Sensitive skin is a common health problem. 50-70% of both men and women self-report having some degree of sensitive skin. Although the condition is generally not severe, and many people self-diagnose, symptoms are not the same for every person. Many people do not realize they have sensitive skin until they experience a bad reaction and are then stuck trying to figure out what caused their symptoms. Research has come a long way in understanding sensitive skin. Here is a breakdown of the current science of sensitive skin and some simple suggestions for the management of symptoms.
What is sensitive skin?
Due to the prevalence of sensitive skin, the International Forum of Itch dedicated a special interest group to sensitive skin and came up with a definition. Sensitive skin is a syndrome defined by occurrence of unpleasant sensations in response to stimuli that should not normally cause such sensations. Stimuli causing the reaction can be either a product, an environmental factor, or even stress. Sensations experienced are stinging, burning, tingling, and itching not attributed to lesions from another skin disorder. Sometimes redness accompanies the sensations, but skin can also appear normal, and symptoms can vary widely from person to person.1 Outside of the syndrome of sensitive skin, people can experience heightened skin sensitivity from other common skin conditions. Common conditions with similar signs and symptoms (differential diagnoses) that will cause the skin to be more sensitive include the following:
- Allergic contact dermatitis,
- Photoallergic contact dermatitis,
- Cumulative irritant dermatitis,
- Atopic dermatitis, and
What are the biological causes of sensitive skin?
The pathophysiology of sensitive skin is not yet fully understood. However, it is believed to be a multifactorial condition involving the following:
- Increased permeability and dryness,
- Thickness of the outer layer of the skin (stratum corneum),
- Occurrence of atopic dermatitis (AD), as sensitive skin is more common in people with AD,
- Overactivation of certain sensory proteins,
- Hyperactivation of epidermal nerve endings,
- Hyper-reactivity of blood vessels,
- Psychological stress, and
- Negative expectations of treatment, or nocebo effects.
Given the variation in what some have called vague symptoms, how do you know if you have sensitive skin?
Many people self-diagnose and successfully self-treat their sensitive skin through product elimination. However, dermatologists have a variety of tools available to help identify and treat sensitive skin. The first step usually involves a full history to rule out other conditions. Patch testing can be done to rule out allergens. If other conditions causing skin sensitivity are identified, they can be addressed. However, if no other conditions are diagnosed, other tests can be done to help categorize and manage sensitive skin symptoms. Various sensory reactivity tests, such as the lactic acid facial sting test, capsaicin test, and dimethyl sulfoxide (DMSO) tests are available. Tests looking at skin function, such as transepidermal water loss (TEWL), skin pH, and epidermal thickness can also be used. Patient surveys and Quality of Life (QoL) questionnaires have also been developed and have proven to be extremely helpful tools in assessing sensitive skin.2
Are men and women equally impacted?
Men and women are both impacted by sensitive skin, however, according to several epidemiological studies more women report having sensitive skin than men. A recent review reported that 60-70% of women and 50-60% of men acknowledge having some degree of sensitive skin.3 One study looked more closely at what sensitive skin meant to men, and after interviewing 1,038 subjects, they found no difference in overall occurrence of sensitive skin between men and women. Younger men were less likely to report having sensitive skin, and the reasons men reported having sensitive skin were different from women. Significantly fewer men reported products as the cause of their sensitive skin, with rubbing and friction being more common reasons for them.4
Does skin sensitivity change over time?
As humans grow and age, so does their epidermis (skin surface). Babies have structural and compositional differences in their skin compared to adults that can lead to increased absorption as well as faster loss of hydration, two factors believed to effect sensitivity of skin. Later in life, changes begin to occur that again alter skin barrier function, leading to more fragile skin that may be more susceptible to external factors. As sensitive skin is a multifactorial condition, skin sensitivity can certainly change over time due to changes in environmental factors as well as changes in the epidermis.5
What part of the body has the most sensitive skin?
According to a review of survey data from several studies, the face is the most sensitive part of the body, with the nasolabial fold (known as smile lines) reported as the most sensitive region of the face.6 However, sensitive skin can occur anywhere on the body.
