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Sensitive skin is something I have had to manage since my teenage years, and while I manage it well now, for a long time it was with varying degrees of success. I am not alone though, with up to 40% of people describing themselves as having sensitive skin and many more reporting an adverse response to a personal care product at some stage. From a dermatologist perspective, the term “sensitive” refers to those with skin that reacts or is intolerant to the use of some or many cosmetics. Sensitive skin can occur in all skin types however, it is more commonly found in women than men and often those with delicate or dry skin and a tendency to flushing. As well as reacting to cosmetics, sensitive skin can also react to environmental factors such as cold or hot temperatures and wind or sun exposure.

While there is no sign of inflammation, sensitive skin is commonly associated with burning, itching, stinging, dryness and redness or feelings of tightness. These reactions can be intermittent or permanent and vary in intensity. Where inflammation is present (welts, hives, raised red skin or lasting redness) it is important to consider an existing underlying skin condition such as dermatitis, rosacea or a contact allergy in which case cosmetic ingredients need to be assessed. Usually a challenge using the suspected product will pinpoint the cause. In the case of a skin disorder, managing the condition is a priority as well as removing suspected cosmetics.

As an advocate of natural and organic skin care, I am not surprised by the number of skin irritations that occur when using cosmetics with synthetic and in some cases potentially toxic ingredients. I will go into ingredient details later however it is important to be aware that natural skin care ingredients can also cause skin irritations for those with sensitive skin. Essential oils, particularly low-grade essential oils are also a common culprit. If you have sensitive skin it is important to find out what the triggers are and to avoid them.

Understanding the causes of sensitive skin

1. Reduced barrier function – if the barrier of lipids (acid mantle) is compromised the skin is less protected against chemicals, irritants and microorganisms and there is chance of greater Trans Epidermal Water Loss (TEWL), increasing the likelihood of dehydration. Skin that is dry, dehydrated or injured has less nerve end protection which continues the cycle of sensitivity reactions. Once this cycle is in place many cosmetic ingredients can cause irritation. Listed at the end of the article are the common cosmetic triggers.

A number of natural base oils help to reduce TEWL and improve the barrier

function. Rosehip, sweet almond, tamanu, jojoba and evening primrose oil are all rich in essential fatty acids (EFAs) which help repair skin cell membranes and as such water holding capacity. While not specific to all people with sensitive skin, EFAs will also dampen down skin cell inflammatory responses.

Avoiding products such as cleansers and shampoos that contain sodium laurel sulphate and like foaming agents is also crucial as they will aggravate skin dryness and further reduce barrier function. In one clinical trial, participants with reduced barrier function avoided all foaming agents (surfactants) and minimised preservative use. After 8 weeks their skin returned to normal barrier function.

2. Skin Trauma – skin traumas, such as sunburn and skin treatments like chemical peels and abrasion can cause ongoing sensitivity. Strong acids such as those found in glycolic acid peels have been known to cause lasting skin sensitivity issues. If the skin barrier function can be repaired, then sensitivity may be reduced however it is likely that cosmetic ingredients with a stronger acid pH will have to be avoided or used with caution. These can include further glycolic acid treatments, lactic and malic acid, vitamin C serums with concentrations over 10%, alpha and beta hydroxy acids.

3. Environmental factors – extremes of cold, heat (including heaters in winter), air conditioning, alcohol & spicy foods can be triggers and should be monitored and avoided if relevant.

4. Stress increases the likelihood of heightened neuro-sensory reaction in the skin. In situations such as this wind, touch and cosmetic brushes can cause irritation or redness. Managing stress can be quite individual and often required internal nervous system support as well as de-stressing practices such as yoga, breathing exercises or meditation.

5. Allergies – true skin allergies arise from immune system dysfunction. These include eczema, hives, rosacea and contact dermatitis. Patch testing can help confirm these conditions to establish if these conditions are contributing to sensitive skin reactions.

Hypoallergenic and “unscented” products are often recommend as a solution to sensitive skin however, just because you can’t smell the scent doesn’t mean that fragrances weren’t added or that fragrance-like substances weren’t used. Often subtle fragrances are used to cover up the scent of the base ingredients, so you don’t smell anything you would identify as a scent but it is still there and is likely to cause irritation regardless.

