“Sensitive skin” is a phrase that’s pretty ubiquitous in the skin-care world—whether it’s being used in beauty headlines, product labels, or just in conversation about one’s skin woes. But perhaps no one is more familiar with the phrase than dermatologists.
“I’d say more than half of my patients come in saying they have sensitive skin,” Arielle Nagler, M.D., a dermatologist at NYU Langone Health, tells SELF.
But what exactly does it mean to have sensitive skin from a dermatologist’s point of view? Is it an actual diagnosis? Is it something you’re born with? How do you know if you have it? And how should you be taking care of it? To answer these questions (and more), we spoke to a few dermatologists about the ins and outs of sensitive skin. Here’s what they want you to know.
1. “Sensitive skin” isn’t really a clinical term. It’s more of an expression for skin that’s easy to irritate.
Even though most dermatologists have a general idea of what you mean when you say you have sensitive skin, it’s not a clinical diagnosis, Marlys Fassett, M.D., Ph.D, a UCSF dermatologist and expert on dermatitis (skin inflammation), tells SELF.
Instead, your dermatologist will likely take it to mean your skin has a tendency to be more reactive than average. “It means skin that is easily irritated, either by environmental things like sun, wind, cold, or topical products, like lotions or fragrances,” Melissa Piliang, M.D., who specializes in dermatopathology (diagnosing skin conditions by studying them at a molecular level) at Cleveland Clinic, tells SELF.
That irritation usually manifests with symptoms like redness, stinging, burning, itchiness, and general discomfort after your skin comes into contact with a particular ingredient or environmental trigger.
Since sensitive skin is more of a nebulous blanket term than a medical one, your doctor will still need help understanding exactly what you’re dealing with. “[Sensitive skin] means different things to different people,” Dr. Nagler says. “It’s something someone presents with, and then it’s a dermatologist’s job to figure out what that means.”
2. Anyone’s skin can react to certain irritants, but if you frequently have sensitive skin, it could be a sign of an underlying condition.
It’s possible to have generally sensitive skin that just can’t deal with products your friends slather onto their faces regularly. But ongoing sensitivity may indicate that you’re dealing with an underlying condition like eczema (also known as atopic dermatitis, which can cause dry, itchy, inflamed skin), rosacea (characterized by red skin, swelling, and visible blood vessels), psoriasis (patches of scaly, dry skin and rashes), or contact dermatitis (rashes triggered by contact with irritants or allergens.
This can involve a pretty vicious cycle: Sensitive skin is a common symptom of these skin conditions, and that irritation can make your other skin symptoms even worse, Emily Newsom, M.D., a dermatologist at the Ronald Reagan UCLA Medical Center, tells SELF.
So, how do you know whether you have generally sensitive skin or might be dealing with an actual condition? Indicators that you may have a diagnosable skin issue include persistent symptoms—extreme redness and irritation, painful burning or stinging, itching, blistering, rashes, scaling, pus-laden bumps—that come out of the blue or stick around no matter which products you use, according to Dr. Piliang. “If it’s more that you put a product on and you feel stinging or burning, or you get a little red from it, that’s probably [general] sensitivity,” Dr. Piliang says.
3. Skin sensitivity actually has to do with the fatty outer layer of your skin.
We all have a protective fatty outer layer on our skin. This is often called the lipid (fat) barrier, and it performs two main jobs: keeping water in, and keeping potentially damaging things, like UV rays, wind, heat, and harsh chemicals, out. In people with sensitive skin, this barrier is typically weaker, thinner, and more easily damaged, making it easier for irritants to penetrate the skin and cause inflammation.
“You can think of your skin barrier like a brick wall put together with mortar between the skin cells,” says Dr. Newsom. That intracellular lipid mortar is partly composed of a form of lipids called ceramides. In sensitive or damaged skin, that mortar is weak or missing in some spots, making the barrier more permeable and the skin underneath more vulnerable. “People who have a thin lipid barrier absorb products more deeply,” explains Dr. Fassett, which is why they are often more reactive to skin-care ingredients.
