An alarming percentage (about 60%) of normal adults, mostly women, self-report that they regularly experience ‘sensitive skin’. Most perceive ‘sensitive skin’ as various amounts of stinging, burning, irritation, and itch with the use of skin care products. In a large population based study in China, we found no increase in the proportion of females among those patients whose reactions were severe enough to seek the help of a dermatologist, but we did find the reactions to be more marked in older age groups.
The types of skin care products that produce these reactions vary greatly – and sometimes even include products like moisturizers and cortisone containing creams that are intended to help – not harm – the skin. This raises two obvious questions. 1) What is it about some people’s skin that makes it so ‘sensitive’ to skin care products? And 2) what is it about skin care products that is so hard on skin?
It is commonly assumed that many of these individuals have underlying skin problems, such as a tendency to develop eczema or history of atopic dermatitis or even other ‘atopic’ or allergic disorders like asthma and hay fever. The unfortunate implication of this view is that the problem lies with them, rather than with the skin products they are using.
Our ongoing research sheds light on this issue. First, many of these individuals with reactions to skin care products do have abnormalities on skin barrier testing – perhaps many do indeed have underlying problem skin. Perhaps in addition to atopic dermatitis, people with a variety of other common, skin conditions, such as seborrheic dermatitis (severe dandruff), rosacea (frequent flushing), or other types of eczema (such as, occupational, irritant, allergic contact dermatitis) are prone to heightened skin sensitivity to skin care products.
Getting old alone may render one more susceptible to ‘sensitive skin’
In our other studies we have shown that an impaired barrier develops in everyone’s skin as they age. Also a weaker skin barrier is part of life for individuals with very fair-skin – blondes and redheads! Then too, individuals during times of psychological stress, or on systemic steroids also have a flawed skin barrier. Clearly if an underlying weakened barrier predisposes to sensitive skin, then a very large part of the population is at risk!
The majority of the skin care products we tested provoked abnormalities in skin barrier function even on normal skin.
We then explored the second question – could skin care products themselves be the problem? Our studies, first in mice and then in humans showed that many commonly prescribed and OTC moisturizers, including many that make claims that they are beneficial to the barrier actually are harmful, or at best ineffective. One important exception is EpiCeram® emulsion, developed out of research from our laboratory and which has been shown repeatedly to be beneficial for the barrier.
The bottom line is that the problems people experience with skin care products often are not theirs. They don’t have defective skin – but rather the problem lies with the products that they are using. And even if they do in fact have ‘problem skin’, these harsh skin care products will aggravate their skin even more.
Yet, the packaging of many of these products we tested and found to be bad for the barrier actually claimed to be designed for ‘sensitive skin’, and some even purported to improve the skin barrier.
What has gone wrong? Although most of these manufacturers test the safety of their products in human volunteers, they only include normal subjects in their evaluations, carefully excluding any subjects with self-reported ‘sensitive skin’. Another problem is that they typically measure hydration – ‘moisturization’ – of the skin – the ability of the cells in the outer skin layers to attract water – rather than the impact of their product on barrier function – the movement of water out of the body. Even those elegant formulations that feel so good after they have been applied and that actually may be effective moisturizers can, nonetheless, be toxic to the barrier. Over time they can provoke itch and redness and other signs and symptoms of irritated skin.
Stay tuned here: in a post to follow we will offer advice about skin care products for our readers with sensitive skin.