Sensitive Skin 101

What is sensitive skin?

Generally if you have easily irritated or reactive skin, then you have ‘sensitive skin’. Most of the time sensitive skin relates to the face. Sensitive skin can be caused by a genetic predisposition or environmental factors. It appears as a redness, a swelling, itchy and dry irritation to the face. One of the major jobs of the skin is to waterproof. This is done to the epidermis or surface layer of the skin, producing a fat-protein sandwich that is always being replaced and is vital to prevent too much water loss from the skin.

Symptoms of sensitive skin include:

• A tingling or tightening of the skin without visible signs
• “Overreaction” to skin care or cosmetic products
• Reactions to shaving, or other physical stress to the skin

Sensitive skin can also be a heads-up for other conditions, such as:

• Altered skin — due to shaving, waxing, medications or heat, cold, wind, and pollution. Also, laser or chemical peels or scar removal
• Allergic skin – the sudden appearance of redness or swelling and itchiness
• Atopic skin – dry skin that is itchy and produces eczema. Eczema is related to hayfever and asthma. (see Eczema Guide for more information)
• Rosacea skin - blood vessels of the face enlarge resulting in a flushed sensation or a redness of the skin

What to do about your skin?

• Perfume or scented creams can be irritating.
• Rinse well after using cleansing products, which should be mild and soap-free as they do not remove so much oil from the skin (www.MildCleanser.ca gives you more information about this kind of cleansers)
• Use a moisturizer and sunscreen that is formulated for sensitive skin
• Don’t over wash your face. Temperature of the water should be tepid; neither hot or cold
• Don’t use exfoliants
• Be aware of seasonal temperatures. The sudden dryness of winter can mean itchy, dry skin until the skin responds by increasing oil production to reduce the water loss
• For breakouts use a cleanser with salicylic acid to help exfoliate pores. There are also moisturizers that contain salicylic acid

Be sensitive to stress

The causes and effects of stress on the body are not fully known, but for some people stress interferes with the body’s systems that repair and regulate the skin. Stress kills your natural antioxidant defenses, which help to prevent accelerated aging of the skin. Hormones can also trigger a histamine release within the skin causing it to erupt in bumpy redness, or breakout in hives.

Desensitize yourself

When choosing makeup, especially foundation and blush, buy oil-free products. Makeup that is water-based won’t clog pores. Look for oil-absorbing foundations that help keep oil off the face.

As for the rest of your body, check ingredients and avoid harsh chemicals in soaps, shampoos, body cleansers and creams, bath oils, bubble baths, etc.

Put your best face forward

• Watch your alcohol intake, spicy foods and caffeine
• Try to avoid excessive temperature changes
• Use the right cleansers, moisturizers and cosmetics
• Manage stress as best you can

About skin care products

For you as a consumer in the billion-dollar skin care industry, lack of information about products is costly, and you have to bridge the gap between.

What you need to know about skin care products.

Without accurate information, you are throwing your money away, because you are completely at the mercy of advertisers and marketers. Knowing more specific information about your skin needs, such as your true skin type , you can take control of your skin. Read more

What to know about skin care products

For you as a consumer in the billion-dollar skin care industry, lack of information about products is costly, and you have to bridge the gap between. Without accurate information, you are throwing your money away, because you are completely at the mercy of advertisers and marketers. Knowing more specific information about your skin needs, such as your true skin type, you can take control of your skin.

In 2001, the average American owned about five hundred dollars’ worth of cosmetic products, and this amount has surely risen dramatically as more and more expensive product lines have been developed since that time. Do you really need to spend that much to get quality skin care? No. What truly matters is not your skin cream’s price, but whether it’s right for your Skin Type. No matter how glamorous its packaging or delicious its feel, that four-hundred-dollar cream is not right for everyone. (In fact, some types don’t need to use any skin cream at all.)

Proper information – not hype - will save you the expense, trouble, and waste of buying the wrong products-while directing you to the right ones. Ingredients are the only thing that should drive your purchasing decisions and once you’ve learned what all the jargon and 14-syllable words mean, you too will be better able to read a cosmetic label and figure out if it’s appropriate for you.
Again, products should be chosen based on their ingredients first, manufacturing practices, and formulations.

Also try to research the clinical trial data of the products, when available, to choose wisely those that have proven effective. Leading dermatologists recommend following these criteria before buying any skin care:
Make sure the product…

1. Contains the right ingredients for your skin type
2. Contains sufficient amounts of active ingredients to be effective
3. Do not contain counterproductive ingredients
4. Are formulated effectively for your needs
5. Are packaged to maintain stability of the active ingredients
6. