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Ep 32: Sensitive Skin & Eczema: Types, Causes & Treatment
Hi guys and welcome to my podcast, Dermatologists Talks: Science of Beauty. I’m Dr. Teo Wan Lin of TWL Specialist Skin and Laser Centre, and in this week’s dermatology flash briefing, we’re going to talk about the differences between sensitive skin and reactive skin. Now these two terms are often cause confusion amongst laypersons. In this podcast episode, I will try to help you recognise if you have any of the symptoms of sensitive or reactive skin. Additionally, how to distinguish between the two categories of symptoms. We’re also going to talk about what the different types of eczema are, how you can manage your symptoms at home and when you need to see a dermatologist.
Firstly, dermatitis is a term that is used interchangeably with eczema. There are various types of eczema, but they all have a common feature. This is the failure of the skin barrier. This manifests in terms of red flaky, dry skin. Skin symptoms can include itching, sensitivity, tingling, stinging especially when exposed to skincare or even water, different types of products, or changes in the environment.
Atopic dermatitis
The first type of dermatitis I want to mention is atopic dermatitis. This is one of the typical types of eczema that starts in early childhood. There is a strong genetic component so it may run in families. Especially in association with conditions such as asthma, allergic rhinitis, hay fever and sinusitis. All these are part of what we call the atopic triad. For childhood eczema, it tends to occur over the flexors or the extensors of your limbs, including the neck area. It can also be worsened by changes in your environment and triggered off by the use of harsh cleansers and soaps.
Another type of dermatitis is contact dermatitis. For dermatologists we further subdivide that into allergic and irritant contact dermatitis.
Allergic contact dermatitis
Allergic contact dermatitis is much rarer than irritant contact dermatitis. It tends to occur in response to repeated exposure to a certain sensitising substance. This results in, for example, what we know as nickel allergy, a sort of metal allergy. Nickel is a common contaminant of non-surgical steel. In most costume jewellery, there is environmental contamination of nickel.
Irritant contact dermatitis
Irritant contact dermatitis is far more common. Exposure to harsh soaps, cleansers can also induce this. Laureth sulfates, in particular has been the cause of a lot of cases of irritant contact dermatitis. We can also associate this with the high pH of cleansers. Laureth sulfates have increasingly been substituted for gentle emulsifier alternatives, either botanical-derived emulsifiers like soy, honey, amino acid based surfactants, or in the case of cleansing for very dry skin cleansing oils, which are usually based off mineral oils.
Seborrheic dermatitis
Finally, seborrheic dermatitis is a special type of eczema that is perhaps not as well known amongst lay persons. The term ‘seborrheric’ really refers to oily skin. It originates from the term sebborhea. It may seem paradoxical to have both oily and dry skin at the same time. But in fact, this is a common complaint of a lot of individuals who feel that they suffer from dry flaky skin on their face. They actually have seborrheic dermatitis. Seborrheic dermatitis occurs predominantly over the face area because that’s where your oil glands are the most active. The eyebrow area, your nose, the junction between your cheeks and your lips which we call the nasolabial area. These areas have concentrated oil glands.
Scalp microbiome
The cause of seborrheic dermatitis is an overgrowth of yeast. In fact, malassezia furfur is a common skin commensal that is responsible for seborrheic dermatitis. It overgrows in tropical climates and results in skin inflammation. It occurs almost exclusively in post pubertal type of skin due to the influence of hormones on the skin microenvironment with the production of oil.
Seborrheic dermatitis actually starts from your scalp. Many patients wonder why when they are diagnosed with seborrheic dermatitis on their face, we also tell them to use an anti-fungal shampoos such as ketoconazole shampoo on the scalp. The reason is because this fungus lives on your scalp, it enjoys the oily microbiome of the scalp. As a result, it overgrows and subsequently, the over-colonisation results in inflammation. Leading to scalp flaking and redness.
The Deep Cleanse Shampoo cleanses the scalp with pharmaceutical grade ingredients to degrease oily scalps. Rebalances the scalp microbiome to minimise dandruff flares and maintain healthy scalp bacterial and yeast flora. Dermatologist-formulated to calm irritated and sensitive scalp problems.
Eczema Treatment and Prevention
Well, we’ve learned a little bit about the different types of dermatitis. Now we also want to touch a little bit on treatments for each type of dermatitis. The important thing to recognise about atopic dermatitis is that it is genetic. Hence, individuals who are diagnosed with atopic dermatitis or different types of eczema need to consider long-term treatment and maintenance. If your symptoms are moderate to severe, you will need long-term follow up with an accredited dermatologist. Your dermatologist will be prescribing you topical steroids or steroid sparing agents like calcineurin inhibitors, which can help to manage this chronic condition.
