What is sensitive skin?
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, for example, genetic factors, especially in women with thin skin epidermis, can easily be sensitive; at the same time, there are many dermatological conditions that can complicate sensitivity, such as inflammatory skin diseases (acne, solar dermatitis), medications (hormones, retinoids, salicylic acid), inappropriate skin care and whitening of blemishes (peeling syndrome), and minimally invasive and invasive skin treatments (post-laser surgery), when dermatologists should be concerned.
The main triggers 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 exposure, air pollution, etc., capillary dilation is severe, and together with 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 take reasonable care of themselves after cosmetic treatments are all potentially susceptible to sensitive skin.
Clinical Diagnostic Criteria for Sensitive Skin
Diagnosis is made from the patient’s subjective and objective symptoms. Patients with sensitive skin often subjectively feel redness and burning sensation on their skin, and are unable to tolerate ordinary 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 how the redness of the skin capillaries changes, and the erythema and capillary dilation is more pronounced in patients with sensitive skin than in normal people.
Pathogenesis of sensitive skin
There are many problems in the treatment of 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. After the barrier is damaged, the external stimulus will easily lead to redness of the skin, while the loss of the ability to retain water leads to dryness and flaking, the blood vessels in the superficial dermis will expand, and the vascular nerves will be highly reactive. When these people are nervous, the blood vessels will expand and subsequently erythematous papules will appear, and together with the nerve signal transmission, some inflammatory reactions will be formed.
Treatment countermeasures for sensitive skin
1, we have to provide health education to patients or customers, I give patients treatment must be 3 ~ 6 months, and repeatedly stressed with each other: at least give me half a year, do not look once, after the prescription of a little medicine and then do not come, this will not be 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.
a to restore the skin barrier, advocate patients to use medical skin care products, rather than using 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. Everyone must have the ability to discriminate.
In the acute stage, it has vascular nerve hyperreactivity and inflammatory reaction, so from the doctor’s point of view, when there are symptoms and rashes, it is still necessary to use medication. For example, Dextran, which I like to use very much to reduce vascular nerve hyperreactivity, is very useful, and when people are sedated, they are not nervous and less sensitive; anti-inflammatory I like to use hydroxyhydroquin, which is able to anti-photosensitivity; treatment of primary diseases, such as acne, anti-acne rods, itself is a multi-type sun rash, to anti-histamine treatment.
Introduction to the main treatments 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 reactions, I will use anti-inflammatory and anti-photosensitive drugs, such as hydroxychloroquine, ammonium glycyrrhizate and other drugs taken orally, so that the skin can be stabilized in a good state through drugs, medical skin care products and SRA treatment.
Causes of recurrent sensitive skin symptoms and ways to cope with them
Review the mechanisms of sensitive skin.
1. damage to the skin barrier.
2. hyperreactivity of vascular nerves.
3, inflammatory response.
When the vascular nerve hyperreactivity and the skin barrier is not well repaired to change the skin trait, once it is stimulated by the outside world, it is easy to be sensitive. 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 the long-term use of medical skin care products.