Do your cheeks sting, burn and turn red easily? If so, you may have sensitive skin. Dr Haran Sivapalan explains why and what you can about it.

Don’t worry, it’s not a disease, it’s not even classed as a formal medical condition – but it certainly is real. So, what is sensitive skin then?

The term ‘sensitive skin’ is usually used to describe your skin’s reduced tolerance to certain cosmetics and personal care products. Stinging, burning, prickling, tightness or itchiness – a person with sensitive skin might complain of any of these symptoms when putting a product on their skin.

To a lesser extent, people might also experience visible signs such as redness, dryness, scaling, peeling or small lumps on the skin. The face is thought to be particularly sensitive, as are the armpits, groin and genitals.

Depending on how it is defined ‘sensitive skin’ may also be caused by another skin condition such as allergic dermatitis.

How common is sensitive skin?

Don’t worry, you’re not alone. According to a US study of 800 women, 52% of women reported having sensitive skin. A similar study of about 2,000 UK residents, published in the British Journal of Dermatology, found that 52% of women and 38% of men described themselves as having sensitive skin.

As ‘sensitive skin’ is not a formal medical diagnosis, these studies rely on patients’ reporting  of their own discomfort when applying cosmetics to their skin.

Around perimenopause/menopause women ofter report their skin becomes drier and more easily irritated, and women with rosacea may experience more flare ups.

What causes sensitive skin?

The answer to this question depends on how you define “sensitive skin.” If sensitive skin is not due to any other underlying skin condition, it may result from a complex mix of factors, many of which are poorly understood. Two major contributing factors include:

• increased permeability of the outermost layer of skin (stratum corneum) – usually referred to as your skin barrier
• altered signalling of nerves. Pain is transmitted by nerve fibres known as C-fibres and in sensitive skin, the firing of these C-fibres may be aggravated by certain cosmetic ingredients.

Sensitive skin due to other skin conditions

As it is a poorly defined, catch-all term, ‘sensitive skin’ sometimes encompasses other underlying skin conditions which include:

• Irritant contact dermatitis. Most commonly, people with ‘sensitive skin’ are actually suffering from a condition known as irritant contact dermatitis. This is where frequent contact with a substance, including chemical agents in cosmetics (see ‘Which ingredients may irritate my skin’ below), causes inflammation of the skin. It is not due to an allergy. Irritant contact dermatitis sometimes causes sensorineural irritation, whereby a person experiences burning, itching and stinging sensations, but biopsies of the skin show no evidence of inflammation.
• Allergic contact dermatitis is where an ingredient that comes into contact with your skin causes an allergic reaction. Usually, your immune system becomes sensitised on first contact with the ingredient. Subsequent exposure to the ingredient then triggers an allergic reaction with redness, itchiness and thickening of the skin.
• Contact urticaria is a form of urticaria or hives that causes a red rash with small lumps (‘wheals’) on contact with certain substances. Contact urticaria may be non-allergic or allergic. Non-allergic urticaria tends to settle down after a few hours – similar to a nettle rash. In allergic urticaria, a person must be exposed and sensitised to the allergen first. Allergic urticaria can cause more serious symptoms such as wheezing, swelling of the mouth and lips (angioedema) and even anaphylactic shock.
• Rosacea – people with this condition may find that applying certain cosmetics can irritate their skin and cause it become red. This may suddenly occur even for cosmetic products which have been previously used without issue.
• Aquagenic pruritus – people with this condition experience itchiness when their skin comes into contact with water.
• Eczema (atopic dermatitis) – eczema can disrupt the barrier function of the skin, allowing certain irritants to penetrate and cause itchiness and rash. Dry skin can also give rise to sensitive skin through a similar process.
• Cutaneous mastocytoses – this is a group of rare conditions where there are abnormally high number of mast-cells in the skin. The mast cells may be triggered into releasing histamine, which causes itchiness and redness.

Is there a test for sensitive skin?