How should I manage my sensitive skin?
Management of sensitive skin requires a holistic approach. There is not one gold standard of treatment for sensitive skin. However, there are a few factors that can help manage and often eliminate symptoms:
- Avoid triggers, such as fragrance, dyes, and irritants,
- Use emollients and moisturizers, and
- Use proper sun protection.
Other things that may be helpful include taking shorter warm, not hot, showers and reducing neurogenic inflammation with botanical anti-inflammatories or low-level laser/light therapy.
What should I look for in skincare products for sensitive skin?
If you have sensitive skin, there are a few guidelines you can follow when looking for products:
- Look for products with few ingredients,
- Avoid or reduce commonly known allergens and irritants,
- Avoid products that may have contaminants or uncertain purity,
- Avoid preservatives when possible, or look for low- or no-sensitizing potential preservatives, and
- Minimize volatile and alcohol-based substances.
However, for best guidance on product selection for sensitive skin, look for Top Allergen FREE rated products on SkinSAFE. These products are known to be free of the top common allergy causing ingredients, and people have reported getting their symptoms under control by switching to products with the Top Free rating. Top Free is safe for sensitive skin.
How do I clean my sensitive skin?
Look for a gentle soap-free cleanser that is easily rinseable with mild and non-irritating ingredients that is perfume, fragrance, and alcohol free. Research also suggests that natural ingredient cleansers may be a better choice for sensitive skin.7 Traditionally, foaming cleansers were best avoided due to the harsh surfactants used to create a good lather. However, there are new sulfate-free, self-foaming technologies being created with glutamate and glycinate that are reported to provide mild cleansing.8 Maintaining proper skin hydration is key in managing sensitive skin. Therefore, moisturizing right after cleansing is recommended.9
Top Free Facial Cleansers for Sensitive Skin
What is the best sunscreen for sensitive skin?
Ideally, the best way to protect your sensitive skin from the sun is to stay in the shade. However, when that is not possible, dermatologists recommend using a broad-spectrum physical sunscreen, such as zinc oxide and/or titanium dioxide. These sunscreens sit on the surface of your skin and function as a shield from the sun’s rays, as opposed to chemical sunscreens that absorb the sun’s rays.10
Top Free Sunscreens for Sensitive Skin
Are fragrance free or hypoallergenic claims on products reliable?
No. A recent study looking at 174 products, found that products marketed as “hypoallergenic” or “fragrance-free” contained 1 or more ingredients listed by the North American Contact Dermatitis Group (NACDG) as chemicals to avoid.11,12
What household cleaners are ok for sensitive skin?
Products in your house might be contributing to sensitive skin flare ups. Many people evaluate personal care products with scrutiny but overlook laundry detergents and household cleaners. In general, strive for fragrance and dye free products and stay away from overly harsh detergents. If a product has a danger or warning sign, it will likely be harsh on your skin. You may want to consider “green” cleaners made with natural ingredients. Although there is no guarantee on skin reaction, green cleaners tend to be gentler overall. If you are uncertain of ingredients contained in a cleaner, you can check out the National Institute of Health’s Household Product Safety list provided by the Consumer Product Information Database, which contains ingredient lists for thousands of products. Regardless of what cleaner you use, you can limit exposure by wearing gloves.13
Top Free Household Cleaning Products For Sensitive Skin
1. Misery L, Weisshaar E, Brenaut E, et al. Pathophysiology and management of sensitive skin: position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI). J Eur Acad Dermatol Venereol. 2020;34(2):222–229. doi:10.1111/jdv.16000.
9. Draelos ZD, Levy SB, Lutrario C, Gunt H. Evaluation of the Performance of a Nature-Based Sensitive Skin Regimen in Subjects With Clinically Diagnosed Sensitive Skin. J Drugs Dermatol. 2018;17(8):908–913.
12. Xu S, Kwa M, Lohman ME, Evers-Meltzer R, Silverberg JI. Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-selling Moisturizers. JAMA Dermatol. 2017;153(11):1099–1105. doi:10.1001/jamadermatol.2017.3046.