While most clients would be very excited to hear that research has found the cure for their ailment, a deeper understanding of their condition is helpful for many of them.

Sensitive versus Sensitized skin
A patient does not receive a diagnosis of sensitive skin. They have a disease or condition that is causing their sensitive skin. Only a licensed medical provider can diagnose the cause for sensitive skin after a thorough examination of the integument and review of the patient's medical history. A true sensitive skin condition is experienced by patients diagnosed with eczema, rosacea, psoriasis, dermatographia, and health-challenged autoimmune diseases including lupus, rheumatoid arthritis, and scleroderma.

Many clients believe that they have sensitive skin because they experience stinging, burning, redness, or tightness. In reality, they are experiencing sensitized skin due to their environment or harsh product usage.

Whether the client's skin is sensitized or an actual sensitive skin condition, it is the skin care professional's job to recognize the condition to make the appropriate treatment and product recommendations. Professionals accomplish this goal by conducting a thorough consultation; reviewing the client intake form and checking for allergies, sensitivities, and any medical conditions; asking the client to describe their homecare regimen and discuss their skin concerns; and completing a skin analysis.

Common presentations of sensitized skin reactions include pustules, rashes, blisters, and lesions; extremely dry skin that does not properly protect nerve endings; a tendency toward redness or blushing/flushing; inflammation that is hot to the touch; and swelling.

Triggers for sensitized skin reactions include exposure to allergens; high levels of exposure to environmental factors, such as sun, wind, excessive heat, or cold; clothing; fragrances and dyes; metals, such as nickel; and household products. The Household Products Database is a helpful online resource maintained by the National Institute of Health and the National Library of Medicine. Products and ingredients are listed by name to check for potential irritants.

New Discoveries in Sensitive Skin Conditions
Each skin care condition has one or more national organizations providing support and information to those afflicted by the specific disorder. These organizations fund medical research to provide advances in new treatments and one day find a cure for each ailment. Often, a better understanding of the condition or information on new treatments offered gives a patient a huge boost in morale.

Rosacea
Just 75 years ago, rosacea was thought of as a rare disease. Today, it is known that over 40 million individuals worldwide are affected by this chronic skin condition that presents as flushing or redness on the cheeks, nose, chin, or forehead. In some cases, rosacea may also occur on the neck, chest, scalp, or ears. Over time, the redness becomes more prominent and persistent, with the appearance of telangiectasias. Left untreated, rosacea progresses as papules and pustules often develop; by subtype 3, nodules develop as well. It is estimated that up to 50 percent of rosacea patients can develop ocular rosacea, where the condition invades the eye tissue, with the potential to lead to glaucoma or even blindness.

The National Rosacea Society is a non-profit organization that began 25 years ago in 1992. It offers a plethora of information to the over 16 million Americans with rosacea. Supported entirely by donations from individuals, the NRS research grants program has awarded more than 1.5 million dollars to fund 66 medical/scientific studies to date. One of the recent discoveries include a link between rosacea and certain types of cancer. A recent study by a research team from the University of Copenhagen found that rosacea patients had an increased risk of liver, nonmelanoma, and breast cancers, but a decreased risk of lung cancer. They studied 13 types of cancers comparing rosacea patients to the general population. Researchers analyzed five years of medical history for 49,475 patients with rosacea and 4,312,213 control subjects obtained from the Danish National Patient Registry. Their findings found no increased risk for malignant melanoma, ovarian, endometrial, cervical, esophageal, kidney, pancreatic, or thyroid cancers; 42 percent increased risk of liver cancer; 36 percent increased risk of nonmelanoma skin cancer; 25 percent increased risk of breast cancer; and that subjects were 22 percent less likely to be diagnosed with lung cancer.

Researchers proposed that there might be a biological reason for rosacea patients' elevated risk for nonmelanoma skin cancer and speculated that patients with rosacea might have an impaired skin barrier and a history of high sun exposure. The research team did note that this study was limited to Caucasians, so results could not be applied to all ethnicities.

Female Alcohol Intake Related to Rosacea
In April 2017, the Journal of the American Academy of Dermatology published the results of a 14-year study that included over 80,000 women. The study was conducted to determine the association between female alcohol intake and the risk of developing rosacea. Researchers reviewed the women's alcohol consumption, what type of alcohol they drank, and whether they had been diagnosed with rosacea. Then the research team calculated the risk of developing rosacea based on the amount of alcohol consumed.

