Our prior discussion of sensitive skin focused on those special skin conditions, namely eczema, atopic dermatitis, and rosacea, which form the basis for a sensitive skin panel. However, we must also consider issues of contact dermatitis. Traditionally, issues of
Table 1 Considerations for the Minimization of Contact Dermatitis from Skin Care Products and Cosmetics
1. Eliminate common allergens and irritants, or reduce their concentration
2. Select products from a reputable manufacturer that uses high-quality pure ingredients free of
contaminants
3. Products should be well-preserved to prevent the formation of auto-oxidation byproducts
4. Paraben preservatives have proven to be the least problematic
5. Avoid solvents, volatile vehicles, vasodilatory substances, and sensory stimulators in all
products
6. Minimize the use of surfactants and select minimally irritating emulsifier systems irritant contact dermatitis are implied under the claim umbrella of sensitive skin, but allergic contact dermatitis issues are sometimes separately claimed. Allergic contact dermatitis issues may fall under the claim of hypoallergenic. Exactly what hypoallergenic means is unclear. In the strictest sense, the word hypoallergenic is used to indicate reduced allergy. Many products that are labeled hypoallergenic are also labeled as appropriate for sensitive skin, but the claims are somewhat different. All sensitive skin products should be hypoallergenic, but all hypoallergenic products are not necessarily appropriate for sensitive skin. In my mind, hypoallergenic simply means that common allergens have been removed from the formulation, but irritants may still be present.
Formulating products with reduced allergy is sometimes difficult. It is obvious that poison ivy, a common allergen, should never be included as an ingredient, but other guidelines are sometimes difficult to develop. It is probably for this reason that hypoallergenic has never been defined by any regulatory body. Hypoallergenic products are probably best formulated by using the fewest, purest ingredients possible and staying away from unusual botanical extracts. A poor approach would be to put anti-inflammatory substances, such as bisabolol or allantoin, in the formulation to minimize any allergic reaction. A quick review of the contact dermatitis literature shows that the most commonly cited cases of skin care product induced problems arise when contaminated raw materials are used, such as nickel-contaminated eye shadow pigments or oxidized vitamin E, or when product preservatives break down. The best guarantee of formulating a hypoallergenic product is to use time-tested ingredients in a stable formulation.
Table 2 Cosmetic Selection Criteria in Sensitive Skin Patients
1. Powder cosmetics should be selected
2. Cosmetics should be water removable
3. Old cosmetics should be discarded
4. Eyeliner and mascara should be black
5. Pencil formulations should be used for eyeliner and eyebrow cosmetics
6. Eye shadows should be earth-toned (tan, beige, light pink, cream)
7. Avoid chemical sunscreens in cosmetic formulations
8. Select cosmetic formulations with as few ingredients as possible
9. Avoid nail polishes
10. Select cream/powder facial foundations or, if liquid, silicone-based formulations