Though not necessarily sensitive, many people mistakenly believe they have sensitive skin because they react to shaving or their acne worsens from pore-clogging ingredients or poor food choices when, in actuality, what they suffer from is sensitized skin. Sensitive skin is not a diagnosis: there are sensitive skin conditions and there is skin that is sensitized. That said, overworking the skin is one of the main reasons it will act sensitive.

Rosacea is usually a constant once it appears. It is characterized by red flushing; small, visible capillaries; watery eyes; and small inflamed bumps; but it can be controlled. Take the necessary steps to treat rosacea before it becomes severe and avoid the triggers that exacerbate it.

If redness and flaking comes and goes, it might be environmental and/or lifestyle-related, such as a skin condition like contact dermatitis, photodermatitis, seborrheic dermatitis, or one of several types of eczema. Autoimmune diseases are becoming more common and often come with skin rashes, severe sun sensitivity, and inflammation.

Dermographism, or skin writing, is an exaggerated skin reaction to scratching or light friction, such as a massive amount of swelling after a few simple extractions. Though frightening to witness the first time, it does not require treatment and disappears on its own because it is part of that person's individual range of normal.

Patch testing is not always accurate because many doctors test for only the 24 most common allergens. Some doctors specialize in this patch testing and may test for over 100 different substances.

Where to Start
Do extensive detective work to determine the probable trigger(s), like addressing sun exposure, fragrances, soaps, products, the weather, chemicals, inflammatory foods, and alcoholic beverages. The client should keep a journal and log exposure to everything by date and time, including what is put in and on the body, stresses, breakouts, stinging, flushing, and bouts of itching.

Firm red nodules, sores, and scaly growths that develop a crust and/or bleed, but fail to improve, should be evaluated by a dermatologist to rule out pre-cancers and skin cancer.

You Are What You Eat
Omega 3 essential fatty acids and vitamin E improve health, strengthen the skin's barrier, and help reduce the inflammation, dryness, and flaking of seborrhea, eczema, psoriasis, and itchy rashes. Clients should eat omega-rich foods, like salmon and other cold-water fish, anchovies, sardines, flax seeds, chia seed, walnuts, seafood, fish roe, spinach, and kale. Supplement dietary intake with flax seed oil, enteric-coated fish oil capsules, and vitamin E supplements. Have clients check with their physician if they take other medications.

Avoid inflammatory foods if autoimmune conditions such as eczema, psoriasis, lupus, and diabetes are a problem. These foods include sugar, dairy, fried foods, refined flour, white rice, vegetable oils, saturated fats, artificial sweeteners, grain-fed meats, artificial additives, lunch meats, refined carbohydrates, white bread, trans fat foods and fast foods, monosodium glutamate, gluten, casein, and omega 6 fatty acids.

Stay Fragrance- AND Dye-Free
Choose fragrance-free products when possible. Perfumes, mixtures of fragrant essential oils or aroma compounds, fixatives, and solvents can be irritating to sensitized skin and very reactive in sunlight.

Make sure all personal care, household, and laundry products say that they are free of perfumes and dyes, unscented, or fragrance-free on the label. Sensitive laundry detergents are often sold in white containers. Stop using chlorine bleach, starch, borax, and fabric softeners. Try chemical-free dryer balls, which are long-lasting, save money, and are environment-friendly.

Look for dermatitis on the side of the face, neck, and body where one sleeps and perspires and anywhere clothing is fitted, tight, or the skin comes in contact with chemical residue from washing powders, liquid detergents, chlorine bleach, additives and fabric softeners.

Clients should not apply fragrances directly to the skin, especially on sun-exposed skin. Do not use sprays like cologne, household cleaners, bug spray, or hairspray as overspray can come in contact with the skin.

Everyday products, including cosmetics, personal care products, soaps, and household products, contain harsh dyes to make them more commercially appealing. Choose colorless products that clearly state they are fragrance-free and dye-free.

Clothes and Bedding
Choose materials made of natural fibers, such as cotton, silk, linen, or a blend of these materials. Chemically-derived synthetic fibers, like polyester, acetate, nylon, modal, and spandex can be occlusive and are more likely to irritate sensitized skin. Despite being natural, wool can feel scratchy, so it is best to avoid it.

