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INTRODUCTION

SUMMARY POINTS

What’s Important?

  1. “Stingers” are a subset of people who feel stinging, burning, or other painful sensations upon exposure to certain chemical (e.g., skincare ingredients) and/or physical factors.

  2. In the Baumann Skin Typing System, stingers are classified as having Baumann S3 sensitive skin. Identifying this skin type using the Baumann Skin Type Indicator (BSTI) is important to prevent patient discomfort and noncompliance.

What’s New?

  1. Mechanisms of burning and stinging work through an increased nervous system response, mediated by sensory nerve fibers connected to specialized receptors in the superficial skin layer.

  2. Though causes of stinging vary by individual, common ingredients include those with a low pH (e.g., lactic, glycolic, salicylic, and sorbic acids, among others), alcohol, and capsaicin.

What’s Coming?

  1. Future research exploring associations between stinging, burning, and itch, as well as the pathophysiology of diseases such as rosacea, are needed to improve treatment options for this subtype of sensitive skin.

  2. Large-scale studies of stinging in non-white populations are needed to better understand the relationship between stinging and ethnicity.

A subset of people feel stinging and burning when exposed to certain skincare products. These people have traditionally been called “stingers” since Kligman coined the term in 1977. This skin type has also been called reactive skin, hyperreactive skin, intolerant skin, or irritable skin. In the Baumann Skin Typing System, stingers are designated as having Baumann S3 sensitive skin (see Chapter 10, The Baumann Skin Typing System); the “3” denotes burners and stingers rather than other types of sensitive skin that develop such as acne (S1), rosacea (S2), or contact dermatitis (S4). One patient can demonstrate one to four different types of sensitive skin. For example, many rosacea (S2) patients are also burners and stingers (S3). Although this skin type is referred to as stingers in the context of applying chemical factors such as skincare ingredients, this skin type also includes those who feel the onset of a prickling, tingling sensation, or slight pain because of physical factors such as ultraviolet radiation, heat, cold, and wind. Psychologic stress or hormonal factors such as menstruation may play a role as well. It is important to know a patient’s susceptibility to S3 sensitive skin because this may lead to noncompliance with certain medications and vehicles that cause discomfort to the patient. Finacea is an example of a rosacea medication that causes stinging in a small proportion of users. Retin-A Micro contains benzyl alcohol (a derivative of benzoic acid) that can cause stinging in certain people. This chapter will discuss what is known about the mechanisms of burning and stinging, what ingredients are most likely to cause it, and how to identify a potential “stinger.”

EPIDEMIOLOGY

Type 3 sensitive skin is common worldwide. In a British study, 57% of women and 31.4% of men reported that they had experienced an adverse reaction to a personal skincare product at some stage in their lives, ...

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