PHOENIX, ARIZ. — Sensitive skin complaints in the absence of a recognizable skin disease or irritation in female patients should not be dismissed, Albert M. Kligman, M.D., said at a clinical dermatology conference sponsored by Medicis.
Sensitive skin is a real subclinical condition that can be verified with a simple skin test and treated with a daily application of Nivea cream, said Dr. Kligman, professor emeritus of dermatology at the University of Pennsylvania, Philadelphia.
Between 30% and 50% of women in the United States, Europe, and Japan complain of itching, burning, stinging, dryness, tightening, or pain in reaction to topical skin care products, Dr. Kligman said. He blamed the problem on erosion of the stratum corneum by heavy use of skin care products in developed countries.
“Anything able to get through a leaky stratum corneum [is] going to pick up afferent responses,” he said. “There's no question that nerves are involved in this.”
To identify credible complaints in a patient whose skin appears normal, Dr. Kligman recommended a “lactic acid stinging test” he developed with colleagues. He said to apply a 10% solution of lactic acid to the patient's medial cheek and ask about the sensation without offering any cues.
If the patient has sensitive skin, the acid should induce a stinging sensation in 1 or 2 minutes. This will reach a peak in 5 minutes, only to become insignificant in 15 minutes. Some highly sensitive women may find the sensation unbearable and ask to have the acid washed away in 3 minutes, Dr. Kligman said. If, however, a patient has an instant reaction, he would conclude she does not have sensitive skin. Most sensitive skin reactions are moderate, and take time to develop.
Women who react to lactic acid are usually hypersensitive to other substances, he added, listing cause-and-effect relationships between capsaicin and pain, histamine and itching, harsh soaps or cleansers and tightness, and balsam of Peru and burning.
Although sensitive skin may take decades to develop, the remedy can be as quick as 7–8 weeks with daily applications of Nivea cream or a comparable product. “Stingers become nonstingers if you improve their barrier—make their skins less permeable,” he said. “It is possible to convert a sting to a nonstinger just by putting on a bland moisturizer.”