Sensitive Skin: The Most Common But Still Enigmatic

Dermatologists, aesthetic doctors, and beauty professionals frequently encounter patients with sensitive skin. However, defining sensitive skin and understanding whether it is a pathology, a skin condition requiring treatment, or a normal skin state remains challenging.

Sensitive skin presents a complex array of symptoms and triggers, making its management and understanding particularly intricate.

The Symptoms of Skin Sensitivity

Sensitive skin symptoms are varied and uncertain. Dermatologists often hear complaints of discomfort, which can range in intensity and frequency. Common symptoms include:

  • Reddening: This can either be localized or cover larger areas such as the face and neck. Some patients experience constant redness, while for others, it may flare up occasionally.
  • Dryness and Tightness: Patients often report feelings of extreme dryness, leading to a sensation of tightness. This is particularly common in those whose skin is naturally dry or prone to this state.
  • Flaking: Dry skin often leads to flaking, which can be mild or severe, causing visible peeling and discomfort.
  • Sebum Overproduction: In patients with oily skin, sensitivity can trigger episodes of drastic increase in sebum production, leading to shiny skin and potential acne breakouts.
  • Inflammation: Sensitive skin can also manifest as inflammatory reactions, with patients reporting a variety of inflammatory elements.

Sensitivity Triggers

The variability of triggers for sensitive skin is a significant challenge. Most people often identify specific triggers, though these can differ widely among individuals. Common sensitive skin triggers include:

  • Temperature Changes: Sensitivity to hot or cold weather or water is frequently reported.
  • Skincare Beauty Products: New or certain types of skin care products can provoke skin reactions. Fragrances, preservatives, and other ingredients often found in cosmetics are common triggers.
  • Fabrics: Contact with certain fabrics in clothes, towels, or bedding can cause discomfort and sometimes rashes.
  • Emotional Stress: Stress, anxiety, and excitement can exacerbate skin sensitivity, likely due to the close connection between the nervous system and skin.
  • Dietary Factors: Certain foods and drinks, such as spicy foods, alcohol, and caffeine, can trigger skin reactions.
  • Skin Injuries and Aesthetic Treatments: Damage to the skin barrier through trauma or treatments like dermabrasion, laser therapy, or chemical peels can increase sensitivity.

The symptoms and irritation triggers are highly individual, often leading to unpredictability in managing sensitive skin.

The Epidemic of Sensitive Skin

Sensitive skin is prevalent, with over 50% of women in westernized countries considering their skin sensitive. This prevalence is consistent across different regions, such as the USA, Japan, and European countries.

Most women who identify their skin as sensitive belong to pre-menopausal and older age groups. Beyond the face, it is also reported on the hands (58%), scalp (36%), feet (34%), neck (27%), genitals (56%), and body (61%).

Despite the high incidence, objective changes in sensitive skin remain elusive. Studies using new research methods, like electron microscopy, suggest that specific structures of skin cells called transient receptor potential (TRP) channels may cause skin sensitivity.

Different TRP channels respond to specific stimuli, explaining the varied reactions to physical and chemical factors. For example:

  • TRPVI Channels: Activated by capsaicin (found in chili peppers), heat, and some chemicals, explaining reactions to spicy foods, hot water, or sauna.
  • TRPMVIII Channels: Activated by cold and menthol, leading to sensitivity to cold environments or mentholated products.
  • TRPAI Channels: React to cold, wasabi, mustard, horseradish, and bradykinin, explaining sensitivity to these certain products and substances.

The activation of different TRP channels leads to various events, such as the release of calcium ions and membrane depolarization, resulting in neurogenic inflammation. This suggests that skin sensitivity results from excessive exposure to TRP channels rather than external stimuli alone.

The Classifications of Sensitive Skin

Sensitive skin can be categorized based on physiological parameters into three types:

  • Ineffective Skin Barrier Function: Patients exhibit increased transepidermal water loss (TEWL) and flakiness due to a compromised skin barrier.
  • Normal Barrier Function but Prone to Inflammatory Reactions: Patients have a normal skin barrier but display inflammatory reactions when exposed to various triggers.
  • “Pseudo-Healthy” with Normal Barrier Function and No Inflammatory Changes: These patients do not show significant barrier function issues or inflammation but still experience sensitivity.

All types show increased nerve growth factor (NGF) in skin structures. Additionally, sensitive skin may be linked to abnormal immune reactions and chronic inflammation, contributing to conditions like rosacea.

Research indicates that people with sensitive skin often have more mast cells and a better-developed lymph capillary network, leading to more pronounced reactions to stress and other triggers.

Diagnostic and Treatment Approaches for Sensitive Skin

Sensitive skin lacks a unified diagnostic tool, relying heavily on the subjective diagnostics of the dermatologist. The SSS-14 questionnaire by Professor L. Misery helps quantify sensitivity levels, guiding treatment plans.

