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Cosmetic Intolerance Syndrome
Dermatologists and pharmacy-assistants or pharmacists are regularly confronted with consumers or patients who have tired about a 100 skin care products and "react" to almost all of them. This could be seen as sensitive or hyper-sensitive skin: self-reported facial presence of different sensory perceptions including tingling, stinging, burning, tingling, pain and pruritis (itch). Sensitive skin was first described by Maibach in 1987 under the name of Cosmetic Intolerance Syndrome. Irritant contact dermatitis (ICD) is caused by the non–immune-modulated irritation of the skin by a substance, leading to skin changes. Allergic contact dermatitis (ACD) is a delayed reaction in which a foreign substance comes into contact with the skin; skin changes occur after re-exposure to the substance. Sounds dramatic, and it is. Buying products to find out that you can not use them is a waste of money, disappointing and if you don't know the cause it is utterly frustrating or problematic. Symptoms can appear local systemic, occur immediately or sometimes with a delay of several hours or days and range from mild to very severe in case of a serious allergic reaction (even life threatening anaphylaxis) and may impact quality of life and/or sleep.
An easy way to avoid wasting your money on a new product is to ask for a sample. It is the most important reason why they exist. Usually with a few applications you can tell if you like the product and your skin likes it too. To find out specifically why your skin is (hyper-)reactive it is smart to go to your dermatologist and ask him/her/they for a test and advice after doing some home-work. You can prior to the appointment make a report as detailed as possible. Checklist for the appointment for a dermatologist / allergologist should contain: symptoms with timing, affected areas (face, scalp, body), co-medication, (family) history of skin diseases (for example atopic dermatitis, psoriasis, rosacea), occupational hazards (for example hair dressers exposed to chemicals), dietary changes, stress, menstrual cycle, use of washing detergents / fabric softeners, sun exposure (photosensitivity) or environmental triggers or changes (like mega-city pollution or skiing by low temperatures or wind), wear of (tight) clothes and anything you deem relevant like recently undergone (aesthetic) treatments. Of course cross-check the INCI's or ingredient lists of the products you use if there are common ingredient(s) listed. Most common triggers in cosmetics are easy to find: latex, dyes, metals and fragrance. Some ingredients are beneficial for skin, but your skin may need slowly adjust to them, like tretinoid or retinol. Some ingredients may be beneficial for some, however not good for your skin when used on a daily base like alpha-hydroxy-acids in high concentrations.
I know that many mention preservatives as a potential trigger. Some certainly can be. However my experience (about 9 years of clinical tolerability and safety tests with modern dermatological skin care) is that almost all users tolerate products containing evidence based modern preservatives really well (rarely any side effects) and benefit from them as they reduce the risk of contaminations by unwanted growth of microflora in a product. Hence, they are there for your safety. Large companies have thousands of people working in R&D every day and know what they are doing and are there to provide you with the best they can offer, based on the latest regulations, insights and science. Moreover, they would not market products risking high complaint rates or more dermatological skin care without clinical proof of good / very good tolerability (even in sensitive skin). I therefor like to challenge the negative reputation preservatives in general have. We all remember that parabens were "killed" by reputation and because companies want to produce products consumers enjoy and love, they started formulating all their products without them. Truth is that most parabens were and are very safe based on ample evidence. In this case a family of beneficial preservatives suffered significantly because of 1 or 2 bad family-members. We don't formulate with parabens or known potential allergens. A very active and skilled safety department is taking care of that.
Don't completely rely on the word hypo-allergenic. It only means that the risk of a reaction to one of the ingredients is reduced and does not provide a 100% guarantee. Don't think that "everything natural" is always good for you. For example latex (a well known potential allergen) comes from nature. Click the button below for a full list of potential allergens in skin care provided by the FDA.
There are preservative, fragrance and dye free options available in skin care. Although "free off" claims are frowned upon by the industry or sometimes not even legal. Usually these "minimal" products come in specific safe packaging (mostly pumps) to avoid contamination, often also protecting them from air and light to avoid oxidation of certain ingredients in the formula. There are evidence based dermo-cosmetic products which actively sooth and calm the skin with ingredients like Symsitive®, reduce related redness or inflammation with licochalcone A or cool or reduce itch with methoxy-propanediol or polidocanol or a combination.
Sometimes the solution is as simple as the problem. Sensitive (hyper) reactive skin can be caused by barrier impairment, which allows irritants to penetrate the skin, sensors in the skin to be exposed and water to evaporate from the skin.....hence often confused or overlapping with dry skin as the symptoms are identical. If your skin barrier is the problem, the solution is to avoid over-exfoliation or harsh cleansing, maintain the skin's healthy pH (around 5) and use products containing ingredients supporting barrier repair like urea and/or dexpanthenol. These are considered the gold standard as written in this position paper by Prof. M. Augustin et al 2019.
In my opinion all skin is "sensitive", and it should be. It is our skin's function to protect us by sensing heat, cold, touch, pressure and pain for example. However when the skin does not tolerate "normal conditions", hence is overreacting to (common) ingredients in skin care, it is telling you "something is off" and it might be Cosmetic Intolerance Syndrome. Listen to your skin. Don't forget to ask for a sample and advice from the pharmacist when buying a new product or go to your dermatologist/allergologist to get a better understanding of the problem, so they can provide a tailored solution for you.
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