The following test on Sensitized Skin is free of charge from BeautyEdge LLC. To take this NCEA certified test and receive (1) continuing education credit from the National Coalition of Estheticians, Manufacturers/Distributors & Associations, follow this link and instructions > NCEA

LEARNING OBJECTIVES

After reading this article and taking this test, the skin care professional will be able to:

1. Understand the cause of sensitized skin and how to lessen the chance of skin reactions.

2. Understand the sensitive skin product claim, and facial treatment options.

INSTRUCTIONS FOR THE FOLLOWING TEST:

1. Read the article below.

2. Scroll to the bottom of article to take the test.

3. Your average results will be visible at the end of the test.

SENSITIZED SKIN ARTICLE

About Sensitized Skin: The term allergic reaction is sometimes misused to describe the symptom of a sensitive skin condition. An allergic reaction and sensitive skin are not one in the same, however, they can have overlapping physical and visual results.

Background: According to Mintel’s Global New Products Database (GNPD), thus far in 2014*, sensitive skin claims represent 25% of total skincare claims, compared to 15% in 2009. What’s more, 71% of facial skin care users say they are interested in ultra-gentle products.

This review will focus specifically on sensitive skin or over sensitized skin, not rosacea, specific dermatological conditions or diseases, although they are common diagnosis’ to sensitive skin conditions.

Understanding Sensitive Skin Product Claims: Skin care formulas that are typically not problematic for the general population can cause intense stinging, burning, and redness in individuals with sensitive skin. When the claim suitable for sensitive skin is on the product’s label, the formula itself is tested, not the individual ingredients within the formula. There should be clinical support from the manufacturer that the formula was specifically tested on individuals that claim they have sensitive skin.

“Known to” claims means that a formula can contain an ingredient “known to” soothe sensitive skin. This does not mean that the formula itself soothes sensitive skin.

Some products are labeled hypoallergenic, a marketing term recognizable to the consumer, but again, there really is not an industry standard to measure the claim hypoallergenic. Generally, with this type of formula the manufacturer has taken measures to remove known allergens from the formulas yet irritants may still be present.

How Healthy Skin Becomes Sensitized: Skin contact with a formula or surface known as the irritant can create skin sensitivities or contact irritant dermatitis. This contact is not the same as contact that causes an overactive immune response with the release of antibodies (histamines) like an allergic reaction does. What happens is that the stratum corneum has been damaged creating a condition for the epidermal barrier to be affected.

When treating sensitive skin, keep in mind that skin becomes sensitive through physical and emotional causes.

Sensitive skin with sensitized being a better descriptor, is not necessarily a skin type, but a symptom of a skin’s condition. Sensitive skin has become a common term to describe the condition rather than a medical diagnosis. When referred to in skin care it describes reduced tolerance to the application of cosmetics and personal care products. Dry, mature, combination, oily, and acne skin types can have symptoms of sensitivities.

Sensitive Skin Stimulants:

Lifestyle - Busy schedules, physical/emotional stress, poor diet, over-indulgence in alcohol or drug consumption, extreme perspiration with exercise, and certain medications.

Climate - Heat, humidity, sun exposure, cold, forced air, pollution.

Aggressive Contact - Excessive friction, brushing, rubbing, scrubbing, scratching, chemical peeling, overuse of cosmetic products.

Improper Hygiene - Improper facial cleansing, or not cleansing skin at all before bed leaving behind irritants from the day.

Improper Cosmetic Product Use - Skin can become over-sensitized by layering multiple skin care products on it, practicing multiple cleansing steps, continually switching skin care products or applying too many products on a daily basis.

Cosmetic Ingredients - Individuals can be sensitive to a substance or ingredient that does not bother other people. SLS and SLES are included in many cleansers on the market to deep cleanse and to give the foaming and sensorial experience during cleansing. Fragrance and parabens can be culprits as well.

Additionally, natural or organic ingredients in a facial formula does not necessarily mean that a product will not cause a reaction for an individual with sensitive skin.

Hormonal Fluctuations - Female monthly changes.

Age - As skin matures, physiological protective and repair functions slow down.

Physical sensations resulting in sensitized skin includes: redness, erythema, inflammation, itching, stinging, burning or extreme dryness. However, there are cases where an individual can suffer from the physical burning or stinging, but there may not be a visual counterpart of these manifestations.