There isn’t a specific diagnostic test for sensitive skin. A GP or dermatologist can conduct a “patch test” to see whether you are allergic to any particular ingredient. While this is useful for diagnosing skin conditions with an allergic reaction (e.g. allergic contact dermatitis), not all cases of sensitive skin are due to allergy.

Patch testing involves exposing small areas of skin to various potential allergens and observing whether an allergic reaction occurs. Several substances (including cosmetic ingredients) are each put in a small (1cm diameter) disc and taped to the skin on your back. A health professional then looks at your skin after two hours to check for any immediate reactions. The skin is also usually checked after 2 and 4 days, to check for any delayed allergic reactions.

Testing for irritant contact dermatitis is more difficult, although some places may offer a ‘repeated open application test’ (ROAT). This is where a potential irritant is applied to a small area of skin twice a day for a week, in order to see whether a skin reaction develops.

Which ingredients may irritate my skin?

People with sensitive skin differ with respect to which particular cosmetic products irritate their skin. Broadly speaking, products containing surfactants (detergent agents used to get rid of oil, grease and dirt) can irritate sensitive skin and may increase the skin’s permeability to other irritant chemicals. Surfactants include:

• Sodium lauryl sulphate
• Sodium laureth sulphate
• Ammonium laureth sulphate
• Sodium tallowate
• Sodium cocoate
• salicylic acid

Soap can contains surfactants; so, when choosing a cosmetic product, people with sensitive skin might find it helpful to opt for soap-free alternatives. (See ESK Calming Cleanser)

People with underlying skin conditions may find certain cosmetic ingredients to aggravate their skin. For example, Balsam of Peru, benzoic acid, cinnamic alcohol, cinnamic aldehyde and parabens are sometimes known to trigger contact urticaria (rashes and lumps).

Lactic acid, propylene glycol, cocamidopropyl betaine and coconut diethylamide may cause irritant contact dermatitis.

Other potential irritants include certain alcohols in skincare that may be drying, deodorants and fragrances. People with sensitive skin are therefore advised, where possible, to choose alcohol-, deodorant- and fragrance-free cosmetic products. (That said no all alcohols in skincare are drying – read more about that here.)

I have sensitive skin – how should I choose a cosmetic product?

The answer to this depends on what ingredients are known to irritate your skin. When choosing a cosmetic product, it may help avoid products containing many of the ingredients listed above. In general, aim for products that are:

• Fragrance-free – fragrances are arguably the most common skin irritants
• Soap-free
• Alcohol free

Less is more: As a rough rule of thumb, the fewer ingredients a product has, the less likely it is to irritate sensitive skin.

Tolerance test: When using a new product for the first time, some dermatologists recommend initially applying a small amount to the skin behind the ear. It is then left overnight and this procedure is repeated everyday for 5 days. If the product is tolerated and there is no skin reaction, then the same procedure can be repeated on the skin alongside the eye. If there is still no reaction and the product is tolerated, then it’s likely to be safe to use the new product as normal.

Should I choose products that are branded as “hypoallergenic” or “dermatologically-tested”?

Unfortunately these terms are not legally-defined and may be misleading. “Dermatologically-tested” simply means the product has been tested on skin – it does not guarantee the product will be free from irritant chemicals. Similarly, “hypoallergenic” suggests that a product has a reduced potential to cause an allergic reaction, yet many ‘hypoallergenic’ products will still contain potential allergens and other irritants such as fragrances.

A person with sensitive skin may be better off looking at the ingredients list of a cosmetic product in order to ascertain whether it contains any known irritants.

Is there anything else that can help sensitive skin?

• Moisturise regularly – dry skin is more likely to be highly sensitive. Keeping the skin well moisturised also helps retain the barrier function of the skin and prevents irritants from permeating.

• Protect your skin from the sun – skin that is damaged from excessive exposure to sunlight is more likely to be sensitive. Wearing sunscreen, keeping out of strong sunlight an avoid tanning beds can all help minimise sensitive skin.

• See a GP or dermatologist – if you think you have sensitive skin, a GP or dermatologist are best placed to advise you on possible treatments and what products to choose.

See products designed for sensitive skin and rosacea here.