Chapter 12: Sensitive Skin

INTRODUCTION

Sensitive skin is a condition characterized by hyperreactivity to environmental factors. Individuals experiencing this condition report exaggerated reactions to topical personal care products that may or may not be associated with visible symptoms. Approximately 50% of patients with sensitive skin manifest their uncomfortable symptoms without accompanying visible signs of inflammation.¹ Sensitive skin can be very distressing to those who have it. Affected individuals often have to travel with their own skin care products because they cannot use the skin care products provided in a hotel. These patients are the ones who should not experiment with skin care products, but should find what works for them and stick with it. Cosmetic companies realize the importance of avoiding marketing products with ingredients that aggravate sensitive skin. Most of the larger well-known companies conduct skin sensitivity testing of their products prior to launch; however, occasionally, a product will sneak through undetected that causes symptoms in sensitive skin types. This is a significant problem for companies when it occurs because 78% of consumers who have sensitive skin state that they have avoided a particular product or brand because of past skin reactions.² Those with frequent skin reactions learn to limit their use of skin products to the few that do not cause irritation in order to avoid the annoyance of redness and itching that can interfere with everyday activities. Those with frequent skin reactions report a decrease in quality of life and frustration is a common complaint. In a French study of more than 2000 individuals, it was found that those with sensitive skin reported a poorer quality of life compared to those without sensitive skin using the SF-12 questionnaire.³ However, depressive symptoms were no more common in those with sensitive skin as compared to those with “normal” skin.

PREVALENCE

Epidemiologic surveys show a high prevalence of sensitive skin. In a phone survey of 800 ethnically diverse women in the US, 52% described having sensitive skin.² In a UK mail survey of 2058 people, 51.5% of the women and 38.2% of the men reported having sensitive skin.⁴ Sensitive skin is most commonly reported on the face. However, one study showed that 85% of the 400 subjects evaluated described sensitive skin on the face, while 70% reported sensitive skin in other areas: hands (58%), scalp (36%), feet (34%), neck (27%), torso (23%), and back (21%).⁵

TYPES OF SENSITIVE SKIN

Sensitive skin has been difficult to characterize in the past because it is often self-perceived, is not accompanied by visible skin changes, and testing can show inconsistent results. In the attempt to characterize sensitive skin, several classification systems have been described. Yokota et al. classified sensitive skin into three different types based on their physiologic parameters.⁶ Type 1 was defined as the low-barrier function group. Type 2 was defined as the inflammation group with ...