Sensitive skin increasing; dandruff, itchy scalp update

Q Why is the incidence of sensitive skin increasing in my patient population?

Your observation is correct. A number of skincare industry surveys of more than 40,000 women worldwide have documented the increase in self-perceived sensitive skin.

No one is exactly sure why this is occurring, but I will try to explain some of the reasons that have been put forth.

Second, women are using more products than ever before on their face. They are using all types of cleansers, toners, moisturizers, sunscreens, anti-aging serums, undereye creams, facial foundations, lipsticks, blushes, eyeshadows, eyeliners and mascaras. The average women 70 years ago used soap and possibly a lip balm with some petrolatum or cold cream on her face. This increase in skincare and cosmetic product use has dramatically increased the exposure of the facial skin to a variety of chemicals that may, indeed, cause an untoward reaction. Furthermore, newer skincare formulations are loaded with botanical cocktails and numerous other ingredients, such that the content disclosure has to be printed in a tiny-size font to fit on the bottle or box. In years past, the number of ingredients in any single formulation was considerably less. Thus, more exposure heightens the probability that a woman will find an ingredient that causes her difficulty.

Last, it is important to recognize that many women have self-induced sensitive skin.

Women are now rubbing, scrubbing, peeling, microdermabrading and exfoliating. They are using six or seven different hydroxy acid or skin renewal moisturizers. All this contributes to a damaged skin barrier. The end result is increased transepidermal water loss and the entry of topical skincare products and cosmetics into the dermis, causing stinging and burning.

I have found the best solution for patients who have problems with sensitive skin is to ask them to bring everything they use on their face to the office for evaluation. Many times I am shocked by the suitcase they bring for my evaluation. These patients need to simplify their skin care routine and allow the skin barrier to heal.

I usually put them on a foaming face wash (Olay Foaming Face Wash for Sensitive Skin, Procter & Gamble), a simple facial moisturizing cream (Cetaphil Cream, Galderma), facial powder (Clinique), blush (Clinique), lip balm (Norwegian Formula Lip Moisture, Neutrogena) and black mascara (Lash Lengthening Mascara, Almay) for four weeks. This allows the skin barrier to heal. Products that they may be using that could damage the skin barrier are then removed from their cosmetic suitcase. Sometimes it is hard to convince patients that less is better when it comes to skin health. They need to understand that their efforts to combat aging are making their skin diseased!

Q What is the new technology that is being incorporated into shampoos designed for persons with dandruff and itchy scalps?

Shampoo technology has advanced significantly in the last three years due to the introduction of silicone conditioners into traditional dandruff shampoos.

Many of the newer dandruff shampoos are now two-in-one shampoos that both clean and condition at the same time. This has been achieved by adding dimethicone to traditional dandruff shampoo formulations based on pyrithione zinc.

In addition, new technology in the manufacture of pyrithione zinc has also been developed. Traditionally, pyrithione zinc, which is a particulate, was produced in a cuboidal shape and then suspended in a shampoo base. Pyrithione zinc is a time-tested anti-dandruff agent that has good antifungal activity against Malassezia species and some anti-inflammatory properties. It is now possible to shape pyrithione zinc as a thin plate 2.5 microns across. This size is important, since the larger cuboidal pyrithione zinc was too large to precipitate on the scalp during shampooing, and plate-like pyrithione zinc less than 2.5 microns is too small and is completely rinsed from the scalp following shampooing.