Steer clear of fabrics labeled static-resistant, stain-resistant, permanent press, wrinkle-free, or moth repellant because extensive chemical processes are needed to produce the finished product. Because imported textiles are shipped in containers sprayed with toxic pesticides and fungicides, launder all new apparel, towels, and linens in fragrance-free detergent before use.

Minerals and Metals
Sensitivity to mineral makeup can often be blamed on bismuth oxychloride, a synthetically-prepared powder created from bismuth, chloride, and water. Used to blur fine lines and add a pearlescent glow to mineral powders, these tiny crystals must be buffed into the skin, which causes the itching and irritation. Though it is not the only cosmetic ingredient to spell trouble for sensitized skin, it is the most common offender.

Metal allergy is also common and nickel is usually the culprit. While several metals are safe on their own, some are so soft that small amounts of nickel are often added to make jewelry, grommets, buckles, eyeglass frames, and more. Safe metals include titanium, nickel-free stainless steel, surgical-grade stainless steel, 18-karat yellow gold, nickel-free yellow gold, and sterling silver. Choose plastic or titanium eyeglass frames if metal allergy is a problem.

Practice Safe Sun
Sun exposure can cause a rough, swollen, itchy rash called photodermatitis on those who are naturally sensitive to the sun, suffer from an autoimmune disease, or take one or more photosensitizing medications.

Choose physical sun protection formulated with zinc oxide and/or titanium dioxide, which are much less irritating to the skin and eyes than chemical sunscreen agents. Before going into the sun, even for a short time, clients should apply a generous amount of physical sunscreen to all exposed skin. It must be reapplied often, even when exposed to indirect sun, and after swimming, exercising, perspiring, and rubbing with a towel.

Do not be fooled by cloudy skies. The glare that causes people to squint on overcast days confirms the presence of the longer UVA rays. It is these longer, skin-darkening, cancer-causing rays that penetrate the cloud layer and car windows, that cause sun damage. In addition to sunburn and sun rash, the skin can become uneven and blotchy, freckles can multiply, the texture will eventually roughen. Furthermore, skin cancers can form.

Skin Care Products
Eliminate everything except lukewarm water; a gentle low-lather, sulfate-free liquid cleanser; and a fragrance-free cream with a short, simple ingredient deck. Introduce new products one week apart. In the absence of irritation, wean on to mild anti-aging and acne products very gradually and apply very sparingly. To reduce or eliminate stinging, wait at least 10 minutes after cleansing before applying products with active ingredients.

If clients must wash their hands often, advise them to choose a gentle lotion cleanser. Moisturize with a fragrance-free hand cream hourly. Wear latex-free gloves when possible and avoid hand sanitizers that contain alcohol and fragrance.

Use Caution with Acids
Acids found in cleansers and toners can wreak havoc on sensitized skin. Ingredients like glycolic acid, salicylic acid, mandelic acid, and ascorbic acid are added to cleansing products because they exfoliate the skin, help fight breakouts, cut oiliness, and perform other corrective functions. More often than not, tightness, flaking, rashiness, and rebound oiliness are the unwelcome consequences. Sensitized skin will improve dramatically with a gentler approach to cleansing.

Avoid Alcohol
Products containing alcohol, an ingredient that is also known as ethanol, can strip and compromise the skin's barrier and cause over-drying, skin irritation, allergic reactions, and rebound oiliness on sensitized skin. Eliminate astringents that contain alcohol and exfoliants like salicylic acid; instead, mist with a water-based hydrating toner.

It is also wise to limit alcohol consumption. Drinking alcohol exacerbates conditions like rosacea, causes flushing, and dehydrates the body, which compromises the barrier function of the skin.

Protect Skin from Chemicals
When choosing skin care products, make every effort to avoid as many known irritants as possible. Cosmetic ingredients known to cause problems include sulfate surfactants; fragrances; aromatics; masking fragrances; colors additive dyes; and preservatives that include parabens, formaldehyde, formaldehyde releasers, lanolin and its derivatives, and chemical sunscreens.

Use nitrile gloves; vinyl gloves are thick and cumbersome and latex gloves cause skin reactions on too many people to continue using them, even if they are un-powdered.

Gentle Skin Care
Sensitized skin can be treated successfully by tweaking homecare and making simple changes. Modify cleansing and skin care routines during the colder months, in dry climates, and in hard water areas. Non-foaming, sulfate-free cleansers, milder exfoliants, and fragrance-free moisturizers suited to skin type will help restore the glow to compromised skin.

