Treatments for Sensitive Skin

FIGURE 25.1 Treatment algorithm for sensitive skin.

Skin Care Products

Numerous skin care products are now available especially for sensitive skin; frequently, they are labeled hypoallergenic. Labeling a product as hypoallergenic implies that it is based on a special formulation, is gentle and safe for skin, and causes less allergic reaction. But the fact that there are no standardized guidelines for sensitive skin, formulations are associated with the problem that there is no specific labeling available. Nowadays, sensitive skin care is an enormous commercial market totaling to many billions annually. Although the majority of manufacturers create high quality products for those with sensitive skin, clinical testing in patients with sensitive skin should be mandatory for hypoallergenic products (13,16).

Basically, potentially irritating or drying substances (Table 25.1) and procedures (Table 25.2) should be avoided or used sparingly. Patients with sensitive skin should use only a few and simple formulated products with a minimum of ingredients or, if possible, not more than 10–15 ingredients. The fewer ingredients, the better! Even chemical sunscreens, which are often added to conventional day creams, should not be used for sensitive skin. They should be replaced by physical UV filters such as titanium dioxide or zinc oxide. Sunscreen gels, waterproof UV products, and filters with very high sun protection factors should principally be avoided by people claiming about sensitive skin. Moreover, a careful examination of the ingredients is of importance. Nevertheless, if a product application is responsible for discomfort (e.g., redness, burning, and stinging), its use should immediately be discontinued. Mostly, removing the irritant greatly reduces the skin reaction. In addition, cool (not cold) wet compresses or thermal water spray can soothe the affected skin. Applying further skin care products, even hypoallergenic products, may aggravate the reaction.

Regarding skin cleansing, an intact skin barrier function is essential for a healthy skin. Therefore, excessive washing of the skin, especially with low-pH exfoliative or abrasive substances as well as with alkaline soaps, should be avoided. Instead, mild cleansing products (intended for sensitive skin) should be used. They should be fragrance free, nonfoaming, and not alcohol based. Synthetic detergent cleansers (syndets) should be preferred because they provide an optimum skin cleansing while minimizing barrier damage. Lipid-free cleansers cleansing without water (nonrinsing cleaning lotions) and leaving a thin moisturizing film on the skin might also be a really good solution. They can be used for people whose skin is extremely dry as well as sensitive. Cleansing masks, peelings, or implements such as a sponge, cotton wool, or brushing machines should be avoided as they are mostly too rough for sensitive skin. Finally, cleaned facial skin should be thoroughly dried by gently patting with a paper tissue.

After cleansing, sensitive skin needs to be moisturized (26,27). Moisturizers should preferably be oil-in-water emulsions, which contain occlusive agents and moisture-retaining substances to increase the hydration of the SC. They should protect the skin barrier by respectively minimizing skin barrier damage. Thus, they not only serve as lipid-replenishing, rehydrating, and smoothing skin care, but also maintain the skin’s health.

While moisturizers as well as thermal water spray can be applied several times a day, cosmetics should be used sparingly. Cosmetics selection guidelines for patients with sensitive skin are defined in Table 25.3.

Depending on abnormal sensory symptoms and the particular degree of specific clinical signs of sensitive skin, individual treatment concepts, which have both a preventive and reparative character, can be developed (Figure 25.1).

TABLE 25.1
Important Contact Allergens in Skin Care Products and Skin Cleansers


Most common causes of contact dermatitis from cosmetics and skin care products are complex mixtures of more than 2000 potential allergens such as the following:

•  Oak moss (Evernia prunastri)

•  Isoeugenol

•  Eugenol

•  Cinnamal (cinnamic aldehyde)

•  Geraniol

•  Hydroxycitronellal (laurine)

•  Cynamyl alcohol (cinnamic alcohol)

•  Cinnamic aldehyde (alpha-amyl cinnamic aldehyde)

•  Hydroxyisohexyl 3-cyclohexene carboxaldehyde

•  Coumarin

•  Citral

•  Citronellol

•  Farnesol

•  Alpha-hexyl-cinnamal

•  Limonene

•  Myroxylon pereira (balsam of Peru) (1721)


Second most common cause of contact dermatitis from cosmetics and skin care products

•  Formaldehyde

•  Methylchloroisothiazolinone

•  2-Bromo-2-nitropropane-1,3-diol

•  Parabens (methyl, ethyl, propyl, butyl, isobutyl, and isopropyl paraben)

•  Quaternium-15

•  Imidazolidinyl urea

•  Dimethyl-dimethyl hydantoin

•  Thimerosal (22)

Hair dyes and hair bleaches

Third most common ingredient to cause contact dermatitis

•  p-Phenylenediamine

•  Aminophenol

•  Resorcinol

•  Toluene-2,5-diamine

•  Ammonium persulfate

•  Hydrogen peroxide

•  Glycerylthioglycolate (23,24)


•  4-Aminobenzoic acid

•  4-Tert-butyl-4′-methoxy-dibenzoylmethane (Parsol 1789)

•  3-(4-Methylbenzylidene)-DL-camphor (Eusolex 6300)

•  2-Hydroxy-4-methoxy-benzophenone (Eusolex 4360)

•  4-Isopropyl-dibenzoylmethane (Eusolex 8020) (25)


•  Butylated hydroxyanisole

•  Butylated hydroxytoluene

Ointment bases

•  Lanolin

•  Amerchol

•  Propylene glycol

•  Polyethylene glycol

Emulsifier and washing-active substances

•  Cetyl alkohol

•  Cetostearyl alcohol

•  Glyceryl stearate

•  SLS

Botanicals and other substances

•  Propolis

•  Panthenol (vitamin B)

•  Rosin (colophony)

•  Camomile

•  Tea tree oil

•  Cocamide diethanolamine (cocamide DEA)

•  Azo- and anthraquinone dyes (19)

TABLE 25.2
Potentially Irritating or Drying Cosmetic Procedures


Hot steam, heating masks


Extremely cold compresses, eye cooling pads


Overcleansing, low-pH products, soaps, alcohol-based products


Low-pH alpha hydroxy acids or glycolic acid


Massage, peeling, dermabrasion, roll-off treatments, sponges, brushing, and suction


Overdrying masks, heating masks

Oil treatments

Essential oils, aroma therapy

Hair removal

Epilation, depilation (e.g., waxing)

TABLE 25.3

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May 14, 2017 | Posted by in Dermatology | Comments Off on Treatments for Sensitive Skin
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