Sensitive Skin
Does the following sound familiar to you? "I just don't know what to do for my skin anymore. I'm so disgusted! I've tried just about everything I can think of at least twenty different makeups and even products labeled hypoallergenic but they all irritate me! I've always had sensitive skin, even when I was a teenager, but isn't there something I can use that won't cause problems?"

"Sensitive skin" is one of the most frequent laments of new patients who come to my office. But one of the biggest problems dermatologists have in addressing the problem is that there is no medical textbook definition of "sensitive skin." This doesn't seem to deter cosmetic manufacturers from using the term freely, especially when they are trying to sell you so-called hypoallergenic cosmetics and other products for the skin that they claim are designed to deal with the condition.

Probably the most remarkable thing about the sensitive skin issue is that, for the most part, both the sufferer and the doctor don't really find much outwardly wrong with the skin. The bitter complaints of the sufferer appear far out of proportion to the medical findings. Precisely because so little is usually found, some doctors incorrectly label the whole condition psychosomatic. And as though that were not bad enough, the sufferer also eventually comes to believe that the whole problem is emotional.

Fortunately, ongoing research has begun to shed some new light on this condition. Based on their observations, some investigators have recently suggested that the sensitive skin problem be labeled the "status cosmeticus syndrome"; others prefer to call it "the intolerant skin syndrome." While these designations lend little to our understanding of the cause of the condition, they at least let the sufferer know that doctors are beginning to view the problem as something physiological rather than psychological.

Regardless of what it is called, however, the sensitive skin phenomenon seems to encompass a condition in which many, if not all, of the cosmetics that the sufferer applies to her face (the condition mostly affects women) produce some degree of tightness, burning, itching, or stinging, without any other objective (visible) findings. More severe cases may exhibit redness, irritation, mild swelling, and complexion changes, especially in the so-called butterfly area of the cheeks and eyelids. For some people, symptoms are limited to the eyes and usually consist of stinging and burning of the eyes and eyelids upon application of cosmetics in the eye area.

Diagnosing the sensitive skin or intolerant skin syndrome is further complicated by the fact that patch tests on the back with suspected allergy-provoking cosmetics and soaps are usually negative (nonreactive). Even "use" tests, in which small amounts of suspected culprits are repeatedly applied to the forearm for several days to look for possible reactions, also commonly prove negative. Rather than indicating that there is no organic problem, such a lack of reactivity may merely reflect the fact that facial skin microscopically differs from other skin areas, especially when it comes to irritant sensitivity to cosmetics. It is for this reason that doctors must maintain a very high index of suspicion for the sensitive skin condition in any person complaining of intolerance to lots of different kinds of topical products and cosmetics. At the same time, before they label the condition intolerant skin, they must make every effort to exclude the presence of subtle forms of eczema or other skin conditions that may be mimicking the problem.