Sensitive skin – a comprehensive diagnosis

Sensitive skin is a complex problem for many dermatologists and cosmetologists. A nthe greatest effectiveness of cosmetic treatments is ensured by good pperformeddiagnosis. For some skin types, it can be questionable to diagnose well whether the skin is sensitive, atopic, reactive, vascular, with symptoms of rosacea. An in-depth interview with the patient is then necessary. 

 

• Sensitive skin is a problem for 44% of the US population according to documented data from doctors and cosmetologists. 60-70% of women and 50-60% of men have it according to self-assessment questionnaires (Maibach H.I. 1987, Brenaut
• Sensitive skin also affects 51% of women and 38% of men in the UK according to self-assessment questionnaires (Willis C. M. et al., 2001).

These studies show that sensitive skin is common. Women are more likely than men to suffer from its hypersensitivity, which is related to their thinner skin.

 

Factors affecting skin hypersensitivity

Sensitive skin can react to various irritants. The so-called ‘immediate irritants’ are individual to each patient. They can be divided into three groups:

Factor types	Contact factors	External factors	Internal factors (including diet, medication)	internal factors
	hard water, certain fabrics or substances in cosmetics that are poorly tolerated by the skin	heat, cold, extreme temperatures, sunshine, wind, dust	increased vascular permeability during consumption of spices and alcohol, certain medications
Symptoms	sensation of tension and/or redness, itching, tingling	sensation of tingling, burning, redness and hot flushes	hot flashes, redness, increased sensitivity to heat

Symptoms usually appear within an hour of exposure to irritants and may persist for minutes or hours (Misery L., 2017).

 

Scale of skin sensitivity

Skin hypersensitivity was studied by Dr Laurent Misery’s team of specialists. They developed a questionnaire called the ‘Skin Sensitivity Scale’ (Misery L. et al., 2014). To describe the skin condition, the authors suggest that patients rate each of the following complaints on a 10-point scale.

1. Dermal irritation
2. Tingling sensation
3. Burning
4. Warm feeling
5. Tension sensation
6. Sensation of tension
7. Itching
8. Sensation
9. Pain
10. General discomfort
11. Sensation of a rush of blood
12. Sensation of a rush of blood
13. Redness

Ratings in the 20-60 point range are typical for people with sensitive skin.

 

Sensitive skin – differential diagnosis

When interviewing the patient, it is important to distinguish the symptoms of sensitive skin from those of other dermatoses. Similar symptoms may also be produced by neuropsychiatric conditions (neurosis, distorted self-image, chronic fatigue syndrome, etc.). Experts now recommend a differential diagnosis of sensitive skin with the following dermatoses, which are also accompanied by reactivity and erythema (Do L.H.D et al., 2020).

• atopic dermatitis
• chemically irritant contact dermatitis
• photo-irritant contact dermatitis
• physically irritant contact dermatitis
• allergic contact dermatitis
• photoallergies
• rosacea

(To LHD et al, 2020)

 

Dermatosis	Symptoms	Recommended examination
atopic dermatitis	rain, scaly skin	interview and questionnaire on the use of medicines and cosmetics, physical examination
	interview and questionnaire on the use of medicines and cosmetics, physical examination
chemical irritant contact dermatitis	Rubescence, hyperkeratosis (excessive keratosis of the epidermis) or cracks in the skin	interview, patch test to identify irritants
photodermatitis contact dermatitis	rouble, hyperkeratosis (excessive keratinisation of the epidermis) or cracks in the skin	interview, patch test to identify irritants
physical irritant contact dermatitis	rouble, hyperkeratosis (excessive keratinisation of the epidermis) or cracks in the skin	interview, patch test to identify irritants
allergic contact dermatitis	visible erythema at the site of contact	patch test to detect allergens
photoallergy	rash, blisters in sun-exposed areas after application of certain products	interview and questionnaire on the use of medicines and cosmetics
rosacea
inquiry on the use of medicines and cosmetics	transient or persistent erythema with attacks and hot sensation	interview and questionnaire on the use of medicines and cosmetics

 

 

How to distinguish between sensitive skin, atopic dermatitis and rosacea?

• Atopic dermatitis is a hereditary disease with a chronic relapsing course with some age-related dynamics, characterised by itchy pimples and lichen-like rashes.
• Rosaceous acne is a chronic vascular disease that affects the skin of the face and eyes and is usually characterised by chronic remissions and exacerbations. Acne rosacea is well recognised by the main symptoms of the disease – congestion, persistent erythema, telangiectasias, papules and pustules. Other symptoms include burning, tingling, dryness, swelling and ocular symptoms. Acne rosacea goes through several different stages.
• Sensitive skin is not defined in dermatology as a skin disease. It is characterised by: redness, itching, sometimes slight swelling, a feeling of excessive warmth, tightness. Sensitive skin also has an excessive reaction to external factors, especially to temperature changes, but also to psychological stress, lack of sleep, poorly chosen cosmetics.

Atopic dermatitis (AD)	Trądzik różowaty	Skóra wrażliwa
beginning in childhood	beginning in adulthood (30-60 years)	can occur at any age
the condition of the skin improves with age	the condition of the skin worsens with age	skin condition worsens with age
long cycles of remission and exacerbation	long cycles of remissions and exacerbations	–
seasonal exacerbations	seasonal sharpening	sharpening after irritation
genetic disruption of the epidermal barrier	–	epidermal barrier disruption after an irritant
disturbance of the pH and consequent drying of the skin
skin can be dry, normal or oily	skin can be dry, normal or oily
breakdown of barrier function	Barrier function impairment	breach of barrier function
breach of barrier function
sebum deficiency	–	–
–	facial swelling	facial swelling may occur
genetic predisposition	genetic predisposition	–
Clinical symptoms: – itching (exacerbated by night sweats) – location of the rash (depending on age) – comorbidities (bronchial asthma, allergic rhinitis, conjunctivitis)	Clinical symptoms: – tingling and burning sensation of the skin – localisation – persistent erythema of the central part of the face – eyes may be involved. – skin roughness and flaking in the central part of the face	Clinical manifestations: – itching after exposure to an aggressive agent – localisation – more often open areas of the face and body – vascular reaction in central part of face

The diagnosis of sensitive skin is very important before choosing care and cosmetic treatments. It is important to take into account the specifics of the individual patient and to understand their body processes. This will help to both solve the problem and improve quality of life despite the hypersensitive skin or other dermatosis.

 

dr Khrystyna Shekhovtsova

Chantarelle expert, dermatologist and aesthetic physician   

 

 

 

Literature:

• Chen Y., Lyga J : Brain-skin connection stress. Inflammation and skin aging. Inflamm Allergy Drug Targets 2014
• Do L.H.D., Azizi N., Maibach H. Sensitive Skin Syndrome: An Update Am J Clin Dermatol 2020 Jun
• Draelos Z.D. Cosmetic selection in the sensitive-skin patient. Dermatol Ther 2001
• Elias P.M., Primary role of barrier dysfunction in the pathogenesis of atopic dermatitis. Exp Dermatol 2018
• Huet F., Dion.,Batardiere A., et al. Sensitive skin can be small fbre neuropathy results from a case-control quantitave sensory testing study/ Br J Dermatol 2018
• Inamadar A.C ., Palit A. Sensitive skin An overview. Indian J Dermatol Venereol Leplor 2013
• Lev- Tov H., Maibach H.I. The sensitive skin syndrome. Indian J Dermatol 2012
• Misery L., Neuropsychiatric factors in sensitive skin. Clin Dermatol 2017