Treatment of atopic dermatitis
Now there are two key challenges in the treatment of atopic dermatitis. Firstly, the phenomenon known as tachyphylaxis. It means that you will get a certain amount of resistance to the steroid after repeated exposure. This means that you no longer respond to something which was once effective for you. It could be the reason why we see a lot of online stories about individuals who have overused steroids to the extent that they have severe steroid-induced skin atrophy. But on the flip side that has also led to a dangerous phenomenon we call steroid phobia.
Steroid resistance
This is something dermatologists are aware of, and it’s not a good thing. Because, firstly, you cannot and should not self-medicate with topical steroids. At the same time, if you have been advised by your dermatologist to use topical steroids which you really need, failure to comply with the advice or not seeking appropriate treatment, for example, with the correct potency or type of steroid because of steroid phobia. This will lead to skin barrier dysfunction failure in which the end stage is a catastrophic condition – erythroderma. Which is the most severe form of skin barrier dysfunction, which is even life threatening.
Nickel sensitisation
For management of contact dermatitis for allergic contact dermatitis types of eczema, my advice is this: prevention is key. In the first place, minimise exposure to costume jewellery. I personally recommend from the time that a child is ready to have their ears pierced or to start wearing any form of jewellery to opt for surgical steel instead.
Surgical steel is different from stainless steel in that is a special grade known as 316L in the manufacturing industry. This as opposed to the normal type of stainless steel, which is most often used in cutlery and cookware and in certain types of earrings. These also have environmental nickel contamination. The presence of the smallest amount of nickel can cause sensitisation over several years. While you may not consider yourself a sensitive skin individual, it does take many years and decades for one to develop nickel allergy. After that, it’s almost impossible to reverse the process.
The Geometric Triangle Drop Earrings is made from 100% implant quality 316L surgical/medical grade stainless steel. It is hypoallergenic, suitable for sensitive skin individuals, as well as those with nickel allergy. Dermatologist approved for pierced ears and other pierced parts of the human body.
Switch to a gentle cleanser
For irritant contact dermatitis, I would advise that all families switch to a gentle dermatologist-recommended cleanser for washing their hands and for showering. Also, to bear in mind that contact with household detergents is a risk factor. Therefore, always wear long gloves when you’re washing the dishes, or better still, invest in a dishwasher. When you’re mopping the floor and there’s exposure to the detergents in the ground, be sure to wear boots that cover your skin fully.
Medical grade honey is used in the dermatologist-developed Miel Honey Cleanser, which has natural emulsifying, antibacterial, anti-fungal properties for gentle and effective cleansing in eczema-prone individuals. Natural honey is also a humectant, trapping a layer of moisture for protection after cleansing
Go minimalist in your skincare
To minimise exposure to too many types of skincare products is also a wise piece of advice because that will reduce your chance of developing contact dermatitis due to sensitisation. As a rule of thumb, look for dermatologist recommended brands. These have been tested for use in a clinical setting on very sensitive skin. The difference here is that these brands are much better tolerated by all skin types.
Sensitive skin vs reactive skin
Now, finally, to distinguish between the public perception of what sensitive skin and reactive skin really is we spoke about right at the start of the podcast, I feel that the most scientific way is to fall back on the manifestations of these different types of dermatitis. For seborrheic dermatitis, and non-dermatitis or barrier related skin disorders such as rosacea, these can also present with facial redness, burning stinging symptoms, worsened by environmental changes.
Reactive skin – rosacea
In particular for rosacea, when the weather gets hot to your face gets red and unlike in normal individuals, the redness doesn’t subside. All these symptoms will be perceived by the individual as a form of skin reactivity. But, in fact, it’s not a form of true sensitive skin in the context of what we’re discussing, which is a form of barrier dysfunctional dermatitis. However, we do want to note that it is possible to have both rosacea and facial eczema at the same time. These conditions can coexist.
Skin sensitivity
True skin sensitivity is likely a form of atopic dermatitis, where you actually have a genetic predisposition to having barrier dysfunction. However, as we have discussed if you have any other types of eczema or dermatitis, you may also present with similar symptoms of skin sensitivity and react to environmental changes. Hence, the most important thing is prevention. Secondly, if you do suspect that you have a form of dermatitis, or facial sensitivity, visit an accredited dermatologist who will treat you with appropriate medications to get the condition under control.
Well, that’s it for this week’s dermatology flash briefing. This is Dr. Teo Wan Lin for Dermatologist Talks: Science of Beauty. You may follow me on my Instagram @drteowanlin.