Strategies for Managing Clinically Sensitive Skin?

Sensitive skin is a specific skin type characterized by the facial skin’s tendency to develop objective symptoms—such as erythema, papules, and telangiectasia—when exposed to external physical, chemical, or thermal stimuli, accompanied by subjective symptoms like itching, stinging, burning, and tightness. Strictly speaking, sensitive skin is not a disease but rather a suboptimal state of skin health that directly affects people’s quality of life. Epidemiological surveys across different countries and ethnic groups show a high prevalence of sensitive skin; for example, the prevalence is 44.8% in the United States and 38.4% in Europe. Consequently, sensitive skin has become a skin concern of both domestic and international interest. Based on its underlying causes, it can be classified as primary or secondary. Primary sensitive skin is associated with factors such as genetics, gender, and age; secondary sensitive skin is primarily caused by inflammatory skin conditions (acne, solar dermatitis, etc.), topical medications (glucocorticoids, retinoids, salicylic acid, etc.), improper skincare and skin-whitening/spot-removal treatments (peel syndrome), and minimally invasive procedures (post-laser surgery).

I. Pathogenesis

The pathogenesis of sensitive skin is not yet fully understood. It may involve the interaction of internal and external factors, leading to impaired skin barrier function, activation of the skin’s immune response, increased sensory nerve input, and heightened vascular reactivity. This results in vasodilation and inflammatory cell infiltration, causing sensitive skin and manifesting as erythema, telangiectasia, and symptoms such as a tight sensation, burning, and itching.

The skin barrier is primarily composed of keratinocytes and intercellular lipids, such as ceramides. In certain individuals, genetic factors result in thinner skin and reduced stability of the keratinocyte-intercellular matrix, leading to an impaired skin barrier function. Additionally, clinical factors such as the topical application of corticosteroids, irritating medications, improper use of cosmetics, and laser treatments can all induce or exacerbate damage to the skin barrier. Once the skin barrier is compromised, the skin’s ability to resist external irritants, sunlight, microorganisms, and antigens is reduced, and its capacity to retain moisture internally is weakened. Under the influence of inflammatory responses and neurovascular hyperreactivity, symptoms such as erythema, papules, telangiectasia, dryness, and desquamation—accompanied by a burning sensation and tightness—are likely to occur.

II. Clinical Diagnostic Criteria

The diagnosis of sensitive skin is primarily based on the patient’s subjective and objective symptoms. Subjectively: Patients report erythema and telangiectasia accompanied by a burning sensation, and an inability to tolerate ordinary skincare products; Objectively: Diagnosis is confirmed using the lactic acid test. A 5% lactic acid solution is applied to the nasolabial folds on both sides of the face, and erythema is observed at 2.5 minutes and 5 minutes. A 4-point scoring system (0–3 points) is then used; if the sum of the scores at 2.5 minutes and 5 minutes is greater than 3, the condition is diagnosed as sensitive skin, and the severity is assessed. Furthermore, facial skin image analysis reveals that erythema and telangiectasia are more pronounced in individuals with sensitive skin than in healthy individuals. Non-invasive skin testing shows that patients with sensitive skin have higher transepidermal water loss and lower epidermal water content compared to healthy individuals.

III. Management Strategies

There is currently no standardized management protocol for sensitive skin. Based on its pathophysiology, key management strategies include patient education, restoration of the skin barrier, reduction of vascular and neural hyperreactivity, alleviation of inflammation, modulation of immune function, and improvement of skin tolerance.

1. Patient Education

Sensitive skin is highly prone to recurrent flare-ups, making psychological counseling crucial. It is important to educate patients so they understand the importance of treatment and maintenance in keeping their skin in good condition. Patients should be advised to avoid excessive use of cosmetics and opt for medical-grade skincare products instead; wash their face with lukewarm water and avoid over-cleansing; limit consumption of spicy and irritating foods; and avoid hot steam treatments and massages. Regular treatment and follow-up are necessary to allow the skin sufficient time to repair itself. With patience and confidence, most cases of sensitive skin can return to normal.

2. Restoring the Skin Barrier

Sensitive skin is characterized by a compromised skin barrier accompanied by an inflammatory response. Medical skincare products primarily consist of thermal spring water or active plant extracts, such as sea buckthorn, chamomile, purslane, and aloe vera. Research by scholars both domestically and internationally has confirmed that these ingredients possess skin barrier-repairing, anti-inflammatory, and anti-allergic properties. Studies have found that natural thermal spring water is rich in silica and bicarbonates, with a balanced Ca²⁺/Mg²⁺ ratio, and possesses natural soothing, anti-irritant, and anti-inflammatory properties. We have confirmed that sea buckthorn oil promotes the synthesis of intercellular lipids—specifically ceramides—in keratinocytes, thereby helping to repair the skin barrier, while purslane exhibits anti-inflammatory effects. Consequently, medical skincare products containing these active ingredients have gradually been adopted for the adjunctive treatment and prevention of clinically sensitive skin. Du Yaowu observed that the combination of Vinona Moisturizing Cream and Compound Glycyrrhizin Tablets demonstrated good efficacy in treating facial glucocorticoid-dependent dermatitis.