Do not scrub the skin. Cleanse with only the fingertips and blot dry; never rub the face with a towel. Because so many things, including even gentle active ingredients and professional treatments, can cause superficial flaking and peeling, the temptation to speed up the process by scouring off dead skin cells can be irresistible.

Grainy scrubs, baking soda paste, sonic cleansing brushes, spa gloves, buffing pads, loofahs, washcloths, and even towel-drying can spell trouble for sensitized skin. Side effects include redness; burning; prolonged scaling; increased sun-sensitivity; a thick build-up of keratin; and an uneven, blotchy skin tone.

Attempting to scrub off flaking and thickened dead skin will backfire. The body quickly produces a thicker buildup to protect itself, just like calluses form after repeated friction from ill-fitting shoes and pedicure paddles. Once this behavior is discontinued, sensitized skin can improve dramatically.

Hot showers and baths disrupt the skin's moisture barrier and strip natural oils, leaving it dry, exposed, and susceptible to irritation. Help maintain healthy skin by using gentle body washes that will not add to the dryness. Clients should blot the skin dry with a soft towel laundered in fragrance-free detergent and immediately apply fragrance-free lotion while the skin is still damp to lock in moisture.

Hard water can be devastating, especially during the colder months. Filtered showerheads and handheld sprayers can make hard water feel like rainwater, soften skin and hair, and eliminate hard-to-remove lime scale.

Hair Removal
Clients should shave with care. Use a fragrance-free shaving cream or foam and a fresh blade and shave in the direction of hair growth. Do not dry shave, shave with soap, shave too close, or use chemical depilatories.

When waxing, never use hot wax or treat irritated skin. Opt for threading, lukewarm wax, or cold sugaring instead. If ingrown hairs and razor bumps are a constant problem, consider laser hair removal using a Q-switched laser. It is both safe and effective for all skin tones and ethnicities when performed by an experienced technician.

Hydration
Water intake hydrates the skin from within, improves elasticity, plumps fine lines and wrinkles, and helps achieve a healthy glow. When the skin is well-hydrated, it is easier to address dry skin, eczema, seborrheic dermatitis, rosacea, and eczema. Caffeine, alcohol, and smoking dehydrate the skin, so it is best to cut back drastically or stop completely.

Running a cool mist humidifier at night will hydrate the skin and help counteract the drying effects of cold weather, dry climate, heaters, and air conditioners. Clean as directed to prevent fungus and bacteria growth.

Do not overheat homes and avoid heat sources like hot stoves, ovens, hairdryers, fireplaces, space heaters, hot showers, and direct sun.

Approach for the Aesthetician
Skin care professionals should educate themselves about skin conditions like seborrheic dermatitis, eczema, rosacea, psoriasis, contact dermatitis, photodermatitis, and autoimmune disorders. Explore the roles that inflammatory foods, the environment, and chemical irritants play in making matters worse.
Be on a constant mission to identify potential irritants and encourage clients and staff to switch to milder skin care, hair and household products, and explore the many lifestyle issues that challenge those with sensitized skin.

Make sure spa sheets and robes are laundered in detergent that contains no fragrances, dyes, or chlorine bleach. Professionals should be proactive if they use a linen service. Always use fragrance-free back bar, higher-pH lactic acid peels, mild enzymes (without steam), and physical sunscreen. Put hot wax, sonic brushes, steamers, scrubs, strong chemical peels, tightening masks, aromatherapy oils, dermaplaning, and microdermabrasion to the side when dealing with sensitized skin.

Ask questions. Once professionals understand why someone's skin is reactive, along with why they think their skin is sensitive, be prepared. Skin care professionals should have protocols in place and dispense drama-free products so they are able to help sensitized-skinned clients solve their skin problems, not create them.

When it comes to sensitized skin, professionals should always remember that every client is different, nothing is carved in stone, and they will learn something new every day. Still, it is tremendously rewarding to be able to help serve this large under-served group of potential clients who really want to use professional services and purchase products, but usually cannot.

Kathryn Leverette is a licensed aesthetician, acne specialist, and ethnic skin care expert in the San Francisco Bay Area. Her skin care practice, Clinically Clear™ Skin Rehab Center, is dedicated to acne, pigmentation, and ethnic skin.