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April 5, 1999

SENSITIVE SKIN

Introduction

       "Sensitive skin" is, for most of us, a very familiar term. We regularly see this expression used in product advertisements, and may even adopt it to describe ourselves. But what do we really mean when we say that we have sensitive skin? Do we have acne that seems to be worsened by the skin care products that we use?  Do we seem to develop hives whenever we try new make-up? Perhaps we merely feel a vague discomfort when we apply the newest "antiaging" cremes? Because the term sensitive skin can potentially describe an extremely broad range of skin behavior, only some of which is objectively verifiable, it is best understood as an expression of an individual’s perception about her or his relative intolerance to cosmetics products.

       For some people, saying that they have sensitive skin means that their acne seems to worsen whenever they try a new skin-care product. Others develop rashes when they use fragrance containing foundations. Still others experience a burning or itching sensation whenever the salesperson applies a different make-up product at the local cosmetics counter. Therefore, whether or not a cosmetics user has sensitive skin is a subjective distinction based largely upon that person’s beliefs.  The following represents an attempt to categorize the symptoms and conditions commonly experienced by women and men with sensitive skin.

Subjective Irritation.

       Individuals who describe themselves as having sensitive skin, most commonly exhibit what has been referred to as "subjective irritation."  These cosmetic users frequently complain of burning, stinging, itching, or other discomfort shortly after cosmetics are applied, but do not demonstrate objective signs of inflammation. Typically, the unpleasant sensations increase in severity over a five to ten minute period following exposure.  They then abate, with complete resolution occurring in about fifteen minutes.

       Dermatologists often refer to such individuals as "Stingers," a category that may represent from one to ten percent of cosmetics users. Stingers are unable to tolerate certain cosmetics products, despite any physical evidence of allergic reactions or irritation. This conspicuous lack of observable inflammation may reflect its genuine absence, or the medical profession’s limited ability to detect it.

Objective Irritation

       Some cosmetics purchasers develop visible irritation after applying specific products. Referred to by doctors as "Irritant Contact Dermatitis," this reaction is the most frequent observable adverse reaction to cosmetics products. Affected individuals experience redness, burning, and itching, with the formation of tiny vessicles, and subsequent peeling. Causes include:   cosmetics formulations that are of high or low pH or which dissolve protective skin oils, rubbing during application, and abrasive particles within the products.

       Identifying and eliminating the offending agent may prove difficult, since almost all chemicals can cause irritation under the right conditions. Moreover, multiple exposures may be necessary to produce the reaction, which further obscures identification of the causative substance. Finally, individuals vary in their responses to different chemicals, and their susceptibilities to irritant reactions depends on the integrity of the skin's protective barrier. Conditions such as psoriasis and eczema, create vulnerability because they involve compromise of the skin’s outer protective layers.  This can translate into increased susceptibility to the irritant effects of products that under ordinary circumstances would be utilized without incident.

Allergic Reactions

       Less often, users may experience allergic reactions to cosmetics products. These are generally the easiest responses to diagnose and manage. Allergy involves an inappropriate response of the immune system to a chemical exposure.  Its symptoms of redness, itching, peeling, and vessicle formation are caused by the body’s ordinarily protective, but in this instance misguided, reaction.

       After identification of the responsible chemical, one need only avoid products that contain it to prevent future reactions. Skin and hair products are a considerably more frequent cause of allergic reactions than are facial cosmetics. Nail products and fragrance products are even less likely than facial cosmetics to cause such responses. Paradoxically, however, when facial cosmetics users do have allergic reactions to products, added fragrances are the most likely culprits, followed by preservatives. When evaluating a patient for cosmetics allergy, a dermatologist, allergist, or other trained physician often performs specialized testing called "patch testing" on all of the patient’s cosmetics products, as well as on a standardized set of potentially allergy inducing substances. When the diagnosis is confirmed, and the offending chemical or chemicals identified, the patient is simply instructed to avoid them. Customers with known allergies to fragrances should purchase fragrance-free formulations.

Contact Urticaria

       Another type of skin reaction experienced after cosmetics exposure is referred to as "Contact Urticaria."   It is characterized by the development of hives in response to cosmetics exposure.   Contact Urticaria may or may not be allergic in nature. Symptoms range from simple itching and burning to generalized hives, and in rare circumstances may involve a life-threatening systemic reaction that includes wheezing, airway obstruction, and shock.

Skin Disease

       Finally, reactions to cosmetics products may be due to the presence of occult skin disease. Common disorders such as rosacea, seborrhea, and psoriasis can present atypically on the face, and thus go unrecognized. Symptoms attributed soley to cosmetics use may actually involve excacerbations of an underlying disease.

Summary

       In summary, sensitive skin is a term that reflects cosmetics users’ perceptions of their relative abilities to comfortably wear or use cosmetics and skin care products. Reactive symptoms can take many forms. Most often, consumers demonstrate no observable skin irritation or inflammation. However, others experience visible irritant, allergic, and hive reactions. Lastly, such reactions may be manifestations of subtle, unrecognized skin disease. In most cases, consumers should simply discard 
or return products that cause difficulty for them. However, if 
an individual experiences frequent reactions from many 
different cosmetics products, or reactions that are severe, she 
or he should seek the care of a dermatologist.