According to the survey, people with sensitive skin account for 30% to 40% of the total population, and this group is also the focus of our cosmetic dermatologists’ attention.
Strictly speaking, sensitive skin is not a disease, but a subhealthy state of the skin. When subjected to external stimuli, this skin is prone to erythema, papules, especially capillary dilation and other objective symptoms, while the patient feels a tingling sensation, burning sensation, and is intolerant to ordinary cosmetics, a condition we call sensitive skin.
From a medical point of view, there are two main types of sensitive skin: primary and secondary. Primary, such as genetic factors, especially women with thin skin epidermis, are easily sensitive; at the same time, there are many dermatological conditions that can complicate sensitivity, such as inflammatory skin diseases (acne, solar dermatitis), drugs (hormones, retinoids, salicylic acid), inappropriate skin care and whitening of spots (peeling syndrome), minimally invasive and invasive skin treatments (post-laser surgery), etc., when dermatologists should be concerned.
I. The main causative factors and potential groups of primary sensitive skin
Due to genetic factors, some people have a thin epidermis, and because there are no blood vessels in the epidermis, the dermal blood vessels are exposed. Under external stimuli such as heat, sunlight and air pollution, capillary dilation is serious, plus the indiscriminate use of cosmetics will induce sensitive skin. In addition to those affected by genetic factors, people who do not pay attention to sun protection, excessive exposure to sunlight, indiscriminate use of cosmetics, and those who do not perform reasonable skin care after cosmetic treatments are all potential groups of sensitive skin.
Clinical diagnosis criteria of sensitive skin
The diagnosis is made from the subjective and objective symptoms of the patient. Patients with sensitive skin are often subjectively aware of redness, burning sensation and intolerance of common skin care products. Objectively, I use the lactic acid test for judgment. A 5% lactic acid solution is applied to both sides of the nasolabial folds at the time points of 2 minutes and 30 seconds and 5 minutes, respectively, to see if there is an erythematous reaction, followed by the use of a four-point scale (0, 1, 2, 3). After the 2 minutes and 30 seconds and 5 minutes scores are added together, a score greater than 3 is diagnosed as sensitive skin, and its severity is also assessed.
In addition, with some equipment, such as under VISIA, it is possible to see the red change of skin capillaries. The erythema and capillary dilation in patients with sensitive skin are more obvious than in normal people.
Third, the pathogenesis of sensitive skin
There are many problems in the process of treating sensitive skin. When patients come to the clinic, our doctors usually use tacrolimus, glycopyrrolate, etc. However, often many doctors do not have a definite plan for treatment and are not mentally sure. For their part, patients believe that they do not need to see a doctor and can go directly to life beauty, while others will fear extreme treatment and resist skin care products or overly fetishize them.
Returning to the pathogenesis of sensitive skin, under the influence of various causes, whether they are pharmaceutical, laser, or even genetic, the first and foremost is the impaired skin barrier function. The meaning of the barrier: external resistance to external sunlight microbial anti-inflammatory substances, internal locking moisture, so that the skin is not easy to dry. And after the barrier is damaged, external stimuli are very likely to lead to skin redness, while the loss of the ability to retain water leads to dry flaking, the superficial dermal blood vessels will expand, vascular nerve hyperreactivity, such people a nervous, blood vessels expand, followed by erythematous papules, coupled with the nerve signal transmission, the formation of some inflammatory reactions.
Fourth, the treatment of sensitive skin countermeasures.
1, we must provide health education to patients or customers, I give patients treatment must be 3 to 6 months, and repeatedly stressed with each other: at least give me six months, do not look once, after the prescription of a little medicine will not come, this is not good. We must master the starting point and end point of the treatment, the sensitivity of the skin into a smooth and delicate elastic, no redness, capillaries do not dilate, increased tolerance, which requires patient education of the patient / customer.
2.Treatment principles.