Sensitive skin can be clinically compartmentalized in two ways:

1. Subjective/sensory irritation, also known as sensorineural irritation - This is characterised by sensory discomfort such as itching, stinging, tingling or burning, but in the absence of any clinical or histological evidence of inflammation. Involvement of nerves and blood vessels contribute to the development of the symptoms. It is generally of acute onset. (http://www.dermnetnz.org/reactions/sensitive-skin.html#ed)

2. Non-erythematous irritation, also called suberythematous irritation

This form of irritant contact dermatitis differs from subjective irritation in that, although the person experiences similar symptoms and no rash is visible, there are changes of inflammation seen on skin biopsy. It often develops slowly and discomfort is experienced with multiple chemicals. (http://www.dermnetnz.org/reactions/sensitive-skin.html#ed)

Stratum Corneum: The process that causes skin to be sensitive or more sensitized is the weakening of the stratum corneum which provides a protective barrier to help defend against environmental/physical aggression. This weakened layer allows external aggressors to penetrate more easily and cause a reaction.

Epidermal Barrier: Impairment of the epidermal barrier, the outermost compartment of the skin, is the breakdown of skin’s ability to defend and repair itself. Transepidermal water loss, UV exposure, free radicals, high pH products all contribute to the breakdown of the skin’s barrier.

This barrier can be divided into three lines of defense: the physical barrier against pathogens and mechanical injuries, the chemical/biochemical barrier with antimicrobial activity, and a barrier against the unregulated loss of water and solutes. The skin barrier is formed by differentiating keratinocytes Int. J. Mol. Sci. 2013, 14 6722 Cytokines and the Skin’s Barrier

Treating Sensitized Skin: The first order of action for a client experiencing sensitized skin is for the client to receive a dermatological assessment. The reason for this is that sensitive skin can also have underlying skin reaction patterns that may require topical medications to address the inflammation, itchiness, and redness and to help rebuild the skin’s barrier.

Precautions During Facial Treatments:

● Use mild cleansers with clean hands to cleanse the face; no cloths, no brushes, no scrubbing.

● Use fragrance free products.

● Avoid cleansers with sodium lauryl sulfate.

● Avoid foaming cleansers, look for non-foaming or milky cleansers.

● Avoid over stripping the skin mantle, for example, use one cleaner, do not cleanse, then deep cleanse, then exfoliate. This may over exacerbate the skin adding to skin sensitivities and barrier breakdown.

● Avoid aggressive granular exfoliants, look for gentle exfoliants that are lightly rubbed off of skin, or ingredients that exfoliate other than acids.

● Avoid excessive hot facial steaming.

● Avoid over manipulation of the skin with massage, this may bring up more redness in the skin.

● Review the formula ingredient list. Take into account that one ingredient may not be the culprit. The formula itself needs to be tested on the client's skin. Sample the product to the client before purchase and instruct the client to use the product on one small area on the face multiple days to ensure that the skin can tolerate the new product.

Strengthening The Epidermal Barrier: A strong barrier makes skin less permeable. There are no leaky ‘holes’ or cracks. The aim in management of sensitive skin is to restore the barrier function through the application of ceramides, and nutritive lipids to improve the lipid content that holds the skin cells tightly together.

The most effective lipids are the one’s that are most similar to skin’s natural lipid composition. They are ceramides (sphingolipids), cholesterol, and fatty acids.

The lipids in skin are found in:

- The Stratum Corneum layer of the epidermis. They are located in the stacked lipid bilayers. Lipids form around the corneocytes and acts like the glue that holds the corneocytes (dead skin cells) together and traps water in the skin.

- The Granular layer of the epidermis located in the intercellular matrix. Lipds here exist in the form of free fatty acids, cholesterol, and sphingolipids as they are released from lamellar bodies in the keratinocytes that are in the process of breaking down into corneocytes.

- Cell membranes.

- Sebum – this is the oil produced by the sebaceous glands attached to follicles.

Patients and clients with sensitive skin still require cleansing hygiene. Synthetic detergent cleansers, also known as syndets, provide the best skin cleansing while minimizing barrier damage. These products may contain water, glycerin, cetyl alcohol, stearyl alcohol, sodium laurel sulfate, and occasionally propylene glycol. They leave behind a thin moisturizing film and can be used effectively in persons with excessively dry, sensitive, or dermatitic skin.

Moisturizers should create an optimal environment for barrier repair, while not inducing any type of skin reaction. The best moisturizers are simple emulsions for sensitive skin. The fewer ingredients the better.

Resources

http://www.medscape.org/viewarticle/839478_4

http://www.justaboutskin.com/skin-barrier-function/

http://www.skininc.com/skinscience/physiology/Making-Sense-of-Skin-Sensitivity-311022341.html

http://www.synergieskin.com/skin-irritation-and-skin-allergy/

http://www.oapublishinglondon.com/article/615

http://www.zoedraelos.com/articles/skin-care/#main

http://www.dermnetnz.org/reactions/sensitive-skin.html

https://rosacea-support.org/syndets-and-lipid-free-cleansers-what-are-they-do-they-work.html

Patch tests - http://www.dermnetnz.org/dermatitis/standard-patch.html