[Academic Presentation] Chinese Expert Consensus on the Diagnosis and Treatment of Sensitive Skin

1. 1 Individual Factors

The causes of sensitive skin are complex, with individual factors including genetics, age, sex, hormonal status, and psychological factors. Recent research indicates that sensitive skin is genetically linked, with a higher incidence among younger individuals compared to older adults, and among women than men. Psychological stress can reflexively trigger the release of neurotensin, thereby precipitating sensitive skin.

1. 2 External Factors

The following factors can all trigger or exacerbate sensitive skin, including: ① physical factors, such as seasonal transitions, temperature fluctuations, and sun exposure; ② chemical factors, such as cosmetics, cleansing products, disinfectants, and air pollutants; ③ iatrogenic factors, such as topical irritant medications, prolonged and excessive topical use of corticosteroids, and certain post‑laser treatment conditions.

1. 3 Other Skin Diseases

Sensitive skin may also develop secondary to certain dermatologic conditions; approximately 66% of female patients with atopic dermatitis and 57% of those with rosacea exhibit cutaneous sensitivity. Other conditions, such as acne, contact dermatitis, and eczema, can likewise precipitate sensitive skin. The scope of this consensus does not encompass sensitive skin arising from underlying skin diseases.

Current research suggests that the development of sensitive skin is a complex process involving the skin barrier, the neurovascular system, and immune‑inflammatory pathways. Under the interplay of intrinsic and extrinsic factors, impaired skin barrier function leads to heightened afferent signaling from sensory nerves, resulting in increased reactivity to external stimuli and triggering cutaneous immune‑inflammatory responses.

2.1 Damage to the Skin Barrier Function

In sensitive skin, the stratum corneum exhibits an incomplete structural integrity and an imbalanced intercellular lipid composition, both of which can lead to reduced ceramide levels. Physiological assessments reveal that sensitive skin is characterized by an increased transepidermal water loss (TEWL) and decreased stratum corneum hydration, indicating impaired barrier function. Moreover, excessively low or high skin surface temperatures—below 34°C or above 42°C—can delay barrier repair; thus, ambient temperature can trigger or exacerbate sensitivity.

2.2 Dysregulation of Cutaneous Sensory Nerve Function

The diminished protective capacity of cutaneous nerve endings, the increased density of nerve fibers, and the heightened responsiveness of sensory nerves interact to induce dysregulation of cutaneous sensory function; this process is associated with the activation of the transient receptor potential (TRP) family. The sensitized member of the TRP vanilloid subfamily 1 (TRPV1) can be activated by physiological or subphysiological temperatures—temperatures below TRPV1’s normal activation threshold—resulting in burning, stinging, and pruritic symptoms in sensitive skin. Because TRPV1 is readily activated by capsaicin, it is often referred to as the capsaicin receptor. The development of sensitive skin is linked not only to peripheral neural dysfunction but also to alterations in central nervous system function.

2.3 Increased Vascular Reactivity

TRPV1 is expressed in mast cells and keratinocytes. Endothelin (ET) is secreted by endothelial cells and mast cells and induces mast cell degranulation, thereby triggering neurogenic inflammation. ET‑1 can stimulate the secretion of tumor necrosis factor‑α (TNF‑α) and interleukin‑6 (IL‑6), and it promotes the production of vascular endothelial growth factor (VEGF), increasing vascular reactivity and leading to vasodilation.

2.4 Immune and Inflammatory Responses

Activation of TRPV1 not only promotes the release of local skin neurotransmitters such as substance P, vasoactive intestinal peptide, neuropeptide Y, and secretin, but also induces keratinocytes and mast cells near sensory nerve endings to release IL‑23 and IL‑31, while activating antigen-presenting cells and T cells, thereby triggering cutaneous immune and inflammatory responses.

3.1 Subjective Symptoms

Typically, following exposure to physical, chemical, or psychological stimuli, the skin may exhibit varying degrees of burning, stinging, itching, and tightness, lasting from several minutes to even several hours, and often failing to tolerate common skincare products.

3.2 Objective Signs

The appearance of sensitive skin is generally normal; in a small number of individuals, the facial skin may exhibit patchy or diffuse erythema, erythematous patches, and telangiectasia, often accompanied by dryness and fine scaling.

At present, the assessment of sensitive skin primarily employs the following three methods:

4.1 Subjective Assessment

First, respondents are asked to self-assess their skin’s sensitivity by indicating whether they experience subjective symptoms such as burning, stinging, itching, or tightness when exposed to triggering factors, thereby determining whether their skin is classified as sensitive.

Possible triggering factors: ① Physical factors, such as seasonal transitions, temperature fluctuations, and sun exposure; ② Chemical factors, including cosmetics, cleaning products, disinfectants, topical irritants like retinoic acid, and environmental pollutants (e.g., smog, dust, vehicle exhaust); ③ Psychological factors, such as anxiety and depression.

4.2 Semi-Subjective Assessment

As a semi‑subjective method, the stimulation test is now widely used to assess sensitive skin; commonly employed tests include the lactic acid pain test and the capsaicin test.