(1) to restore the skin barrier, advocate patients to use medical skin care products, and can not use general skin care products, because the most common cause of cosmetic adverse reactions are fragrances, pigments, preservatives, and the definition of our medical skin care products is the absence of these ingredients, and efficacy, to anti-inflammatory, soothing, moisturizing, these functions must be experimental and clinical verification, and now a variety of medical skin care products have been introduced The first thing you need to do is to have the ability to identify them.
(2) Sensitive skin must be divided into the acute phase and the stable phase, in the acute phase, it has vascular nerve hyperreactivity, inflammatory response, so from the doctor’s point of view, when there are symptoms and rashes, or to use medication. For example, I like to use Dextran to reduce the vascular nerve hyperreactivity, which is very useful. After people are calmed down, they are not nervous and not easily sensitive; anti-inflammatory I like to use hydroxyhydroquin, which is able to anti-photosensitivity; treatment of the primary disease, such as acne, anti-acne rods, itself is a multi-type sun rash, to anti-histamine treatment.
V. Introduction to the main treatment methods for primary sensitive skin
For sensitive skin we still divide into those with and without conscious symptoms. If the quality of life is not seriously affected, we do not use ordinary cosmetics, but use medical skin care products to soothe the skin while restoring the skin barrier. At the same time, we use some modern medical cosmetic means, such as having patients receive yellow light treatment or do radio frequency + photon, or SRA treatment; we will also have the skin treated with some masks that can moisturize and repair the skin barrier, such as hyaluronic acid masks, so that the skin can be treated in a comprehensive way. If the patient has obvious symptoms, such as itching, even papules, inflammatory reaction, I will use anti-inflammatory, anti-photosensitive drugs, such as hydroxychloroquine, ammonium glycyrrhizate with oral, so through drugs, medical skin care products and SRA treatment can make the skin stable in a very good state.
Sixth, the mechanism of sensitive skin photoelectric treatment countermeasures to explore
Sensitive skin is a state in which the epidermis is thinning, the dermal capillaries are dilated, and the tolerance and resistance of the skin is weakened. In this case, the purpose of treatment is to be able to close the blood vessels and enhance the skin’s resistance and tolerance. SRA, a device that combines both ordinary photons with wavelengths of 590~700+, can have a therapeutic effect on the dilated capillaries, while RF penetrates the epidermis to stimulate the rearrangement of dermal collagen fibers, which will enhance the skin’s tolerance and resistance, and is more effective than simple photons and RF alone can be very effective for sensitive skin. The main reason why SRA is used is because it has the effect of radiofrequency to stimulate the rearrangement of collagen fibers, knowing that collagen fibers are the protective cushion of our skin. While enhancing the tolerance of the skin, the photons penetrate into the blood vessels of the epidermis and play a closing role, which is more effective for people with dilated capillaries and thin epidermis.
The laser is damaging to the skin, so it is important to take good care of the skin after the procedure, and to be sure of the starting and ending points of the treatment. When it comes to maintenance treatment, I am used to using LED’s light therapy, yellow light plus cold ultra to maintain the treatment.
Seven, the causes of recurring sensitive skin symptoms and ways to deal with them.
1, damage to the skin barrier.
2, hyperreactivity of vascular nerves.
3, inflammatory reaction.
When the vascular nerve hyperreactivity and the skin barrier is not well repaired to change the skin trait, it is easy to be sensitive once it is stimulated by the outside world. Therefore, if the skin barrier is not completely restored and the vascular nerves are not kept stable, it is easy to recur if it is always in a hypersensitive state. In the face of recurring sensitive skin symptoms, I advocate long-term use of medical skin care products and different courses of treatment with yellow light and SRA.
Eight, sensitive skin treatment experience summary.
1, to identify whether the sensitive skin is primary or secondary.
2, according to the three pathogenesis of sensitive skin links: skin barrier damage, vascular nerve hyperreactivity, inflammatory response to treatment.
3, photoelectric technology with medical skin care products is an important part of the treatment of primary sensitivity.
4.For secondary sensitive skin, the primary skin disease should be treated on the basis of the treatment of the primary.