The goal of this article is to offer practical information, tips, and advice on how to handle sensitized skin. It will review the difference between and characteristics of the sensitized skin condition and the sensitive skin type. It will also establish a set of diagnostic questions for determining if the client’s skin is sensitized or sensitive, as well as provide a list of possible irritants. The article will offer guidance for addressing the sensitized skin client’s concerns and will establish treatment room and homecare protocols. THE SENSITIZED SKIN CONDITION AND THE SENSITIVE SKIN TYPE Let’s explore the sensitized skin condition and the sensitive skin type to ensure a thorough understanding of the difference between the two. A professional’s confidence will reassure the client to feel confident in the diagnosis and treatment recommendations. Sensitized Skin Sensitized skin is a skin condition resulting from the skin being exposed to an irritant (internal or external), as opposed to the inherent characteristics of the skin. Sensitized skin occurs when the skin is subjected to something irritating, such as too much sun (sunburn), too much wind (windburn), strong chemical peels (impaired barrier), certain medications (sun sensitivity), harsh, high pH soaps (impaired barrier), harsh cleaning products (impaired barrier), harsh laundry detergents and bleach (impaired barrier), and so forth. It is important to note that sensitized skin will resolve itself to a normal state once the irritant is eliminated and the skin is given the proper care needed to calm and repair the skin’s barrier. Sensitive Skin Sensitive skin is a skin type shared by at least 50% of the United States population and, therefore, very common. Sensitive skin is most often characterized by high reactivity and low tolerance to most irritants and stimuli from both internal and external sources. Sensitive skin is not caused by contact or reaction with any specific ingredient or material; rather, it is an established state of the skin’s inherent structure, nerve sensations, and inflammatory response. Sensitive skin is most often linked to one or more of the following characteristics: a systemically impaired barrier, a high neuro-sensory response, or chronic inflammation (frequently caused by heightened immune response). Characteristics Now, having distinguished between the sensitized skin condition and the sensitive skin type, let’s go a little deeper into the characteristics of sensitized and sensitive skin. Sensitized skin manifests itself with many of the same characteristics as irritated or reactive sensitive skin: redness, itching, burning sensations (especially with product application), rashes, swelling, excess dryness, rough patches, flaking, hives, and red raised patches. Please note that sensitized skin can occur regardless of skin type or condition. Sensitive skin is generally characterized by thinner skin (most common in those of northern European ancestry), which by its nature has smaller sebaceous glands and, therefore, predisposes one to dryer skin. Thinner, dry skin is prone to having an impaired barrier function and the skin becomes open to irritation and invasion by bacteria and viruses. Sensitive skin tends to have more nerves present in the stratum corneum, so by its very nature it is more sensitive to stimuli than skin with a normal number of nerves in the stratum corneum. People with sensitive skin are also likely to have a heightened immune response, which, when combined with an impaired barrier or heightened neuro response, can lead to chronic inflammatory skin conditions such as rosacea, eczema (atopic dermatitis), and psoriasis. DIAGNOSIS AND DIAGNOSTIC QUESTIONS Sensitized skin and the sensitive skin type can appear the same. So, what is an aesthetician to do? The best way to determine if someone has sensitized or sensitive skin is to play detective. Remember, sensitized skin is caused by an event or series of events, sensitive skin is something the client is born with. Sensitized skin can come about because of exposure to any number of irritants. Sensitive skin is something the client has been dealing with for life, to one degree or another. A thorough intake form and client interview are an important part of every skin care practice. Below is a quick list of common questions to help distinguish between the sensitized skin condition and the sensitive skin type. Describe in detail (using product names) how you are presently caring for your skin? (It may be helpful if they bring current homecare products to the initial consultation.) What specific skin problems are you now experiencing? How long have you had this skin condition? When did you first notice it? Describe what type of skin your parents have or had? Do you use prescribed internal or oral medicines for skin conditions or medications that might affect your skin? Do you use prescribed topically applied skin products? Do you use over-the-counter vitamin A (retinols or related)? Do you use alpha hydroxy acid or beta hydroxy acid products? Do you blush easily? Do you sunburn easily? Do you have a redness tendency? Do you have sinus problems? Do you have any allergies? Do you have rosacea? Have you recently had any of the following: chemical peels, laser treatments, dermabrasion, microdermabrasion, or any aggressive resurfacing treatment? Do you have eczema or psoriasis? Generally, a thorough intake form and client interview, coupled with the aesthetician’s experience and knowledge, will yield a sound diagnosis and identification of the cause of the sensitized skin. Below are various possible irritants that can cause or exacerbate sensitized skin. The list is not exhaustive, but it is a good start. Environmental irritants can include: excessive sun exposure, extreme heat or cold, allergens, junk food, smoking, pollution, harsh laundry detergents, and too many alcoholic beverages. Chronic stress is a factor that should not be underestimated, as it affects the skin directly and also the client’s ability to manage their homecare. Aggressive skin care protocols and treatments, such as microdermabrasion, aggressive peels, scrubs, high pH bar soaps, scrub brushes, and any treatments or products that severely compromise the skin’s barrier, can lead to sensitized skin. Product ingredients that can cause or further irritate sensitized skin include: artificial fragrance, artificial colorants, essential oils, sodium lauryl sulfate, sodium laureth sulfate, alcohol, alpha hydroxy acids (with a pH below 4.5), or beta hydroxy acids (with a pH below 4.5). In cases where the irritant is not quickly identified and is, therefore, elusive, client journaling is often the next advisable course of action. ADDRESSING THE SENSITIZED SKIN CLIENT’S CONCERNS Remember, the client is likely traumatized by what is happening to their skin, so when addressing their concerns, be confident but also empathetic. Please realize that they may have been down this path before, so the