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Author: Natalia Korneiko, cosmetologist K é raskin Esthetics (Kiev)<hr /> The concept of “sensitive skin” is interpreted completely differently today. Despite the fact that we talk and write a lot about sensitive skin, we have not yet been able to formulate clear postulates, because we do not have clear criteria by which to accurately diagnose a patient’s sensitive skin condition (as, for example, with atopic dermatitis). . Therefore, the diagnosis of “sensitive skin”, as a rule, is often subjective. However, more than 38% of Europeans consider their skin to be sensitive; for a number of people, skin irritation when using cosmetics is a manifestation of an allergic reaction to a particular ingredient. So one of the signs of sensitive skin can be called increased skin tolerance to toxic substances in combination with its increased reactivity. Factors that provoke skin reactivity There are endogenous and exogenous factors to which the skin reacts. Endogenous factors include: disruption of barrier function (transepidermal water loss, modification of intercorneocytic lipids) and neurogenic changes (features of sensitivity of nerve endings, peculiarities of skin innervation). Exogenous factors include: lifestyle (spicy food, alcohol, coffee, smoking), environmental factors (UV radiation, cold, heat, wind, pollution), aggressive cosmetics, shaving. The barrier properties of the skin are mainly provided by the epidermis. A special role here is played by the stratum corneum, on the surface of which a delicate balance is established between the water content in the stratum corneum itself and in the environment. To maintain normal moisture in the stratum corneum, there are highly specialized and uniquely organized intercellular lipids (ceramides, cholesterol, fatty acids, as well as phospholipids, glycosylceramides, free sphingoid bases, cholesterol sulfate, etc.). They form the main barrier to moisture, thereby preventing its transepidermal loss, and play the role of a special intercellular cementing substance that provides adhesion strength to the postcellular structures of the stratum corneum and ensures the integrity of the skin. Six major classes of so-called free, non-corneocyte-associated ceramides and two major classes of ceramides covalently associated with the corneocyte surface have been described. The functions of ceramides include not only the retention of water in the skin, but also the regulation of the rate of desquamation, as well as the influence on the differentiation of keratinocytes. The formation of a water-lipid mantle on the surface of the skin is also one of the mechanisms that ensure its barrier properties. The composition of the water-lipid mantle includes sebum, the secretion of sweat glands, as well as lipids of the stratum corneum. The barrier properties of the skin are disrupted due to a decrease in the amount of lipids between the horny scales in the stratum corneum, which is one of the reasons for its increased sensitivity. This is possible with the constant use of aggressive detergents and with a number of dermatoses (rosacea, eczema, atopic dermatitis, etc.). Clinical signs of sensitivity All identified clinical signs of sensitive skin can be divided into objective and subjective. Subjective signs include patient complaints of burning, a feeling of skin tightness, itching, and tingling. At the same time, determining the intensity and nature of these complaints is often quite difficult. Objective signs include dryness, redness of the skin, the presence of dilated blood vessels (rosacea), peeling, etc. These phenomena are always clearly visualized and can be easily assessed qualitatively and quantitatively using modern skin diagnostic methods. Today there are many classifications of sensitive skin, but for a cosmetologist, in our opinion, the most convenient division is into three types :<ul><li> skin prone to hypersensitivity reactions (seborrheic dermatitis, rosacea, mixed rosacea, deficiency of polyunsaturated fatty acids, etc.);</li><li> skin with reduced tolerance (irritated, damaged);</li><li> skin with signs of increased reactivity (allergy, atopy).</li></ul> As a result of skin damage with seborrheic dermatitis or rosacea, its sensitivity increases. Increased skin sensitivity is one of the manifestations of hereditary enzymopathies. A lack of unsaturated fatty acids occurs when their absorption is impaired due to a lack of lipases, fatty acids in food, and dysbacteriosis. In this case, dryness, peeling, hyperemia, and irritability of the skin may occur. Irritable skin is characterized by a constant internal readiness for irritation. At the same time, subjective complaints are richer than the clinical picture. This is a feeling of tightness, tingling, and clinical manifestations may be absent. Pathogenetically, this is an inflammatory reaction in its pure form, without an immune component. Irritated skin is sensitive skin that reacts to environmental factors: mechanical (epilation, shaving), chemical (detergents, cosmetics), as a result of acne treatment (drying agents, keratolytics). Clinically characterized by a feeling of tightness, tingling, redness, peeling, and roughness. Sensitivity = rosacea? Sensitive skin is one of the factors in the development of rosacea. Cuperosis is a disorder of blood circulation in the skin due to dilation of blood vessels and loss of their elasticity. Factors in the development of rosacea can be divided into endogenous and exogenous. Endogenous include increased levels of estrogen, diseases of the cardiovascular system, kidneys, liver, etc. Exogenous - lack of vitamin C, environmental exposure, frost, snow, wind, abuse of sauna, bathhouse, UV radiation, bad habits. The vascular network of the skin is located at the border of the papillary and reticular layers of the dermis and at the border of the dermis and hypodermis. On the skin, rosacea manifests itself in the form of telangiectasias, which are formed from superficial capillaries. Stages of development of rosacea:<ul><li> isolated telangiectasias on the cheeks and wings of the nose;</li><li> vascular pattern occupies 1/3 of the face;</li><li> diffuse rosacea, occupying almost the entire surface of the skin.</li></ul> A patient who exhibits manifestations of rosacea should definitely be referred for a consultation with a dermatologist. A diet excluding alcohol and spicy foods is recommended. It is also recommended to use cosmetics containing vitamin C. Sensitive skin care Ideal skin is an impeccable balance and harmonious interaction of its cells. Skin irritation indicates that its protective systems have failed to cope with toxic and foreign substances. This means that the barrier and immune functions of the skin are weakened. Typically, skin irritation indicates a breakdown of the epidermal barrier. Therefore, when caring for sensitive skin, it is necessary to use gentle cosmetics. This is especially true for cleansing. Makeup removers should be soft, hypoallergenic and contain ingredients that restore the hydrolipid mantle. In addition, it is necessary to select cosmetics that contain as few active ingredients as possible (many cosmetics contain a large list of active ingredients, some of which may cause a reaction). You should avoid cosmetics that contain dyes, alcohol, essential oils, and alkalis. Some plant extracts may also cause allergic reactions. The use of products with UV protection, as well as antioxidants, is one of the mandatory stages of care. Agents that reduce skin reactivity include anti-inflammatory ingredients such as bisabolol and azulene. Immunomodulators are also introduced into cosmetics for sensitive skin. Recently, the immunomodulatory effect of omega-3 oils (fish oil, flaxseed and rapeseed oils) has been actively studied. Scientific studies have confirmed that the use of moisturizers reduces skin reactivity. Increased sensitivity for problem skin Recently, skin sensitivity has become more common among clients with problem skin. By ineptly using aggressive cosmetics and self-medicating, our patients often increase the sensitivity of their skin, doing a disservice to it. Therefore, new products for the care of problem skin are entering the market, containing innovative ingredients (for example, totarol, LHA) and capable of solving the problem of cleansing and caring for oily and problematic skin without increasing its sensitivity. We cleanse and tone the skin, then turn on the vaporizer and direct a stream of steam to the face and décolleté. To deeply cleanse and remove dead skin cells, we perform gommage, selecting a product that is suitable for even the most sensitive skin. <table border="1" cellpadding="1" cellspacing="1" style="width:500px"><tbody><tr><td style="background-color: rgb(255, 255, 204);"> Elena Arabiaskaya in her article “Symptom complex of sensitive skin: a rational approach to the patient” provides the following data: “...the causes of hypersensitivity may be associated with a violation of barrier properties, characteristics of the neuroreceptor apparatus of the skin, as well as the nature of inflammatory processes in the skin. In particular, the erythema that occurs in sensitive skin is the result of dilation and increased permeability of small blood vessels in the area of the papillary dermis. The important role of inflammatory mediators in the development of sensitivity is emphasized: TNFα, interleukin I, prostaglandin E2, leukotriene B4, etc. With erythema, overexpression of the growth factor by keratinocytes - vascular endothelial growth factor (VEGF), which interacts with receptors on the surface endothelial cells of blood vessels, the result of which is angiogenesis. VEGF increases vascular permeability and also stimulates the synthesis of collagenases that can destroy the fibrous structures of the dermis, making room for the growth of newly formed vessels. The action of VEGF has been described in normal conditions (embryogenesis, menstrual cycle, wound healing, sensitive skin, etc.), as well as in a number of diseases (rosacea, congenital hemorrhagic telangiectasia, some vascular tumors, etc.). The most promising new direction in correcting the symptom complex of sensitive skin is the use of VEGF inhibitors and a number of inflammatory mediators...&quot;</td></tr></tbody></table><hr /> Source: Les Nouvelles Esthetiques Ukraine, No. 6 (70), 2011-2012, pp. 100-102