The study found that women who drank alcohol had an elevated risk to develop rosacea compared to those who did not drink; the risk increased as alcohol consumption increased. Neither beer nor red wine was found to significantly increase the risk of developing rosacea. The risk of white wine drinkers who drank one-to-three glasses monthly increased by 14 percent. The risk of the participants drinking five or more glasses weekly increased by up to 49 percent. Red wine has been widely identified as a trigger for those who already have the disease; it does not appear to be a factor in developing rosacea. The risk for liquor drinkers ranged from eight to 28 percent, depending on the amount consumed. The investigators suggested that alcohol's weakening of the immune system and widening of the blood vessels may contribute to the redness and flushing that occur when developing rosacea. There were 4,945 cases of rosacea identified. The study team added that further research is needed to gain more insight into the connections between specific types of alcohol and rosacea.

Eczema
Eczema, or dermatitis, is a chronic condition that causes the skin to become inflamed or irritated. In 2015, it was estimated to afflict over 245 million people. The seven common types of eczema include atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, neurodermatitis, and stasis dermatitis.

Top Research Advances in 2016
According to the National Eczema Association, there are more than 40 therapies currently in development for eczema that have the potential to help symptoms such as itch and redness, improve barrier function, and calm the immune system.

Biologic drugs are made from proteins derived from human DNA. They can inhibit parts of the immune system that cause inflammation, exacerbating atopic dermatitis. Biologic drugs are currently used to treat rheumatoid arthritis, psoriasis, and cancer.

Dupliumab is an injectable, biologic drug developed to treat moderate to severe eczema. Previous clinical trial results for this biologic drug included significant improvement in the severity of atopic dermatitis, clearing of the skin, itchiness, patient anxiety, and depression. The FDA approved dupilumab, which is marketed as Dupixent®, to treat moderate-to-severe atopic dermatitis in March 2017.

Association with ADHD
Individuals with eczema are more likely to develop other diseases – the most common of these include asthma; hay fever; staph infections; other forms of eczema, such as seborrheic dermatitis; and depression. The study that determined the preceding information examined survey data from 354,416 children between the ages of two and 17 and 34,613 adults.

The study's analysis found that both children and adults with eczema were at an increased risk of developing attention deficit hyperactivity disorder (ADHD). This risk was further increased among people with eczema who also had certain other conditions, such as asthma or insomnia.

The study found that eczema was associated with ADD/ADHD in both children at ratios of 1-to-14 and adults at 1-to-61. Children with both severe eczema and only zero-to-three nights of adequate sleep per week had much higher odds of ADD/ADHD at a ratio of 16-to-8. Children with severe eczema and zero-to-three nights of adequate sleep per week had a ratio of 1-to-83. The study also found that eczema was most strongly associated with severe ADHD. Eczema unaccompanied by another allergic disease was also associated with an increased risk of ADD/ADHD in children. Among children with eczema, a history of anemia, headaches, and obesity were associated with even higher odds of ADD/ADHD. Asthma, insomnia, and headaches increased the odds of ADHD in adults with eczema.

Psoriasis
Psoriasis is an autoimmune disease that produces sensitive skin conditions. According to the World Psoriasis Day Consortium, over 125 million people worldwide suffer from various forms of this malady. Psoriasis comes in many types, the most common being plaque. Other forms include guttate, inverse, pustular, and erythrodermic.

The patient's skin cells grow at an abnormally fast rate, causing the buildup of psoriatic lesions. Up to 30 percent of individuals with psoriasis go on to develop psoriatic arthritis.

Rac1 Gene
Researchers at Stanford University discovered that a protein gene called Rac1 might play a big role in psoriatic disease. Rac1 drives the interaction between the skin and the immune system that leads to psoriasis, so blocking it in the body could effectively treat the disease.
Additionally, in 2016, advances were made for a topical treatment that works by gene editing. Gene editing is a technique used to meticulously and efficiently modify the DNA within a cell. The modification can add, remove, or alter the DNA, changing the characteristics of the cell.

New Topical Therapy
Dr. Amy Paller from Northwestern University leads a research team working on a topical therapy that could prevent one of the major immune system responses that lead to psoriasis. Initial results have been promising; the research is currently in the clinical trial phase.

Genetic Factors
An international study published in the American Journal of Human Genetics states that certain genetic factors might increase a person's chances of getting psoriatic arthritis. Psoriasis is caused by a combination of genetic risk factors and environmental triggers. Scientists have identified almost 70 genetic risk factors for psoriasis and 13 genetic risk factors for psoriatic arthritis. Genetic variants could be separate from genetic risk factors associated with psoriasis.

Additionally, a specific part of a person's DNA, the chromosomal loci, may help determine if someone will develop psoriatic arthritis.

This study involved 6,000 participants and compared the genes of people with psoriatic arthritis to healthy controls. The researchers then combined this data with previous genetic studies of psoriatic disease.

The analysis involved about 3,000 people with psoriatic arthritis and another 3,000 patients who had psoriasis for at least 10 years with no signs of psoriatic arthritis. Researchers identified several loci associated with psoriasis and psoriatic arthritis. Among the loci identified, they found three that were more associated with skin psoriasis and two that were more associated with psoriatic arthritis.

As scientists are able to identify the specific genetic causes of psoriasis and psoriatic arthritis, they can study the effect these gene variants have on bodily functions. Findings from this valuable research may be used to develop biomarkers (measurable indicators) to help diagnose and treat psoriatic disease.

Dermatographia
Dermatographia (skin writing), which is considered as a subcategory of dermatitis, is a touch disorder that can be confused with sensitized skin because it is characterized by hypersensitivity to touch. It is a type of urticaria or hives where a raised, itchy rash appears on the skin after touch. It is referred to as skin writing because what appears to be a minor scratch has a major skin reaction that often looks like writing.

Symptoms
It is believed that dermatographia is caused when the cells under the skin's surface release histamines in response to the slightest touch, scratch, or rub. The symptoms of dermatographia include the affected skin becoming red and inflamed; scratches reddening into raised wheals like hives and remaining elevated for about 30 minutes; and, occasionally, the scratches exacerbate, causing deep wounds or allergy-like reactions.

Triggers
The triggers of dermatographia include a history of allergies; stress; infections; certain medications, such as penicillin; low cortisol levels; clothing or bedding that is too tight or anything that rubs against the skin; activities that cause excessive rubbing of the skin, like wrestling; hot and cold, dry weather; hot water in showers and baths; and saunas.

Symptoms can worsen in extreme temperatures. Luckily, they can be lessened with antihistamines. Daily intake of an antihistamine can suppress symptoms. A physician may recommend phototherapy for severe cases. Other topical remedies including oatmeal and tea tree oil. Aloe vera and rice bran broth may improve the itchiness.

Skin care professionals treating a client with this disorder must take extra precautions not to scratch the skin and to continually check upon client comfort throughout the treatment.

Sensitive and Sensitized Skin Care Tips
The skin care professional's goal is to return the client's sensitive skin conditions or sensitized skin to the state of homeostasis. In order to do so, they should start with a gentle skin care regimen when dealing with compromised skin.

Cleansing
Each client is unique; their skin responds differently to different cleansing methods. Most skin care professionals agree that clients with skin sensitivities should avoid soap, fragrances, and strong detergents.

Look for gentle cleansers that are formulated with calming, anti-inflammatory ingredients. The list of ingredients is extensive. However, a few examples are aloe vera, feverfew, argan oil, oat, ginger, chamomile, avocado, and sunflower oil.

Another option for cleansing the skin is to use a gentle sponge rather than rubbing with a washcloth. An incredible cleansing implement is the Japanese konjac sponge, which is made from the root of the konjac plant. These sponges glide across the face like a pillow, feeling weightless against the skin. They balance the pH, hydrate, and gently exfoliate. Konjac is rich in proteins; lipids; fatty acids; vitamins A, B1, B2, B6, B12, C, D, and E; and natural minerals, including copper, zinc, iron, and magnesium. The konjac sponge is excellent for all skin types including those with sensitive skin conditions or sensitized skin.

Moisturizing
Moisturizing products soften and hydrate the skin. Skin that is soft and hydrated will experience reduced sensitivity. Look for humectants to bring moisture to the surface of the skin, ceramides to increase lipid content, and occlusive ingredients to seal in the moisture preventing transepidermal water loss.

Humectants include hyaluronic acid, butylene glycol, glycerin, urea, honey, sorbitol, sodium PCA, algae, seaweed, and sodium lactate. Ceramides are a type of lipid found in the membranes of skin cells. Lipids play an important role in maintaining the skin's barrier by maintaining hydration levels and preventing irritants from entering the skin. Ceramides comprise about 40 percent of the lipids found in the stratum corneum. Ceramides found in skin care formulations are phytosphingosine, sphingosine, ceramide 3, ceramide AP, ceramide EOP, ceramide NG, ceramide NP, and ceramide NS.

Seal in the humectants and ceramides with occlusive ingredients. Occlusive ingredients found in skin care products include shea butter; titanium dioxide; zinc oxide; silicones; squalene; lecithin; cholesterol; fatty alcohols like cetyl and stearyl alcohol; and oils, including olive, rice bran, macadamia, castor, and soybean.

Product Selection
Skin care products should be gentle, simple, and pH balanced. When selecting products, avoid unnecessary antibacterial ingredients, retinoids, alpha hydroxy acids, and certain alcohols as some are drying; fatty alcohols are not.

Sunscreens
Use a physical broad-spectrum sunscreen with zinc oxide or titanium dioxide as active ingredients. Physical sunscreens reflect ultraviolet rays and are far less irritating to sensitized skin than chemical sunscreens. Apply at least one ounce liberally to all exposed skin 15 to 30 minutes before going outdoors. Use sunscreen year-round and reapply it every two hours when outdoors. Be sure to reapply sunscreen immediately after perspiring or participating in any water activities, avoid direct sun exposure during the hours of 10 a.m. and 4 p.m., and wear protective clothing when outdoors.

Cosmetics
For clients with sensitized skin, the American Academy of Dermatology recommends powder foundations because they have fewer preservatives and a minimal risk of skin irritation; silicone-based foundations also have minimal skin irritation. Avoid waterproof cosmetics as a special cleanser is often needed to remove them. The Academy notes that black eyeliner and mascara appears to be least allergenic and suggests using pencil eyeliners and eyebrow fillers. Liquid eyeliners may contain latex and may cause an allergic reaction.

It is also suggested that clients throw out old cosmetics as they can spoil or become contaminated. Different sources cite various time frames that vary minimally. Sensitized skin types should pay extra attention to cosmetic guidelines: eyeliner lasts six months to one year; mascara lasts two-to-six months; blush, shadow, and powders last one-to-two years; foundation in a pot lasts six months; liquid foundations last six months to one year; lipstick will last two years if cared for properly; lip gloss lasts for one year; and natural products last only three-to-six months because they are preservative-free.

Treatment Options
Depending on the condition, clients may be prescribed medication, or – as in the case of contact dermatitis – be advised to avoid certain ingredients, or a combination of both. Sensitive skin conditions can benefit from professional exfoliation as part of the professional treatment regimens. Select exfoliation methods best suited for the condition. Generally, avoid scrubs and physical exfoliants as they tend to be a bit too stimulating.

A mild alpha hydroxy acid chemical exfoliant will usually deliver the best results. The key is to control inflammation and use mild daily care products that do not overstimulate the skin.

Scientific research teams are constantly discovering new treatments and cures for sensitive skin conditions. Knowledgeable skin care providers can inform and educate their clients with the latest advances.

References
Okura, L. (2014, August 18). The Makeup Expiration Dates You Need To Know. Huffington Post.
Hoff, V. D. (2013, December 9). The Definitive Guide to Makeup Shelf Life, According to Bobbi Brown. Elle.
McDonald, R. (2016, December 20). Top Advances in Eczema Research in 2016. National Eczema Association.
Leavitt, M. (2016, November 7). NPF researchers identify protein driving skin-immune connection. National Psoriasis Foundation.
Leavitt, M. (2016, September 9). Could a topical transform your DNA? National Psoriasis Foundation.

Brenda Linday is a licensed aesthetician, licensed aesthetic instructor, and certified aesthetic consultant with over 12 years of experience in the medical aesthetic industry. She offers consulting services to medical and aesthetic companies desiring to build strong sales and education teams. She also develops educational and engagement-marketing content for employees, contractors, practitioners, and industry distributors around the world. Linday's passion is to share her wealth of knowledge with other like-minded professionals who believe that education is key to building lasting relationships with clients, making each clinician more successful by increasing client satisfaction.