Sensitive skin: a routine that doesn't sting

Key takeaways

• Sensitive skin is defined by symptoms (stinging, burning, itching, tingling) in response to things that should not cause them. The skin can look normal or slightly red.
• Common triggers include too many active products, fragrance, acids, retinoids, hot water, sun, heat, pollution, stress and hormonal change.
• A barrier reset means a gentle cleanser, a fragrance-free moisturiser and sunscreen for two to four weeks, nothing else.
• Add new products one at a time, testing on a small patch for several days first.
• Constant redness, flushing, rashes or swelling suggest rosacea, eczema or allergy, which need a diagnosis.

What is sensitive skin, exactly?

Patients come in and say, "Doctor, everything burns." That is a very real complaint, and it has a definition now. An expert group from the International Forum for the Study of Itch defined sensitive skin as unpleasant sensations, such as stinging, burning, pain, itching and tingling, in response to stimuli that normally should not provoke them. The skin can look normal or have some redness. The face is the most common site.

See, what happens is, two things go wrong together. DermNet describes it as a disrupted skin barrier plus nerve endings that fire too easily. The barrier lets irritants in, and the nerves overreact to them.

What makes skin sensitive?

In my clinic in Thane and Mumbai, the most common cause I see is not a disease. It is the routine. People layer a vitamin C serum, a niacinamide serum, an acid toner, a retinol and a face mist, all bought because of a video. Each one is fine alone. Together, they wear the barrier down.

Other triggers DermNet lists: - Fragrance, preservatives, soaps and alpha hydroxy acids - Hot water and long baths - Heat, cold, low humidity, pollution and UV - Friction, including face towels, scrubs and masks - Hormonal change, alcohol and stress - Some medicines that make skin sun-sensitive

In Indian homes, I would add lemon, raw turmeric, toothpaste on pimples, and kitchen remedies with baking soda. These irritate even healthy skin, and on brown skin they often leave dark patches afterwards.

The four-week barrier reset

Basically, you give your skin a rest. For two to four weeks:

A few more rules for the reset: - Pat dry with a soft towel, do not rub. - Keep showers short and not hot. - Avoid steam, saunas and home facials. - Wash pillow covers often, using a fragrance-free detergent if you can. - If any product stings for more than a few seconds, stop it.

Most people feel calmer skin within two weeks. That is very important to understand: the reset is not forever. It is to get you back to a baseline so you can see what actually suits you.

How do I add products back safely?

DermNet recommends introducing one product at a time and testing it on a small area first. A simple way to do this: 1. Choose one product you really want, for example a retinoid for acne or a vitamin C serum. 2. Apply a small amount to one spot, such as near the jawline or behind the ear, once a day for several days. 3. If there is no stinging, redness or itching, use it every other night on the whole face. 4. Wait two weeks before adding the next product.

If the skin reacts, stop that product and go back to the reset. Do not try to "push through" a burning product. For actives, the gentler options are usually fine for sensitive skin: azelaic acid, lower-strength niacinamide, and adapalene used slowly. I discuss these in niacinamide explained and retinoids explained.

When is it not just sensitive skin?

Sensitive skin, by definition, cannot be explained by another skin disease. So if you see more than mild redness, I want to look for something else.

• Rosacea: flushing, persistent redness on the cheeks and nose, small red bumps, sometimes burning. Often missed in Indian skin.
• Eczema: dry, rough, itchy patches that come and go.
• Irritant contact dermatitis: the NHS explains this is the more common type, where a substance directly damages the outer layer of skin, such as soaps and detergents.
• Allergic contact dermatitis: an immune reaction to a specific ingredient, such as hair dye, fragrance or preservatives. Indian studies have found hair dye ingredients and fragrances among the common culprits in facial reactions, and some reactions leave grey-brown pigmentation on the face. Patch testing can help identify the trigger.
• Steroid-damaged skin: if you have used a mixed cream from a chemist on your face for months, redness, burning and pimples when you stop are very common. See the hidden steroid problem in mixed creams.

Can sensitive skin have treatments like peels or lasers?

Sometimes, after the barrier is calm, and with care. I would not do a peel or laser on skin that is burning today. Once it has settled, gentle treatments may be possible, with a test patch and lower settings. For some people with redness, laser for blood vessels can help, and I explain that in lasers for skin explained. The decision depends on your diagnosis, not on what a friend had done.

How we approach this at Dr Tvacha

For sensitive skin, my first job is to find out whether it is a weak barrier, rosacea, eczema, an allergy or steroid damage, because the plans are different. At a Rs 499 skin consultation, I go through every product you use, look at your skin closely and write down a short routine. If you need patch testing, I tell you why and where to get it done, and any treatment is quoted in writing first. The approach is on the Second Layer Skin Plan page, and you can see us at any of our centres.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.