Rosacea is an example of the third component of sensitive skin, which is heightened neurosensory response. This means that patients with rosacea experience stinging and burning to minor irritants more frequently than the general population. For example, I demonstrated that 62.5% of randomly selected rosacea patients demonstrated a positive lactic acid sting test for sensitive skin (1). Furthermore, rapid prolonged facial flushing is one of the main diagnostic criteria for rosacea. Whether this sensitive skin is due to nerve alterations from chronic photodamage, vasomotor instability, altered systemic effects to ingested histamine, or central facial lymphedema is unclear.
The treatments for rosacea-induced sensitive skin are much different than those for eczema or atopic dermatitis. Anti-inflammatories in the form of oral and topical antibiotics form the therapeutic armamentarium. Antibiotics of the tetracycline family are most commonly used orally, while azelaic acid, metronidazole, sulfur, and sodium sulfacetamide are the most popular topical agents. However, the effect of the antiinflammatory antibiotic can be enhanced through the use of complementary skin care products that enhance barrier function.
Eczema, atopic dermatitis, and rosacea are in some ways the easiest forms of sensitive skin to treat. The skin disease is easily seen and treatment success can be monitored visibly. If the skin looks more normal, generally the symptoms of itching, stinging, burning, and pain will also be improved. Unfortunately, there are some patients who present with sensitive skin and no clinical findings. These patients typically present with a bag full of skin care products they claim cannot be used because they cause facial acne, rashes, and/or discomfort. This situation presents a challenge for the physician, since it is unclear how to proceed.
Several treatment ideas are worth considering. The patient may have subclinical barrier disruption. For this reason, treatment with an appropriate strength topical corticosteroid for two weeks may be advisable. If symptoms improve, then the answer is clear. The patient may have subclinical eczematous disease. If the symptoms do not improve, it is then worthwhile to examine the next most common cause of invisible sensitive skin, which is contact dermatitis. This is accomplished by considering the ideas presented in Table 1 (2). Sometimes a more regimented approach to contact dermatitis is required, as represented by the basic product selection ideas presented in Table 2.
Sensitive skin products are increasing in the marketplace, since many individuals consider themselves to possess sensitive skin while others feel that products labeled for sensitive skin are less likely to cause problems in all populations. Exactly what is unique to sensitive skin products is unclear. In many ways, it is simply a marketing statement; however, some manufacturers will elect to test their formulations on persons with eczema, atopic dermatitis, and rosacea as part of a sensitive skin panel to substantiate the claim.