Best Ingredients: Hyaluronic Acid, Niacinamide
Adjunctive Treatments: LEDs, vascular lasers
Worse Ingredients: Glycolic, Retinoic & Ascorbic Acids
Tips: Keep skin care really simple
How common is sensitive skin?
Super common. Over 65% of skin care users report sensitive skin and it only looks to be on the rise... but more on that later. Sensitivity can change with the seasons, for example, winter skin is more sensitive than summer. Flare factors such as UV, heat, cold, wind, foods, topicals, stress etc… can all contribute to sensitive skin. This is especially true for those with rosacea. Other things like the types of products you use and even the menstrual cycle can play a role in skin reactivity.
What causes sensitive skin?
The majority of skin sensitivity is due to too many skin actives in either the wrong concentration, wrong mix, or simply an ingredient that is not correct for your skin condition. A classic example is the use of either high strength retinoic or ascorbic acid in rosacea patients.
Sensitive skin is very complex, however the one common factor is a compromised skin barrier function. This is seen in conditions such as acne-rosacea, endogenous atopic dermatitis, irritant dermatitis, contact dermatitis as well as incorrect product use/combinations/ iatrogenic/ self-inducted skin sensitivity. For the later condition, I hope that this sensitive skin guide will help patients navigate through their condition with clarity & future direction.
**Disclaimer: I am a procedural dermatologist, and I play a small role in the management skin sensitivities, namely I laser. Not all patients with sensitive skin will require nor benefit from laser therapy. I do not give skin care advice during the consultation as patients with sensitive skin should be managed by a medical dermatologist. The CORRECT way to work things out is a medical consultation that involves understanding your innate sensitivities, your current skin care routine, your work environment & in some cases extensive product testing & screening. Some cases of skin sensitivity are secondary to allergic contact dermatitis.
How should patients approach skin care if one has sensitive skin?
Slowly titrating skin care application is what everyone should practice. This is especially important if you have sensitive skin. Here are a few tips:
- Start off with niacinamide & hyaluronic acid for a few weeks
- Gradually add tocopherol (Vitamin E)
- The least irritating retinoid preparation is retinyl palmitate
- Start off application every alternate night
- Conduct a test spot (1 inch area in front of your ear)
- Listen to what you skin is trying to tell you, decrease application if irritation ensures. Increase application if all is good!
- Avoid retinoic, ascorbic & skin care acids (at least initially)
What is the best anti-aging skin routine for patients with skin sensitivities?
Things to avoid include retinoic, alpha hydroxy & ascorbic acids. Whist niacinamide, tocopherol, hyaluronic acid, argan oil & retinyl palmitate are the least reactive ingredients.
It is important to note that those with sensitive skin will not be banned from certain ingredients or products for life, nor is it absolute that you can not use more potent skin care products. By gradually incorporating powerful actives slowly, your skin may build up tolerance. An example of this is the use of low percentage (less than 0.03%) retinoic acid once a week, increasing as tolerated. Repair & restoration of barrier function with emollients, squalene & hyaluronic acid can also decrease skin sensitivities, enabling future use of actives.
*Disclaimer: I do not consult for skin care products. This can be discussed with your skin care expert. My job is a procedural dermatologist, I do give pointer post procedures. For a skin consult, please book in with my clinical team @theformulated. If you do suffer from recurrent skin sensitivities, please book in with a medical dermatologist @cliniccutis.
What is the best sunscreen to use if I have sensitive skin?
In most cases, physical sunscreens over chemical sunscreens. Look for ingredients like zinc oxide or titanium dioxide which can be found in well known brand Invisible Zinc. There are many low irritant sunscreens on the market including Ego, La Roche Posay plus more. Always try before you buy. Remember, sun protection is paramount if you have rosacea as over 80% of patients will have UV as their flare factor.
What is the best retinoid - vitamin A for sensitive skin?
Retinyl palmitate is the least irritating retinoid, followed by retinol, then retinaldehyde, then adapalene, tretinoin followed by tazarotene.
Sensitive skin patients, including rosacea patients should start their retinoid journey with retinyl palmitate followed by a good formulation of low percentage retinol. As always patch test, apply every second night & increase as tolerated. If you can not tolerate retinoids don’t push it, or you will end up in the waiting room of a dermatologist.
*Disclaimer: I am a procedural dermatologist not a medical dermatologist. Please consult your skin care expert for a guide on how to use retinoids. I provide skin care advice pertaining to your procedure. For general skin care advice, please consult with my expert team @cliniccutis
What is the best Alpha Hydroxy Acid for patients with super sensitive skin?