Patients rate their sensations over the past three days on a scale of 0 to 10, with 0 being 'never experienced' and 10 being 'extremely severe.'

Sensations and skin reactions include:

  1. Skin irritation
  2. Burning
  3. Stinging
  4. Warmth
  5. Tightness
  6. Itch
  7. Pain
  8. General discomfort
  9. Redness
  10. Flushes
  11. Flaking
  12. Puffiness
  13. Weeping/oozing
  14. Abrasions and scabs

Scores of 20 or less indicate normal sensitivity, 20 to 60 suggest sensitive skin needing specific care, and over 60 warrant further investigation for a possible underlying cause like skin conditions or nervous system diseases.

Recommendations for Managing Sensitive Skin Irritation

Dermatology professionals often follow the Pons-Guiraud guidelines for managing sensitive skin:

  • Minimal amount of Cosmetic Products and Makeup: Reducing the number of products helps minimize potential irritants.
  • Fragrance-Free Products: Fragrance is a common irritant and should be avoided.
  • No Soap for Cleansing: Soap can strip the skin of its natural oils, exacerbating dry and sensitive skin.
  • Use of Thermal Water: Thermal water can help soothe and act as a moisturizer for sensitive skin.
  • Disposable Paper Towels: Drying skin with disposable towels avoids potential exposure to a possible skin irritant in fabric towels.
  • Light-Textured Creams: Heavier creams can clog pores and cause allergic reactions.
  • Frequent Moisturizing: Applying cream multiple times a day in air-conditioned rooms or in extreme weather can help maintain hydration and moisture levels and provide relief.
  • Avoid Aggressive Hair Wash Products: Harsh shampoos and conditioners can irritate the scalp and skin.
  • Avoid Exfoliants and Cleansing Devices: These can damage the skin barrier and increase sensitivity.
  • Avoid Hydroxy Acids and Retinoids: These ingredients can be too harsh for sensitive skin.
  • Discontinue Irritating Products: Any product causing discomfort should be stopped immediately.
  • Sun Protection: Using broad-spectrum sunscreen for both your body and face and avoiding excessive heat and UV rays and can prevent further sensitivity.
  • Limit Alcohol and Caffeine: Both can exacerbate sensitive skin condition.
  • Avoid Spicy Foods: Foods that cause redness and rosacea should be minimized.
  • Seek Mental Health Support if Needed: Stress and mental health issues might be the underlying condition and can worsen skin sensitivity.
  • Cautiously Reintroduce Skincare Products: Wait 3-6 months after an irritation episode before reintroducing products.

Dermatology Classifications for Practical Use

Several empirical classifications exist, but a factor-based approach may be most useful for separating patients with contraindications to certain treatments. Here are some of the most well-known classifications:

Yokota's Classification

  • Unprotected: Reduced barrier function, increased TEWL, and flakiness
  • Inflamed: Inflammatory changes without a decline in barrier function
  • Neurosensitive: No inflammation, no decline in barrier function

Mills & Berger's Classification

  • Group I: Dermatoses patients outside of remission
  • Group II: Patients with dermatoses with minimal or atypical manifestations
  • Group III: Healthy people with the experience of skin trauma
  • Group IV: Patients not included in the previous categories

Classification Based on Degree of Change

  • Very Sensitive Skin
  • Sensitive Skin
  • Slightly Sensitive Skin
  • Resistant Skin

Classification Based on Factors and Triggers

  • Severe Reaction to All External Factors and Triggers
  • Reaction Only to Contact Triggers
  • Reaction Only to Natural Factors
  • These classifications help in understanding the broad spectrum of sensitive skin but are not very comprehensive for practical use.

Microbiome Research and Sensitive Skin

Recent studies suggest a connection between sensitive skin and microbiome changes. The microbiome of sensitive skin is less diverse and contains more pathogenic microorganisms than that of resistant skin.

Additionally, skin dryness and a damaged barrier function exacerbate microbiome changes, while regular topical application of prebiotics in skincare correlates with positive outcomes.

Creating an Individual Skincare Program

An effective skincare program for sensitive skin should be tailored to individual needs. Here are key components:

  • Gentle, pH-Neutral Cleanser: Use cleansers without aggressive surfactants, preferably with soothing effects.
  • Soothing Ingredients: Incorporate ingredients that reduce TRPV receptor sensitivity and inhibit the release of neuromediators. Effective ingredients include Albatrellus ovinus extract, Acetyl Tetrapeptide-15, Centella Asiatica extract, green tea, chamomile, aloe vera, bisabolol, and chamazulene.
  • Prebiotics: Include at least one prebiotic solution in the home care routine to support a healthy microbiome.
  • Moisturizers: Apply moisturizer containing hygroscopic substances (e.g., hyaluronic acid, glycerin, urea) and film-forming substances (e.g., petrolatum, shea butter) to prevent TEWL.
  • Day Cream with Sun Protection: Ensure the day cream includes SPF to protect against UV radiation.

