Sensitive Skin’s Level of Cognitive needs Promotion

Sensitive skin refers to a highly reactive state of the skin under physiological or pathological conditions, mainly occurring on the face. The incidence rate of it is high in all countries around the world, and the incidence rate reported by each country is quite different. Its occurrence reason is complex, occurrence mechanism is not complete clear, easy relapse, and serious influence patient life quality. The diagnosis of sensitive skin is characterized by subjective symptoms such as burning, stinging, itching and tightness, rather than objective signs. In the past, the concept of sensitive skin was unclear, misdiagnosis or missed diagnosis was common. And the treatment was unreasonable. Therefore, it is necessary to improve the cognitive of sensitive skin.

1.Accurately grasp the definition of sensitive skin

In the past, people were not clear about the sensitive skin. Some people believed that it was a natural condition of the skin, and no medicine should be applied to treat it, leading to the development of more serious skin diseases such as allergic dermatitis. Some people think it’s a skin disease. But dermatosis is an abnormal life activity process of skin due to the disturbance of self-stabilization and regulation under certain pathogeny. It can cause a series of metabolic, functional, and structural changes that manifest as symptoms, signs, or behavior abnormalities. And early sensitive skin may be a stress response that the body makes to adapt to the environment, and can spontaneously fade in a short time. Obviously it is not scientific to regard it as a skin disease. Consensus science explains the definition of sensitive skin, emphasizing that its essence is the skin’s hyperreactive state.

2.Deeply understand the cause and mechanism of sensitive skin

The cause of sensitive skin is complex and has been considered as an allergic skin disease in the past. Glucocorticoid hormone preparations are often applied externally during treatment. Instead of solving the original problem, it aggravates the damage of the skin barrier, and leads to new skin diseases such as hormone-dependent dermatitis, resulting in low cure rate and easy relapse of sensitive skin. The consensus systematically states that it is a skin condition induced by various individual factors (Such as genetic, age, sex, hormone levels and mental factors) and external factors (Such as sun exposure, haze and other physical, chemical, iatrogenic factors) on the basis of a certain genetic background. It provides theoretical basis for avoiding inducement and scientific prevention and treatment. According to the pathogenesis and correlation of each mechanism, the damage of skin barrier is considered as the basis of the occurrence of sensitive skin and is correlated with telangiectasia, immunity and inflammation. This further explains that sensitive skin is a complex process involving the skin barrier – nerves, blood vessels – immunity and inflammation.

2.1 Sensitive skin barrier damage and high temperature

Low temperature and histamine release interact with each other and cause each other. Changes in skin infrastructure, reduction in ceramide content, and imbalance of lipids between cells in the cuticle are important causes of skin barrier damage. Both high and low temperatures can delay skin barrier repair. Histamine can inhibit the final differentiation of keratinocytes and affect the skin barrier function.

2.2 Damage to the skin barrier causes sensory nerve dysfunction of sensitive skin

Damage to the skin barrier causes the epidermis to weaken the protective ability of the skin nerve endings, directly causing burning, stinging, itching and tightness.

3.Improve the understanding of the clinical features and diagnostic criteria of sensitive skin

Clinically, sensitive skin is diagnosed only based on objective signs such as erythema, papules and telangiectasia, but a large part of sensitive skin does not have these signs. The consensus clearly indicates that subjective symptoms such as burning, tingling, itching and tightness are the basic clinical features of sensitive skin. Objective symptoms such as flushing, erythema, telangiectasia and scale, subjective, semi-subjective and objective evaluation methods can only be used as a reference for auxiliary diagnosis. The subjective evaluation was done using questionnaires and semi-subjective evaluation of lactate tingling test. Objective evaluation of noninvasive skin physiological indicators, local blood flow velocity and histogram of blood flow distribution are commonly used.

There has been no definitive diagnosis of sensitive skin, often confused with allergic dermatitis. It is also thought that sensitive skin is an early manifestation of rose acne. Clinically, some or all symptoms or signs of sensitive skin can be seen in patients with acne, hormone-dependent dermatitis, contact dermatitis, atopic dermatitis and other diseases in the early stage. This leads to misdiagnosis and missed diagnosis. The consensus has clearly defined the diagnostic criteria for primary sensitive skin. To replenish the diagnostic criteria for secondary sensitive skin, that is to say the subjective feelings such as burning, tingling, pruritus and tightness, etc. occur during the development of other skin diseases or under the stimulation of external factors, but cannot be explained by primary diseases. In the process of diagnosis, clinicians should grasp the essence according to the consensus and identify whether sensitive skin is primary or secondary, which is of vital significance for treatment.

4.Pay attention to the treatment of sensitive skin

Due to the unclear mechanism of occurrence, the previous treatment of sensitive skin is often not standard, resulting in low cure rate and easy to relapse. The occurrence frequency and severity of sensitive skin is variety, and the treatment is based on avoiding various inducing factors and restoring the skin barrier. The consensus establishes the general treatment principles for primary sensitive skin according to the pathogenesis. However, individualized management mode should be adopted to select corresponding treatment methods for different causes, different populations, different degrees and associated symptoms to avoid inducing factors. Whether it is primary or secondary should be confirmed before treatment. Primary may be treated according to the principles of consensus. The secondary disease should be treated according to the principle of the primary disease based on the treatment of primary disease.

4.1 Recover the sensitive skin barrier

The key to recover skin barrier is to select medical skin care products which have been tested and clinically verified with good safety, repair skin barrier and soothing function. Silicon dioxide and bicarbonate, green thorn fruit oil and purslane in natural spring water all have natural soothing, anti – stimulation and anti – inflammatory effects. Hyaluronic acid is an intercellular component that can recover skin barrier function. Sensitive skin is often resistant to ultraviolet light due to damage to the skin barrier. When going out, use medium or high sun protection lotion. But we should pay attention to that when acute phase inflammation reaction is heavy we should not use sunscreen.

4.2 Physical therapy is fundamental of sensitive skin treatment

Physical therapy such as cold spray, red and yellow light and intense pulsed light can effectively relieve patients’ discomfort and constriction and dilatation of blood vessels. Combined use of yellow light and cold super technology to improve sensitive skin can have better effect. Intense pulsed light and radiofrequency should be used on the basic of recovering the skin barrier.

4.3 According to the severity of patients to select appropriate drugs for sensitive skin treatment

patients with obvious stinging, burning, tension and itching can take antiphotosensitive drugs (such as hydroxychloroquine hydrochloride), antihistamines drugs (such as loratadine tablets), nonspecific anti-inflammatory drugs (such as compound glycyrrhizin), and appropriate external use of calcineurin inhibitors (such as tacrolimus cream, pimelimus cream). The patients with anxiety and depression can take fluoperthixate hydrochloride/melikoxine hydrochloride orally at their discretion.

5. Pay attention to unresolved problems with sensitive skin

Much things remain to be done in basic and clinical research on sensitive skin for example to clarify the prevalence of sensitive skin in China. In particular, the incidence of different regions and different ethnic groups and related factors, inducing factors. Then conduct the research about molecular mechanisms and susceptibility genes; identify key targets in the pathogenesis and develop new therapeutic drugs such as the treatment that inhibits the activity of TRP ion channels. Defining the severity of sensitive skin is critical to treating sensitive skin. How to use subjective sensation, subjective, semi-subjective and objective indexes to systematically evaluate the severity of sensitive skin is an urgent problem to be solved.

In conclusion, sensitive skin is common in China, and basic and clinical research should be strengthened to comprehensively improve the prevention and treatment of sensitive skin.