4. 2. 1 Lactic Acid Prick Test

It is one of the most widely used evaluation methods, with the most classic approach being the application method: at room temperature, 50 μL of a 10% lactic acid solution is applied to the nasolabial fold and to either cheek. Subjects are asked about their subjective symptoms at 2.5 minutes and 5 minutes, respectively, and scores are assigned on a 4-point scale (0 = no stinging sensation; 1 = mild stinging; 2 = moderate stinging; 3 = severe stinging). The two scores are then summed, and subjects with a total score ≥ 3 are considered positive for lactic acid‑induced stinging.

4. 2. 2 Capsaicin Test

This is a commonly used method for assessing sensory‑neural hypersensitivity of the skin. Two layers of filter paper, each 0.8 cm in diameter, are placed approximately 1 cm lateral to one side of the nasolabial fold and on either cheek. Fifty microliters of capsaicin at a concentration of 0.1‰ is applied to each piece of filter paper, and the subject is asked to report their sensation (1 = barely perceptible, 2 = mildly perceptible, 3 = moderately perceptible, 4 = strongly perceptible, 5 = painful). A positive result is defined as a burning or painful sensation that persists for more than 30 seconds and rates ≥3 on the scale.

4.3 Objective Assessment

Objective assessment primarily relies on non‑invasive measurements of cutaneous physiological parameters, which can effectively reflect the severity of sensitive skin or the efficacy of treatment. Common quantitative indicators include: (1) transepidermal water loss: an indirect measure of the skin’s stratum corneum barrier function; in sensitive skin, this value is often elevated; (2) stratum corneum hydration: typically reduced in individuals with sensitive skin; (3) pH: often increased in sensitive skin; (4) sebum: assessed by measuring sebum levels derived from sebaceous glands; sebum production is usually lower in sensitive skin; (5) erythema index: determined using a skin colorimetric spectrophotometer to indirectly quantify the degree of facial erythema; erythema‑related parameters are frequently markedly elevated in sensitive skin; (6) local blood flow velocity and blood flow distribution histograms: evaluated with color Doppler ultrasound to assess regional perfusion; sensitive skin often exhibits signs of impaired local microcirculation.

Diagnosis requires fulfillment of the major criteria; minor criteria are for reference only.

5.1 Main Conditions

These include the following points: ① Subjective symptoms: characterized by sensations of burning, stinging, itching, and tightness that are easily triggered by physical, chemical, or psychological factors; ② Exclusion of primary conditions that may be associated with sensitive skin, such as rosacea, seborrheic dermatitis, hormone‑dependent dermatitis, contact dermatitis, atopic dermatitis, and lupus erythematosus with erythematous edema.

5.2 Secondary Conditions

These include the following points: ① Physical signs: erythema, erythematous plaques, telangiectasia, and scaling; ② Subjective assessment indicating sensitive skin; ③ Semi‑objective assessment: a lactic acid challenge test score ≥3, or a capsaicin test score ≥3; ④ Non‑invasive measurements of cutaneous physiological parameters revealing abnormal alterations in skin barrier function. 6 The overall treatment principles are to strengthen patient education, promote skin barrier repair, reduce neurovascular hyperreactivity, and control inflammatory responses, with the ultimate goal of enhancing skin tolerance.

The overarching principles are to strengthen health education, promote skin barrier repair, reduce neurovascular hyperreactivity, and control inflammatory responses, with the aim of enhancing skin tolerance.

6.1 Health Education

Sensitive skin is highly prone to recurrent flare-ups, making psychological counseling and health education essential. Patients should do their utmost to avoid triggering factors such as sun exposure, consumption of spicy foods, alcohol intake, emotional stress, and enclosed, hot environments, and should refrain from the overuse of cosmetics. Regular treatment and follow-up visits, combined with therapy under medical supervision, along with patience and a positive outlook, can help maintain the skin in a healthy condition.

6.2 Proper Skincare

Repairing the damaged skin barrier is a key component of managing sensitive skin. Proper skincare should adhere to the principles of gentle cleansing, soothing hydration, and rigorous sun protection. It is advisable to choose medical‑grade skincare products that have been rigorously tested and clinically validated for safety. Avoid exfoliating products; use lukewarm water for cleansing, and limit the frequency of cleansing to no more than once daily. Select medical‑grade skincare formulations with barrier‑repairing properties according to seasonal changes.

6.3 Physical Therapy

6. 3. 1 Cold Spraying, Cold Film Coating, and Cold Ultrasonic Treatment

For patients who are sensitive to thermal stimuli, low‑temperature physical therapy can constrict dilated capillaries, thereby helping to reduce inflammation.

6. 3. 2 Red Light and Yellow Light

Red light has anti-inflammatory effects and promotes the repair of the skin barrier; yellow light can enhance cellular metabolism and reduce the excitability of peripheral nerve fibers, thereby alleviating and treating various symptoms associated with sensitive skin.

6. 3. 3 Intense Pulsed Light and Radiofrequency

Intense pulsed light can close dilated capillaries through thermal coagulation and, by exerting photomodulatory effects on epidermal cells, promote the repair of the skin barrier and alleviate symptoms of cutaneous sensitivity. Radiofrequency can stimulate the proliferation of type I and type III collagen in the dermis, thereby enhancing the skin’s tolerance.

6.4 Pharmacological Treatment

In cases with severe symptoms, pharmacologic therapy may be considered as appropriate. For patients experiencing marked burning, stinging, pruritus, and tightness, anti-inflammatory and antihistamine agents may be selected. In those accompanied by anxiety or depressive symptoms, anxiolytics and antidepressants may be used as indicated.