SENSITIVE SKIN TYPES
Skin is a reactive mechanism that responds to internal and external factors like the environment, foods, medications, and cosmetics. Some individuals are more sensitive or reactive to these elements.
In my many years of working with skin, and being someone who is more sensitive to substances, I have observed that most sensitive skins are reacting to inferior products or those that contain dyes, preservatives, and perfumes. Often, when these three antagonizers are eliminated, the skin begins to calm.
Truly sensitive skin reddens and develops rashes easily. Where all skins are affected by outside influences like pollution, smoking, sun, or wind, sensitive skins will overreact. This skin type tends to be thinner and more prone to surfaced or distended capillaries. Thus, the approach for treating this skin will differ slightly, but in most cases, rejuvenating, exfoliating treatments tend be ideal supports. This is because exfoliation causes stimulation at the basal cell, resulting in new, healthy cells. As these new cells surface, skin integrity is improved, becoming less irritated and reactive. Skin renewal also thickens the skin, reducing some of its fragility.

PEELING SENSITIVE SKIN
It is a misnomer that chemical peels do not mix well with sensitive, rosacea, or pigmented skin types. With a clear understanding of acid solutions and the various levels of superficial chemical peels, most skin types respond well to these types of procedures. In fact, peels will generally have a very positive effect. Skin peels deliver considerable improvements to even the most sensitive skins, but a safe and successful peel depends on four things: knowledge, the selection of fresh, quality ingredients, the ability to read the skin, and the client’s compliance. As with any chemical peel, there are a few general rules of thumb to which to adhere.

Always:

• Undergo appropriate training.
• Complete a skin assessment and skin history on the client.
• Perform a patch test at least 48 hours before treatment.
• Send the client home with care instructions.
• Take before-and-after photographs to track progress.
• Manage the client’s expectations prior to starting a program.

Never:

• Perform a peel on the client’s first visit.
• Administer a peel on a client using retin-A or accutane.
• Conduct a peel if a client has received Botox or another injectable procedure the same day.

APPROACHING SENSITIVE SKIN
When creating a corrective treatment plan for sensitive skin types, the intensity of the treatment and formula used make the difference. Skin care professionals should begin with a less aggressive approach, using lower-strength acids and a low-intensity treatment.
A series of progressive peels is a great way to strengthen skin integrity and desensitize the skin, bringing it to a less reactive state. Progressive peels are typically the mildest course of treatment and do not usually cause immediate exfoliation as they only remove the stratum corneum. Repeated treatments will create mild sloughing with cumulative effects.
Today, there is a wide variety of formulas ranging from those strictly for medical use and those for aesthetic. For skin care professionals working with sensitive skins, knowledge of the types of agents available is essential. While duration, Fitzpatrick classification, and technique all play a role in determining peeling depth, the peeling agent used is one of the most important factors of a peel.
In aesthetics, we must follow self-imposed boundaries and always work within the superficial layers of skin. Avoid medical peeling agents; they are medical for a reason and generally create deeper chemical peels that require longer healing times, greater depth, and have greater potential for complications.
Sensitive skin types typically do not tolerate alpha hydroxyl acids as well as they do beta hydroxyl acids and retinol. Introducing lower-strength alpha hydroxyl acids with enzymes, instead of high-strength alpha hydroxyl acids, will assist in smoothing down the stratum corneum, allowing regeneration to begin. This may be followed with lower-strength retinols and beta hydroxyl acid peels.

PEELING AGENTS FOR SENSITIVE SKIN
Aesthetic peeling acids certainly come with their cautions and require study and training. Some solutions that work well with sensitive skins include:

• Azelaic Acid – Created by oxygenating oleic acid, it is an unsaturated fatty acid found in milk fats. This is used as a lightening, lifting, and antibacterial agent.
• Salicylic Acid – A beta hydroxy acid extracted from wintergreen and birch. It is a relatively safe, low-risk acid, as it is self-neutralizing and produces a drying and lifting effect. Repeated applications in high-strength doses can result in systemic toxicity.
• Flower Acids – These are classified as second-generation alpha hydroxyl acids because of their ability to increase cell turnover without irritating the skin and they provide more hydration than lactic acid. These work very well for all skin types, including hyperpigmentation, rosacea, and impure skins. They also work well in tandem with other acid formulations.
• Mandelic Acid – This is found in almonds; it is used as an antiseptic for its antibacterial activity. It is highly supportive for acne conditions and beneficial in treating irregular pigmentation. It is generally more tolerable for most skin types.
• Retinol – A vitamin A derivative that converts to retinoic acid and is a DNA regulator. It assists in the synthesis of collagen, aids in the formation of blood vessels, and encourages healthy cell formation.
• Jessner and Red Wine Vinegar Acid (acetic acid) – Jessner is a combination of lower-strength acids (salicylic, resorcinol, and lactic, all at 14 percent), which synergize to produce an efficient exfoliating agent with less risk. Red wine vinegar (acetic acid) is an all-natural acid with high antioxidant content. Some studies have shown it to produce exfoliation with less free radical damage, thus causing less injury to the skin.
• TCA (trichloracetic acid) – This will penetrate only if used in an aqueous base. It is nontoxic, self-neutralizing, keratolytic, and is very effective in low strengths. It can be used alone or in tandem with other acids.

Acid blends like trichloracetic acid, lactic and salicylic acids, L-ascorbic and azelaic acids, or enzymes are also great options for skin with sensitivities. Enzymes, when used alone, fall into the progressive range of skin rejuvenation. Blending enzymes with acids and other treatments will provide a deeper preparation and begin the skin rejuvenation process.

TAKING ON THE SENSITIVITIES
From rosacea to acneic, dry, and even men’s skin, there are a variety of sensitivities of which to be cognizant, and specific treatments will perform better for different conditions. The good news is that chemical peels contribute in bringing each of these skin types back to health.
Men’s skin, though very similar to women’s, tends to be more sensitive. Some primary reasons for this is their skin has not been tempered with like women’s has, who start using skin topicals and corrective ingredients at a younger age, as well as a lack of care, drying soaps, environmental exposures, and, of course, shaving.
Shaving overall causes the skin to be more sensitive to topicals and creates patches that become tender and irritated. Additionally, if they shave the day prior to treatment, less solution will be required around the shaved area. Oftentimes, depending on their skin, it is recommended they refrain from shaving two days prior to a peel, and three to four days following the peel.
Though rosacea and hyperpigmentation are not classified as sensitive skin, they do require special handling. The focus is to reduce inflammation and add supportive and soothing elements like epidermal growth factors, marine-based ingredients like thermus thermophilus ferment, and sea buckthorn oil, to name a few.

REDUCING THE RISK
When working with a client with sensitive skin, the key is to reduce the risk. Always start with a skin assessment. This will allow the professional to determine what, if any, medications and active topicals they are using, what procedures they have recently had (including waxing), and if they have any skin allergies. Always conduct a patch test prior to working with a new client or rendering a new treatment on a returning client. It is a simple, yet crucial step and one of the best defenses against allergic reactions.
During the treatment, constantly observe the skin closely. Catching a complication early on will be much easier to treat than one that has escalated, but keep in mind this can happen very quickly.
If a client experiences a reaction, it is essential not to panic. Stay calm, remove everything from the skin, and remind them to stay calm as well. With skin reactions, less is always more. The common thought is to put more on the skin to calm it down, but it actually increases the irritation. Just in case, have tools, ingredients, and formulas like hydrocortisone and willow herb, on hand to correct complications.
I remember listening to a lecture by a plastic surgeon more than 30 years ago in New York, and what he said has always stayed with me. “Never do a peel that you cannot treat the complications of that peel.” His point was that complications may and will occur. It is skin care professional’s responsibility to know what to do. Do not let the fear of complications deter you from working with sensitive or reactive skin types. There are a number of excellent skin rejuvenation choices for reactive skin types that will support and enhance the health and appearance of the skin – just be sure to know the acids with which you are working, understand the client’s skin, and have preventative measures in place to reduce risk.

Rhonda Allison, a pioneer in the skin care industry, is the founder and CEO of Rhonda Allison Cosmeceuticals and RA for Men. She is also an author and internationally known speaker with more than 30 years’ of aesthetic experience.