The Spectrum of Sensitive Skin: Considerations for Skin Care in Vulnerable Populations openaccess articles

January 2019 | Volume 18 | Issue 1 | Supplement | s68 | Copyright © 2019

Stacy S. Hawkins PhD and Vickie Foy BS

Unilever Research & Development, Trumbull, CT


Sensitive skin is a multifactorial condition, where the underlying pathology is not fully understood, and the clinical signs may not always be present or obvious. Despite this challenge, there has been recent progress to understand the different subtypes of sensitive skin, as well as new methods to measure the sensorial response that may not be obvious from visual examination. Similarly, there has been progress in understanding in the management of symptoms through skin care regimens designed for sensitive skin. The implications of this new research indicate the potential of better clinical outcomes for sensitive skin sufferers, as well as regimens more personalized to different triggers in the full spectrum of sensitive skin. J Drugs Dermatol. 2019;18(1 Suppl):s68-74

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Sensitive skin, or increased irritation or sensorial response to skin care products, environmental factors, and/or stressors compared to population norms, has been increasingly studied over the past 30 years. The face has been shown to be more sensitive than other parts of the body1,2; however, skin sensitivity can also vary significantly between individuals due to a number of factors such as ethnicity, gender, age, product irritancy, etc.3-7 Rising prevalence of sensitive skin and research on previously unknown factors that increase the symptoms of sensitive skin has further fueled the need to better understand the condition, as well as research into different skin care technologies to address the symptoms and minimize the onset of future sensitive skin events. The intensity of the symptoms varies widely and can also change throughout an individual’s lifetime. Although erythema and dryness are typically involved, sensations such as stinging, burning, tingling, tightness, itching, pain, etc. can persist with no clinical signs of dryness or erythema. Sensitive skin sufferers have lower Quality of Life (QoL) scores compared to normal-skin individuals, and impaired barrier function is the main biophysical finding across the different subtypes of sensitive skin individuals.8-11 Research in this area has resulted in more comprehensive subtyping of sensitive skin, to better understand the underlying causes and, consequently, potential skin care regimens to alleviate symptoms for a particular sub-type.Kligman et al12 described the characteristics of sensitive skin by different symptoms:

  • Subjective irritation: irritant response (eg, sting, burn, itch) without visible clinical signs
  • Neurosensory irritation: neurally mediated responses such as itching, stinging, burning, tightness
  • Chemosensory: relates to sensory responses induced by chemicals in contrast to physical, mechanical, and environmental factors
  • Psychophysical irritation: implies a psychological component.
Pons-Giraud14 proposed three clinical forms or subtypes of sensitive skin individuals:
  • Very sensitive skin: a subtype of individuals with especially strong reactions to external factors such as cosmetic product usage and environmental;
  • Environmentally sensitive skin: reactive to rapid temperature and environmental changes, with frequent bouts of flushing; and
  • Cosmetically sensitive skin: a lower intolerance compared to the very sensitive skin group, and often limited to specific identifiable cosmetic products.
The methods for positively identifying sensitive skin individuals or subtypes have evolved over time. One of the first methods used was the lactic sting assay,15 to identify sting potential individuals for facial skin. One limitation to this method is that an individual’s response to sting can vary over time and in addition this can be a very small subset of the population, whereas the prevalence for individuals with sensitive skin is much higher. In addition, a negative response in the lactic acid sting test is not a predictor for a sensitive skin response to other ingredients. Retinoid intolerance, for example, is fairly common in sensitive-skin individuals and will not necessarily be identified in this test. The time course for the dryness, irritation, and other symptoms in retinoid-intolerant populations follow

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