Meder Skincare For Sensitive Skin

Dr Tiina Meder researched sensitive skin for many years before launching the first products addressing skin sensitivity. Meder skincare for sensitive skin was one of the first Neurotherapy collections using anti-inflammatory and calming peptides, plant and mushroom extracts, alongside prebiotics and probiotics restoring a healthy skin microbiome. 

Net-Apax Cleansing Mask for Sensitive Skin

Sensitive skin gentle cleanser Net-Apax is the trusted, hypoallergenic solution beloved by skin therapists worldwide. Formulated specifically for sensitive skin, Net-Apax provides instant comfort, calms redness, and restores the skin's natural protection and healthy microbiome. 

Net-Apax is a soft micellar cleansing emulsion that effectively removes impurities without stripping the skin's precious protective lipids. With a natural prebiotic, Net-Apax promotes the growth of beneficial microorganisms on the skin, suppressing unwanted bacteria and ensuring a healthy and balanced skin microbiome.

The organic extract of Wild Silver Malva flowers in Net-Apax delivers anti-inflammatory benefits, offering immediate relief and calming for sensitive or damaged skin. It soothes irritation and aids in skin recovery. For an extra boost, use Net-Apax as a 2-minute mask. Simply apply, leave on for a couple of minutes, and rinse off.

Soin-Apax Antioxidant Serum For Sensitive Skin

Sensitive skin serum Soin-Apax is your ultimate solution for instant relief and calming of irritated skin. Our lightweight serum is formulated with pure Alpine water sourced from the pristine glaciers of the Swiss mountains near our laboratory.

This water is naturally enriched with prebiotics and essential ions like Magnesium and Cuprum, renowned for their healing and anti-inflammatory properties. To enhance its effectiveness, we have infused the serum with potent Centella Asiatica extract sourced from a chemical-free plantation in Madagascar.

Centella Asiatica, also known as CICA or Gotu Cola, has been used for centuries in traditional medicine for its anti-inflammatory benefits, now backed by science. Soin-Apax is specially designed for sensitive skin, providing immediate and long-lasting relief from redness, irritation, itching, and other forms of discomfort.

Red-Apax Active Care Serum for Red and Sensitive Skin

Red-Apax active serum is a groundbreaking microbiome-friendly solution that brings instant relief to red and highly sensitive skin. This lightweight gel is enriched with a potent extract from the Northern truffle mushroom, able to interact naturally with the skin's nervous system, effectively calming redness, pain, and discomfort.

But that's not all — our innovative blend of prebiotics and probiotics works tirelessly to restore a healthy and diverse skin microbiome, boosting the skin's natural protective abilities. To top it off, organic yacon extract provides deep moisturization while soothing inflammation, redness, and sensitivity.

By incorporating Red-Apax Concentrate into your daily skincare routine, you can experience long-term relief from sensitivity and redness associated with rosacea and menopause. For optimal results, apply it twice a day for a recommended period of 5-10 weeks.

Red-Apax Mask For Red And Sensitive Skin

The Red-Apax mask acts globally, addressing the nervous structures within your skin. It effectively suppresses inflammation, strengthens capillaries, and restores a healthy skin microbiome. Crafted from bamboo fibers, this sheet mask is soaked in a probiotic extract of Japanese sake, along with anti-inflammatory peptides and a powerful combination of organic flower and leaf extracts such as Chamomile, Centella Asiatica, and Calendula.

The result? Immediate comfort and a calming effect on redness and irritation. Your sensitive skin will instantly feel better, and the visible reduction in redness will leave you amazed.

Salva-Derm Cream For Sensitive Skin 

Sensitive skin moisturizer Salva-Derm is a unique skincare solution designed to restore balance and provide natural protection. Silky emulsion, enriched with organic macadamia oil and ceramides, effectively recreates the skin's protective lipid barrier.

A powerful blend of prebiotics derived from natural sugars and sweeteners works to promote the growth of beneficial microflora while suppressing irritating microorganisms that can lead to flakiness. Additionally, natural algae extract, infused with a hyaluronic acid complex, deeply moisturizes the skin and boosts its water-holding skin's capacities.


People with sensitive skin often experience significant discomfort, affecting their quality of life, but their discomfort is often underestimated by medical professionals. Proper diagnosis from a dermatologist, lifestyle adjustments, like changing some household products, and tailored skincare routines are essential.

Medical professionals and skin practitioners must pay closer attention to patients' symptoms and provide informed, empathetic care to manage this widespread issue effectively.

The complexities of sensitive skin require a nuanced understanding and individualized approach to treatment, considering the myriad of triggers, symptoms, and patient-specific factors.

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