professional may need to reestablish trust when it has been lost before. Be compassionate, be confident, and provide anticipatory guidance to the client as to the timetable and the process. Share the good news about sensitized skin – it can be calmed and repaired. Let the client know the timeline and that the process is to calm the sensitized skin and then to help it repair itself. Recovery is dependent upon the severity of the reaction, how quickly the cause of the irritation is removed, and how diligent the client is in following a protocol that will calm and repair the barrier of the skin. While it can take anywhere from several days to several weeks for the skin to return to a normal state, the prognosis is the client’s sensitized skin will recover. Fundamentally, most professionals recognize that the body and its skin are extremely resilient when well treated. Clients are likely to naturally understand the protocol of calming, comforting, nourishing, feeding, repairing, and fortifying the skin barrier. CALMING AND REPAIRING THE SKIN BARRIER IN THE TREATMENT ROOM The most important thing aestheticians can do in treating sensitized skin is to have their clients eliminate the irritant that caused the sensitized condition and recommend products that will calm and repair the skin barrier. A client’s compliance with this and consistent homecare is critical to strengthening the natural barrier and returning the skin to a normal state. A note of caution to manage client expectations: please remember to be clear with the client at what point the condition is manageable through aesthetic practices and at what point temporary medicinal solutions should be sought in order to return the skin to an aesthetically manageable level. The below in-clinic and homecare protocols are outlines only. They will need to be modified depending on the severity of the sensitization of the skin. For instance, some skins may be too irritated to apply product along with excess water. In such cases, the professional may find it necessary to use more product than water and gently remove the product with a damp 100% cotton four by four or extremely soft, damp microfiber towel. When dealing with sensitized skin, it is especially important to let the client know what is being applied and check in on how the client is tolerating the product during treatment. The one through 10 scale method is often the simplest. For example, “On a scale of one through 10, with one being no tingling sensation and 10 being uncomfortable, how does your skin feel?” If they are experiencing tingling, ask, “Is the sensation increasing or decreasing?” This will guide you on how to move forward with the facial and help recommend appropriate homecare. The following protocols for treating sensitized skin focus on calming, comforting, nourishing, feeding, repairing, and fortifying the skin barrier. Focus on products that utilize nutritious plant oils, vitamins, mineral-rich clays, gentle botanicals, and protective zinc oxide or titanium dioxide to meet standards for calming, nourishing, repairing, and ultimately protecting the skin. Basic In-clinic Treatment Protocol Cleanse to remove makeup. Apply an unscented, calming cleansing oil to the client’s skin. Perform a cleansing massage, adding product as needed. Gently remove the cleanser using the press and pickup method with a lukewarm microfiber towel or damp 100% cotton four by fours. Apply an unscented, calming cleansing oil or gentle, cleansing cream to the client’s face, neck, and décolleté. Perform a gentle, hydrating, cleansing, and relaxing massage for 10 to 15 minutes, adding product as necessary to maintain slip. Gently remove the cleanser using the press and pickup method with a lukewarm microfiber towel or damp 100% cotton four by fours. Apply a calming, nutrient-rich oil serum (unscented) to the client’s face, neck, and décolleté by gently pressing product into the skin. Perform a pressure point massage to encourage lymphatic drainage for approximately 10 minutes. Remove excess oil with a damp 100% cotton four by four. Apply an unscented, rich, calming, cream mask to the client’s face, neck, and décolleté with a fan brush. Allow the mask to sit for 10 to 12 minutes. Gently remove the mask using the press and pickup method with a lukewarm microfiber towel or damp 100% cotton four by fours. Apply an unscented zinc oxide or titanium oxide SPF 30 sunscreen. Chemical sunscreens are not advisable for sensitized skin. Please note: The duration of the facial may need to be reduced, depending on the state of the skin. If the skin is severely sensitized, less is better – less product, less time. Let visual cues and the client’s reaction be a guide. Also note, steam is not advisable when treating sensitized skin. Wet skin is much more permeable than dry skin, therefore, the steam coupled with products can cause further irritation. CALMING AND REPAIRING THE SKIN BARRIER THROUGH HOMECARE The client’s reaction or lack thereof during the in-clinic treatment will be the basis for what should be sent home with them. Basic is best for sensitized skin, as outlined as follows. Basic Homecare Treatment Protocol The client should cleanse twice daily with an unscented, calming oil cleanser. Have the client use their fingertips to cleanse the skin – no washcloths, scrubbing devices, or brushes. They should remove the cleanser with lukewarm water and pat dry. Twice daily, the client should gently press a calming, nutritious oil serum (unscented) into the skin. Note, in certain cases, it may be advisable to apply the calming, nutritious oil serum many times throughout the day for maximum benefit. The client should moisturize by applying an unscented, calming moisture cream twice daily. The client should protect their skin with an unscented zinc oxide or titanium oxide SPF 30 sunscreen. Chemical sunscreens are not advisable for sensitized skin. Sensitized skin can be challenging, sometimes even daunting, for aestheticians and clients alike. However, the body and its skin are extremely resilient when well treated. Armed with the correct knowledge, skill, products, and compassion, it is possible to offer relief to these often-traumatized clients, which is extremely rewarding for the professional and the client. Michele Corley is the founder and CEO of Michele Corley Clinical Skin Care, a nationally-distributed, premium, professional-use-only skin care line based in Napa, California. Corley’s mission is simple: to provide efficacious products that deliver superior results and to back it up with exceptional customer service. Every Michele Corley Clinical Skin Care product is crafted with care and consideration to the health and well-being of the skin. Corley believes her clients’ success is as important as her own and values everyone she has the pleasure to work with. She loves to say, “If my clients are successful, so am I.” Want to read more? Subscribe to one of our monthly plans to continue reading this article.