Sensitive Skin: Causes and Treatments

WebMD Live Events Transcript

Is your skin sensitive? Looking to avoid the redness and itching? Wondering how to deal with it when it happens? Ask for advice from dermatologist Brandith Irwin, MD, author of Your Best Face: Looking Your Best Without Plastic Surgery. She joined us on Sept. 22 , 2004.

This event was made possible through a grant from All Free Clear.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome back to WebMD Live, Dr. Irwin. What are the characteristics of sensitive skin?

IRWIN:
Sensitive skin is really a lay term, not a medical term. It has come to mean people who have allergic or irritant reactions to products mostly, but can also mean sometimes people who develop rashes in response to external environmental things such as plants or foods.

MEMBER QUESTION:
I am a black woman with very sensitive skin. I have had facial hair for over 20 years, which I have in turn picked with tweezers, shaved, and treated with hair-removing creams (Nair, Veet, etc.). What I now have is a lot of black marks from the tweezing and razor burn bumps from shaving. Is there any way I can safely get rid of these marks -- and is there any thing to stop the growth of the unwanted facial hair?

IRWIN:
Let's take those two questions separately. The first problem is really the hair, because it's the hair removal process that's causing the marks. The first thing is to find a reputable laser center in your area that has a GAG laser. This is a laser that is safe to use on African-American skin and they should be able to get the hair removal done safely.

The next question is the dark marks that are being left when you try to pluck the hair. Please see a good dermatologist in your area. There are a number of bleaching creams and peels that can help remove the dark spots left by the hair plucking.

MEMBER QUESTION:
I have incredibly sensitive skin; you barely touch it and it turns bright red. But my main concern is a flushing reaction that I have that starts at about my nipple line and goes up my chest and neck. It can happen under stress or completely without triggers. I have been to so many doctors, but they all say they've never seen it before. I tested negative for carcinoid. It's been happening for over 10 years and it's incredibly disruptive in my personal and professional life. Any thoughts would be appreciated.

IRWIN:
As long as you've been thoroughly evaluated by a good endocrinologist and you're sure there's nothing internal causing the flushing, the best solution for flushing is a type of laser cousin called an intense pulse light. These work best on the face but can also be helpful on the neck and chest. I would consult your nearest reputable laser center. Please always look for one that is doctor owned and supervised, not a commercial "McLaser" center.

Also, there are medications called beta-blockers. The one I usually use is Inderal. These can be taken in small doses about an hour before presentations or stressful situations and can help to prevent the flushing that occurs under stress. Talk to your doctor about those.

"The best solution for flushing is a type of laser cousin called an intense pulse light. These work best on the face but can also be helpful on the neck and chest."

MEMBER QUESTION:
What are some of the main triggers for sensitive skin? When I get a red reaction, what should I be checking out first? I try not to change facial soaps or shampoos. What else might be a problem?

IRWIN:
Have you been evaluated to see if you have rosacea? It may not be an allergy or sensitive skin, but rosacea instead. If you're pretty sure it's environmental, it takes some detective work to figure out the cause. Usually I recommend eliminating everything that goes on your face except water, Cetaphil liquid cleanser, and cream. Once you're clear for about two weeks, then try adding your regular products back one at a time about a week apart.

Also eliminate any sprays you might be using, including perfumes, cleaning sprays, hair sprays, etc. Also consider that it may be your shampoo, conditioner, detergent, and please just eliminate your fabric softener; those are often a problem. Go with a detergent with no fragrance, no whiteners, like All Free Clear, Tide Free, or Cheer Free.

MEMBER QUESTION:
The redness comes and goes. It feels like it's stinging/burning when it is red -- and dry, too.

IRWIN:
It sounds like a type of eczema, but you really need to see your dermatologist. There are so many kinds of eczema; it's impossible to evaluate over the web.

MEMBER QUESTION:
I've had a dry patch on the side of my chin, below my mouth for a couple months now. I've been getting this rash for a couple years now, but it comes and goes. I've been told I'm allergic to fluoride and also that it's eczema. But it doesn't itch, and it just basically looks like a dry patch of skin. But I can't get it to go away. Any ideas of what it is or how I can get rid of it? I've used cortisone on it, but it doesn't seem to help.

