- Hi guys. Welcome back to the channel.
Today I'm kicking off The Sensitive Series.
Now, the reason for this
is that when we launched our Routine Finder
for the Dr. Sam System two weeks ago now,
it was downloaded by 3,000 of you
and a whopping 70% of you said
that your skin was sensitive.
So I wanted to explore this topic.
Are we really much more sensitive?
Are we missing a skin disorder
that has sensitive skin as a feature of it?
Or are we simply doing certain things
with our skincare behavior
that is promoting a problem
in the way our skin functions?
So firstly, I want to eliminate the disorders
of which sensitive skin is a part of.
So when I think about sensitive skin in context of disease,
I immediately think of rosacea.
The condition where it's almost an inevitability
that there'll be intolerance
to certain skincare ingredients,
that there'll be a stingy, burny sensation.
There'll be associated reddening.
There may even be rough patches
because barrier dysfunction is part
and parcel of rosacea.
And barrier dysfunction is something you're gonna see
it's a bit of a theme
as we talk through the different ways
sensitive skin presents.
Now, I've done video content on rosacea.
So I'm gonna park that over there.
Next condition is eczema or dermatitis.
The two terms can be used interchangeably.
Now, there are different patterns to eczema.
We have atopic eczema, which is the classic patterns.
Presents in childhood.
In front of the elbows, behind the knees.
And can change over the course
of teenage life into adulthood.
Can often become facial.
Again, we're parking atopic eczema over here.
Seborrheic eczema, red scaly patches here and here
in the scalp.
Parked over there.
So I think let's exclude the disease situations.
What we then are left with,
which my feeling is from the Routine Finder
that is the majority of the individuals
that we're left with
are those who experience a kind of a bucket
of kind of subjective symptoms.
They'll often complain of a tight feeling
or a stingy feeling or a burny feeling of their skin.
And from time to time,
they will experience dry patches,
redness, but typically, skin changes won't be consistent.
They'll come and go
and the skin may even look normal.
So when I think of sensitive skin,
I'm excluding the disorders we've left over here
and I'm focusing in on this group
who have normal, often normal to dry skin
as their skin type
but this is possible really in context
of any skin type, any skin.
You can have oily skin and still behave sensitively.
But it is this kind of ragbag of symptoms
and occasional signs on the skin.
And I think it takes that group down a certain path
where we start to really dig into their behavior.
So these patients come into clinic
with a huge bag of products typically
that they haven't been able to use
'cause everything stings, doctor.
And oftentimes, as I've said,
the skin can look normal.
So I think one of the first things I make sure
I'm not missing is subclinical eczema,
where there's very little inflammation to see
but there is evidence of barrier disruption
as manifest by the fact
that everything that you put on your skin irritates them.
So a trial of topical anti-inflammatories,
using a mild topical steroid,
alongside a product detox
is something that's often worth trying,
particularly if somebody's skin is really itchy.
If that isn't working out,
if that doesn't make a big difference,
then again, I have to think
about is there a contact sensitivity issue?
And I do have a low threshold
off sending those patients
off to proper patch testing
where we look at their skin's behavior in detail,
following exposure to a numerous barrage
of common allergens,
including the kind of ingredients you find
in personal care products.
So those are two more exclusions
in terms of there is no disease present here.
So that leaves us with the kind of normalish-looking skin.
These symptoms are going on.
Bag of products potentially.
So what's actually causing the problem?
So in many of these instances,
the primary problem is barrier disruption.
Barrier disruption means
that our complicated stratum corneum
is no longer doing its magical thing
of keeping all the bad stuff out.
And that means that with ongoing use
of personal care products,
ingredients are penetrating into the skin
and potentially stimulating immune reactivity
and aggravating our nerve endings,
which can then release inflammatory ingredients,
all of which stacks up to activate the inflammatory cascade
and that's what we're seeing.
We're seeing this grumbling, low-level inflammation
because the barrier is not intact.
So that's the simple thought process
that I go through when I'm looking
at someone who's complaining of sensitive skin.
Is there a disorder?
Is it part and parcel of their normal skin's behavior?
Or is it due to skincare activity,
like product hopping
and how do we go about solving it?
So I'm gonna come on to product hopping next week
because I really do believe
that's probably the root cause
in many, many instances.
And that's a good thing
because of course, that is eminently fixable.
So stay tuned, come back and see us again next week
for the next part of The Sensitive Series.
Bye for now.