Mandelic acid is the best AHA for sensitive skin (however there is a caveat to come). The large molecule size of mandelic acid means it penetrates the skin at a much slower rate compared to glycolic or lactic acid. Some patients with rosacea-sensitive skin can tolerate this AHA. In my clinical practice, I do prefer laser or light based technology over chemical peels in the context of patients with sensitive skin. The advantage of lasers over chemical peels is that they reduce inflammation as well as provide a rejuvenation effect with very little change of flaring up sensitive skin.
To see what is the best procedure for your skin type, please book for a consultation with my clinical team @cliniccutis
What products should you avoid if you have sensitive skin?
Three words- Skin Care Acids. These include retinoic acid, ascorbic, glycolic, lactic, citric & beta hydroxy acids. The exception to the rule is azelaic acid, which can reduce skin sensitives & inflammation in some patients.
Why is my skin still sensitive when I use creams made for ‘sensitive skin’?
Possible reasons include-
- Sensitivity to other ingredients in the product. This may be an irritant reaction or an allergic contact dermatitis to preservatives, fragrances, parabens, etc...
- Time intervals are not long enough for your skin to recover. It can take up to 2 weeks before inflammation subsides from previous application.
- Barrier function is compromised due to irritation & ongoing intrinsic factors such as eczema, dermatitis, rosacea
- Environment factors such as UV, humidity & wind that contribute to skin sensitivity
- Other factors include allergic contact dermatitis to other agents, eg. acetone, formaldehyde, alcohol
*This group of patients should be managed by a general dermatologist & not a procedural dermatologist. Many cases require patch testing using both the European Standard battery as well as to your own personal products.
How do I calm down sensitive skin - DIY at home methods?
A really simple guide to calm down angry skin is as follows:
- Stop all skin care products, this includes sunscreen. Give your skin a break for 3 to 5 days.
- Use a mild corticosteroid OINTMENT not a cream for 3 days ONLY. Apply twice a day. Do not use longer than 3 days.
- It is super important to stay away from your skin care actives. Use a bland cleanser & moisturiser. The least ingredients the better. Look for squalene, paraffin, aqueous cream, hyaluronic acid as the key ingredients.
- You can restart ONE active at a time. Apply every second day, test spot an area, example a one inch patch in front of your ear. Increase application as tolerated.
- You can recommence sunscreen after 3 to 5 days.
- Avoid physical exfoliation if you have sensitive skin
- If you can not find an answer as to why your skin is sensitive, consult your doctor or a medical dermatologist
- Common causes of sensitive skin include skin irritation, skin allergies, dermatitis & rosacea
Why is laser treatment the best procedure for sensitive skin?
An important concept to understand is that physical therapy including lasers, IPL, BBL, & Low Level Laser Emission Devices can help reduce inflammation but at the same time repair & build collagen. Correct light wavelength & therapy will also reduce skin sensitivity. Vascular lasers including V Beam, Prima, Laser Genesis as well as procedures such as SkinTyte can effectively treat sensitive skin patients.
Laser Toning is a great way to treat wrinkles, pigmentation & pores in patients with sensitive skin, whilst Tixel Fractional Technology will improve wrinkles, skin texture & skin tone without downtime or the risk of flaring up sensitive skin.
Why should you avoid chemical peels?
A low pH acid including lactic, glycolic, and ascorbic acid can upset the pH balance of your skin, resulting is skin irritation. Peels are best avoided if you have sensitive skin, this includes mandelic acid. Yes, the theory behind mandelic is that it has a molecular weight DOUBLE that of glycolic, so in theory it penetrates slower, & has less skin irritation. Yes it is the lesser or all evils, however lasers & LEDs provide far safer treatments in this subgroup of patients.
Who Should You See If You Have Undiagnosed Skin Sensitivities?
Your first & best port of call is a medical dermatologist as they can guide you through ways to reduce skin irritation, repair skin barrier function & investigate as necessary. Dermatologists may perform patch testing to exclude common allergies including skin care preservative, parabens, fragrance, & other common ingredients. Skin prick testing can be conducted to test for allergies to house dust mites, pollens, grasses & animal dander.
Common causes of sensitive skin include rosacea, irritant dermatitis (too much product), allergic contact dermatitis (true allergies), seborrhoeic dermatitis, atopic dermatitis & perioral oral dermatitis. These conditions are best treated medically.
Davin’s Pro Tip For Managing Sensitive Skin
Keep things really simple.The number one cause of the marked increase in sensitive skin is iatrogenic, or self induced as more than ever super strong ingredients can be reality obtained at a fraction of the cost a few years back. Understanding your skin’s irritant threshold will reduce the risk of exceeding it. Best ingredients for sensitive skin? Physical sunscreens, niacinamide, hyaluronic acid, squalene, green tea & aqueous cream as a wash.