IRWIN:
My concern would be this is maybe not eczema and is either a precancerous lesion or perhaps early skin cancer if it really has been there that long. You really need a dermatologist to look at this, or if you have had someone look at it, maybe a different dermatologist.

MEMBER QUESTION:
Can a dermatologist determine if dryness and redness are an allergy or something else? What is the procedure?

IRWIN:
Yes, I can often determine if there's an allergy through the history and physical examination, but if it isn't clear after doing that there is a procedure called patch testing. This is different than the allergy testing that allergists do. Small amounts of different substances are placed on the back and left for two to three days and then the tests are read, looking for allergic reactions. There is a system called the true test, which many dermatologists have. It tests for the 24 statistically most common allergies in skin. Then in most cities there is also a dermatologist who specializes in patch testing, and he or she often has a hundred different substances they can test for.

MEMBER QUESTION:
I'm an Asian American and have suffered from moderate acne for a few years now. I had tried different types of skin care products both from over the counter to a dermatologist's recommendation but it didn't help. I have redness on my cheeks (not due to acne) due to using some type of chemical that a not-so-good friend gave it to me. I used to have really fair, nice skin. Is there anything I can do to get rid of the redness and acne on my forehead and chin?

IRWIN:
It sounds like to mere there are two problems: the redness you think was due to the cream your friend gave you, and the acne. As for the cream, your skin will repair itself in about 30 days after a mild skin injury as long as you don't keep re-injuring it. Make sure you're using very bland skin care products only, like Cetaphil, for about a month. Don't use any glycolic acid, vitamin A, or vitamin C products for about 30 days if you've had a lot of irritation from a cream. Just let your skin rest for a month and see if it doesn't get better on its own. If not, see your dermatologist.

As for the acne, there are four different types. Without seeing you it's very difficult to know what to do. It sounds like your face does not respond well to topical agents, in other words creams and agents. It may be that oral contraceptives might help, or if you have cystic acne, or scarring, then Acutane.

"Don't use any glycolic acid, vitamin A, or vitamin C products for about 30 days if you've had a lot of irritation from a cream."

MEMBER QUESTION:
My skin reacts to cold weather by getting very red and flaky. Since I can't control the weather, what can I do?

IRWIN:
First, make sure you're not overly drying or irritating your skin with the products you're currently using. You want nondrying cleansers and lots of moisturizer. If you're very dry you may need to apply the moisturizer three or four times a day. Also, if you live where it's very cold, protect your face from the wind and cold with a face mask when you're outside. Other than that, what you may think is dryness may be eczema, and you need to see your dermatologist.

MEMBER QUESTION:
I have been having problems with red patches that I get on my arm. Any time I rub my arm on something it gets really red. My face is the same way; I blow my nose and around my nose it gets red and throbs and when I yawn around my mouth gets red. And shaving? Look out. Any ideas?

IRWIN:
Sounds like you might have what is called dermatographism, which is fairly common. The way you know you have it is to take the end of a pen and write three letters firmly on your back. If it puffs and gets red and you can see the writing, you have dermatographism. What this means is you're very sensitive to physical touch because mast cells in your skin release histamines at the slightest touch. The histamine causes the redness. Usually this is just an annoying problem but is not itchy or painful. Again, you might want to see your doctor to talk about antihistamines if it's really bad.

MEMBER QUESTION:
When I wash my face with a cleanser that has acids, my skin turns red for about 15 minutes or so afterwards. Then it goes away. I am told the acids are good for my skin. Am I doing any real harm?

IRWIN:
As long as it doesn't persist, probably not.

MEMBER QUESTION:
What is the least irritating fabric for sensitive skin?

IRWIN:
Try to use natural fabrics like cotton and silk that breathe easily.

MEMBER QUESTION:
I have just been told I have hypothyroidism and anemia. My skin is so dry I can peel it. Will this improve now that I am on meds?

IRWIN:
Yes. But it takes about two months.

MEMBER QUESTION:
Are there ways to prevent allergic hives I get on my mouth and around my eyes? Seems to be an environmental reaction, but maybe it's a product I'm unaware of.

IRWIN:
It's probably a product you're using. See my first answer about how to be a detective on your own.

"If you try new products, try one at a time a week apart, so if you have a problem you know which one it is. And see your dermatologist if the problem persists."

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