Other common skin irritants include:
•    Balsam of Peru – perfume and skin lotion
•    Formaldehyde – a preservative found in nail polish

•    Quaternium 15 – a preservative in shampoo
•    Sodium lauryl sulphate (SLS) – a detergent found in shampoo, toothpaste, body wash and bubble bath
•    Propylene glycol – found in cosmetic products
•    Methyl, propyl, butyl, and ethyl parabens – used as preservatives, they are found in many cosmetic products
•    DEA (diethanolamine) and MEA (monoethanolamine) – foaming agents in products that “bubble”
•    Artificial Colours – FD&C and D&C are used in make up
•    Phthalates – found in plastic containers and some cosmetics

Below are some guidelines you can follow to manage sensitive skin:

1.    Avoid artificial fragrances and products that contain high concentrations of essential oils or natural fragrances
2.    Avoid the most common irritant in your skin and hair care as listed above
3.    Avoid “acids” such as glycolic, lactic and malic acid products without the advice of a specialist
4.   Avoid products that contain artificial dyes
5.    Use non-soap cleansers for at least 2 months. Soapwort based products and cream cleansers are ideal to give the skin a break.
6.    Use tepid water to wash your face and avoid hard scrubs and they may increase irritation.
7.    Introduce one new skin care product at a time and use for at least 3 days to evaluate how your skin reacts. Ideally ask for a tester before you buy. When you find something that works, continue to use it.

View products suitable for sensitive skin.

Ananda Mahony ND is a naturopath and holistic skin specialist. Her practice focuses on the treatment of skin conditions and Food As Medicine. Ananda also owns Vitale Natural Skin & Body Care, a natural & organic skin care store in Paddington. www.vitalenatural.com.au

Following up from the previous blog on SLS, I thought I would mention some of the issues that customers come in with after routinely using commercial shampoo. And let me say for the record that many of the more expensive “salon” brands also use SLS even though it is basically a cheap, nasty ingredient. What it does do is produce bubbles, lots of lovely bubbles! As consumers we have been programmed to expect shampoo that foams – anything less and we think the product isn’t working. However, all a surfactant (see previous blog for explanation) needs to do is break the surface tension of the hair follicle and it will wash out all the dirt and oil. A soap based product is needed but it doesn’t have to foam at all!

So back to the issues I often see. Most often it is a dry scalp that builds up a scurf of dead skin cells. Sometimes the dead cells flake off making people think they have dandruff when in fact it is just that the scalp has been stripped of its protective oils. The opposite problem can also occur, a scalp that over-produces oil, creating greasy hair and sometimes blocked pores around the hairline. This happens because the skin, including the scalp has a great balancing mechanism – when stripped of naturally produced oil by a product like SLS, it responds by producing sebum and in some cases it goes a little bit over the top creating too much sebum resulting in greasy hair.

Increasingly I also see people that come in with a “sensitive scalp”. They find their scalp feels irritated, itchy or sensitive to touch after shampooing. In this case it is likely that the SLS has stripped back the scalps protective layer leaving it exposed to other irritating ingredients such as artificial fragrances. Usually, changing to a  naturally scented or unscented shampoo with no SLS will clear this problem up. If your scalp is still sensitive or irritated at this stage, a natural scalp oil including calendula and jojoba oils will help to soothe and nourish the cells. Scalp oils can be applied the night before a morning hair wash so that they have a chance to work effectively. Or they can be left in for a few days if the hair doesn’t look too greasy.

The scalp responds quite quickly to products that don’t contain SLS. After about 4-6 weeks, the dry, itchy or oily scalp starts to rebalance and any scurf build up starts to clear. When I made the switch to natural SLS free hair care my scalp was fine after about 6 weeks however it took a little longer for my hair to become healthy again as it was dyed and very dry (as curly hair tends to be). I also stopped washing my hair so often and now only wash it once a week. GROSS you may say, but being dry anyway, my hair doesn’t build up grease and still looks and smells fine for that time. I also use natural wax based hair styling products that don’t build up grease in my hair.

In general I think that most people tend to wash their hair too frequently, each time stripping back the protective oils from the scalp and hair. I did a quick vox pop of the staff at Vitale to see how frequently they washed their hair. The average was twice a week. Natarsha (the office manager) told me that she tried to stop washing her hair altogether based on the fact that in Ayurveda, oils are used to strip out dirt and grime rather than shampoos. It went well for 6 weeks, and her hair was much more healthy in general. Then she cracked becauseit she missed the squeaky clean feeling so returned to washing it once a week. Liz, the beauty therapist washes hers twice a week but told me she uses an oil to style her hair which is why it is always so shiny.

Once or twice weekly for normal to dry hair is a good benchmark to go by. Obviously oily hair needs to be washed more often. Washing hair often entails blow-drying or straightening which if done excessively, damage the hair shaft. The less you dry & straighten, the better your hair condition will tend to be.

What hair stories are out there? Tell us your experiences.