to daily skin care products. The atopic complaints, hay fever and asthma can also be linked with an increased likelihood of sensitive skin.

2. What causes sensitive skin reactions, is there any particular trigger?

We do not fully understand what causes sensitive skin and why it has become such a common phenomenon.  Research has shown that this may be related to increased activity of skin nerves, a thinner skin texture or a combination of both which make the skin more easily irritated.

Climate often plays a part with symptoms being worse in cold, dry or windy weather.  Ultraviolet (UV) light and hot climates can also be triggers, as well as pollution, hormones and stress.

Skin care products, and especially skin cleansers, are usually the main causes.  Our changing habits of skin care, particularly showering or bathing more frequently are significant.  While washing helps maintain good skin hygiene (and in a busy office or crowded commuter train this is highly desirable) the daily use of soap, shower gels and bubble baths can lead to skin dryness, which makes it prone to sensitivity. 

People of all races can get sensitive skin.  Interestingly, there seem to be some differences between ethnic groups in that different triggers such as alcohol and spicy food cause more problems in some than others.

3. How do I know if I have sensitive skin? Can I develop sensitive skin conditions if I have never had it?

There is no medical test for sensitive skin, and because the symptoms do not last long or cause a persistent rash, most people will not ask for help from their doctor.  If you notice tingling, prickling, itch, soreness to burning or a tight feeling after washing or bathing, when applying creams, moisturisers or make up, or with certain climates, then you have sensitive skin.   All ages can be affected and some studies have found that sensitive skin gets more common in later life.

The face is the most common site for skin sensitivity. More specifically, the nose-cheek or nasolabial folds, the forehead , the cheekbones, the chin and the upper lip are the affected the most.  The hands, feet, neck, torso and back can also be affected and about half of sensitive skin sufferers also have a sensitive scalp.  Sometimes the genital skin may be affected, which can cause a lot of embarrassment as well as discomfort.

4. How important is following a skincare routine in managing sensitive skin?

If you suffer from sensitive skin, try to stick to a straightforward and simple skin care regime.  Do not use soap as this alters the natural skin pH and strips away essential protective oils. 

Avoid toners as these can remove natural skin oils, and exfoliators which can damage the outer protective skin layers.  Regular use of a gentle moisturiser should help improve sensitivity.

5. What are some tips for caring for sensitive skin?

A daily regimen with a gentle cleanser and carefully formulated/balanced moisturiser can help protect the skin against the effects of climate, while maintaining good hygiene.

Choose toiletries and cosmetics that have been specially formulated to avoid irritating ingredients such as detergents, alcohols and sensitisers such as perfume and preservatives.
The skin has its own natural protective layer of microbes, oils and even produces antibacterial  peptides that prevent infection.  Stripping these away with harsh cleansers may be one of the factors leading to the increase in sensitive skin and eczema that we have seen in recent years.

6. What are some tips for protecting my sensitive skin in winter and summer?

Someone with sensitive skin needs to take extra care to avoid extremes of temperature, especially cold windy weather when the humidity is low.  Air conditioning and central heating can also worsen the problem as they reduce the moisture content of indoor air leading to skin dryness. We expect a lot of our skins nowadays.  For example, during the winter period stepping out of a warm home into cold weather and then another warm vehicle, or perhaps a cold walk or cycle ride, before reaching work, the exposed body areas of the face, neck, scalp and hands have to constantly adjust to changes in temperature and humidity, in addition to the extra stress put on the skin by air pollution. Try to keep the ambient temperature more even by avoiding hot car heating, hot showers or sitting next to a fireplace or radiator when coming in from the cold. Ultraviolet (UV) light in strong sunshine can also trigger sensitive skin, being the leading cause of skin ageing. So it makes sense to protect repeatedly exposed areas with a high factor sunscreen. People with fair skin need to take particular care in the sun as they are more prone to the long term damaging effects of UV exposure, such as premature ageing and skin cancer.     

Swimming is a great way to exercise, but it can lead to skin irritation.  It is important to rinse carefully after swimming in a pool or seawater. Use a gentle cleanser and then apply a moisturiser to any areas prone to dryness. Air travel can aggravate sensitive skin as the cabin air is extremely dry, so carry a small container (check 100mls rule) of thermal spring water and use this to freshen up instead of wet wipes which contain a cocktail of chemicals and potential allergens.

7. How sensitive skin impacts the quality of life of families you see and what advice do you give?

Although not a serious problem, sensitive skin can cause annoyance, frustration and anxiety. Many people with this problem believe they have undiagnosed allergies and can spend a lot of time and money searching for the cause and cure.  Sometimes this involves trying a lot of different cosmetics and toiletries without seeing improvements.  It is usually a relief to find out that you are not alone, and that help is at hand.

8. What should I look for in skin care products that will make them less irritating to sensitive skin?

It is recommended to avoid any form of bar soap or liquid soap and wash with warm water using a gentle cleanser twice a day, patting the skin gently with a soft absorbent towel rather than rubbing.  For extra sensitive skin, use thermal spring water instead of tap water. 

Use a fragrance-free moisturiser on any dry skin areas, and reapply as needed.  Avoid anti-ageing products as these often contain irritating substances.  Toners and exfoliators should also be avoided on sensitive areas. Make up can irritate sensitive skin and people with facial rashes.  Usually, mascara, liquid eye liners and foundation cause more problems than other cosmetics.

9. Which clothing fabrics are less irritating to sensitive skin?

Wear extra soft, breathable fabric. Fine, soft cotton and silk are good choices.  Modern man-made fabric such as polar fleece can also be comfortable, and is light and easy to launder.  Wool is not a good choice as it has coarse fibres that prickle and irritate the skin. Contrary to popular belief, wool garment itch has nothing to do with having a lanolin allergy. It is caused by the pricking effect of the individual fibres.

Remove any garment labels that come into contact with the skin and check the seams to make sure they have not been stitched with ‘invisible’ monofilament thread as the ends of this can be sharp and uncomfortable. Avoid lace fabric worn directly on the skin.
It may be surprising to learn that dermatologists do not think that laundry detergent is a big cause of rashes or skin sensitivity.  How you wash your skin is much more important than how you wash your clothes.  However, don’t use more than the recommended amounts of laundry detergents so your clothes are adequately rinsed by the end of the wash cycle.

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