On the flip side, having a thin lipid barrier means it’s also easier for moisture to escape. This is why dryness and sensitivity often go hand-in-hand.
Even if you don’t have sensitive skin, you’re more likely to experience sensitivity in certain spots where that protective outer layer is thinner, like around your eyes, says Dr. Newsom.
4. But your immune system can also sometimes play a role in skin sensitivity.
The second part of the sensitive skin equation is what happens once an irritant gets through that lipid barrier: an inflammatory response from your immune system.
“[What] you see and experience as skin sensitivity [can be] the result of the immune system getting hyperactivated in your skin,” explains Dr. Fassett. This essentially happens when your immune system goes into overdrive as a result of a perceived threat. Redness, pain, scaling, itching, and other similar symptoms are signs this reaction is taking place. This is the case with conditions like eczema, psoriasis, and rosacea, as well as generally sensitive skin.
5. If your immune system is way too sensitive to a specific substance, it can cause a skin allergy over time.
A skin allergy (allergic contact dermatitis) can develop if your immune system is repeatedly exposed to a certain irritant—either a skin-care ingredient like a fragrance or dye, or a substance like rubber, formaldehyde, or nickel—and becomes increasingly sensitive to it, according to the National Institutes of Health (NIH). Unless you’re dealing with something really irritating like poison ivy, this kind of allergy might take multiple exposures over several years to develop, but once you have it, it’s permanent.
Signs, including a red rash, extreme itchiness (including hives), dry, cracked, or scaly skin, oozing blisters, and tenderness, can develop up to 48 hours after exposure, so it might be hard to figure out what’s throwing your skin for such a wildly irritating loop.
6. It’s pretty common for your skin to become more sensitive as you age.
The natural construction of your lipid barrier is partly up to luck. “Some of it is just constitutional, so you may just have more sensitive skin than someone else just based on your genetics and the way your lipid barrier is made,” says Dr. Piliang.
But all of us see that barrier break down as we get older, which can cause increased sensitivity over time. “As we age, that lipid barrier replaces itself less frequently, so people can become more irritated more easily,” says Dr. Piliang. That’s why products you used to use with no problem can suddenly mess with your skin as you age. It also explains why you might experience more dryness as you get older, since your skin can’t hold onto moisture as well.
7. One of the worst things you can do for sensitive skin is wash it more frequently.
For most of us, the biggest enemy when it comes to keeping that outer barrier intact isn’t time. It’s over-washing and over-exfoliating, which is something dermatologists say they see all the time in patients who complain of sensitive skin.
Soap and hot water can diminish your lipid barrier, Dr. Piliang explains. “Think about it like butter on a knife. If you put it under cold water, that fat on the knife doesn’t go anywhere. But if you put it under warm water, those lipids will melt away.” She continues, “It’s the same kind of issue with the lipid layer in our skin. If you put your skin in hot water or you use harsh soaps, then it tends to wash that outer protective fatty layer away.” Instead, use cool or lukewarm water on your face, and don’t wash more than once a day.
As for products? Glad you asked…
8. Stick with products that are gentle, fragrance-free, and have a fairly simple ingredient list.
“The basic advice for patients who experience sensitive skin, chronically or just in the short term, is to keep it simple,” says Dr. Fassett. This applies to both the number of products in your routine and their ingredient lists, unless otherwise recommended by your dermatologist.
In general, if your skin is more dramatic than a high school theater troupe, stick to things like gentle cleansers free of harsh ingredients. The exact ingredients that will piss off your face will vary from person to person, so it may be helpful to look for products specifically formulated for sensitive skin, meaning they don’t contain common irritants like sulfates, dyes, preservatives, emulsifiers, alcohols, certain botanical oils like lavender, and fragrances. That said, you can’t always trust a “sensitive skin” label, since, as we mentioned, there are so many different kinds of skin conditions and sensitivities out there. So, when it doubt, ask a dermatologist for the ingredients you may want to steer clear of, or do a small patch test before putting it all over your face (more on that in a bit).
“There are a lot of inexpensive, over-the-counter options available at every single pharmacy that lack common irritants and fragrances [and] are really good,” says Dr. Nagler. Dr. Fassett likes drugstore brands, like Eucerin, Aveeno, Cerave, Cetaphil, and Vanicream: “Those are all excellent for people that have eczema and sensitive skin in general.” (To be certain, scan the ingredient list every time, or ask your dermatologist for specific recommendations.)
You should also consider staying away from abrasive scrubs and mechanical exfoliants, like microbeads and walnut shell powder, which can cause tiny tears in your skin’s barrier, Dr. Nagler says. And use brushes on devices like Clarisonics with caution, and only after ensuring your skin doesn’t react with irritation.
The ingredients you do want to see are those that retain moisture (including emollients and humectants like glycerin and hyaluronic acid) and replenish the the lipid barrier (including ceramides and fatty acids like linoleic and alpha-linolenic acids). “It’s about trapping water and creating a protective layer,” says Dr. Nagler.
9. Most of the derms we spoke to actually singled out fragrances as the biggest sensitive-skin offender.
“Fragrances, both natural from essential oils and synthetic, [can be] irritating to the skin and a frequent cause of allergic contact dermatitis,” Dr. Piliang says. This is why dermatologists often include at least one or two fragrance mixes when they do testing for skin allergies, Dr. Newsom says. That can determine whether you have a reaction to a litany of naturally and synthetically derived chemicals commonly found in fragrance formulations. Since these chemicals can simply show up on the ingredient labels of skin-care or beauty products as “fragrance,” it can be hard to pinpoint what exactly is bothering your skin until a doctor investigates.
Other times, Dr. Piliang says, a fragrance agent will be hiding in the ingredients list under the name of the specific ingredient(s) being used, instead of “fragrance,” which can also make it tough to identify the offending substance. “You do have to read the list carefully,” she says. (The Contact Dermatitis Institute has a list of fragrance agents to avoid if you’re sensitive here.)
And always look for labels that say “fragrance-free,” not simply “unscented.” As the Environmental Protection Agency notes, “unscented” products may still contain fragrances or other chemicals that mask the scent of other ingredients to create a neutral-smelling product.
10. If you have sensitive skin or a diagnosed skin condition, use caution (and the help of a dermatologist, if possible) before adding any strong products to your routine.
People with sensitive skin need to be careful and patient with products that contain strong active ingredients. You should research products that intrigue you but contain powerful ingredients, like chemical exfoliants such as glycolic acid and salicylic acid, vitamin C, or topical retinoids/retinol (vitamin A).
Generally, you should start using a new product gradually so your skin can build up a tolerance, says Dr. Nagler. Select a lower concentration, use a small amount, and only use it every two or three days at most. Apply a very simple, very gentle moisturizer underneath (or mix it in) to create a buffer. This will reduce the irritating effects of strong active ingredients. (Keep in mind, though, that this method can also reduce the product’s overall efficacy by interfering with the mechanism of the active ingredient, so talk to your derm or do some research first.) Then, as your tolerance grows over time, you can start to gradually increase the frequency and apply the product directly, before your moisturizer.
11. Just go ahead and accept that patch tests should be a staple of your routine before going all-in with any new product.
“Use [a new product] on your inner arm first every day and see what happens,” Dr. Piliang recommends. “If your inner arm doesn’t get irritated after a week, then you can maybe try it on the side of your face.” Your neck is also an option if you’re not ready to move to your face.
If a product does cause irritation, don’t panic. Stop using it, wait for your skin to calm down, and then try something else, Dr. Fassett says. “Knowing which [formulations] will be well tolerated versus which ones will set off your irritation is just a matter of trial and error.” If your skin responds with a level of sensitivity that’s causing you a lot of stress, pain, or irritation, don’t hesitate to see your dermatologist to get checked out.
On a similar note, if you have an actual, diagnosable skin condition like eczema, psoriasis, or rosacea, definitely check in with your dermatologist before adding anything you suspect might be too strong to your routine in the first place. Your skin—and wallet—may thank you.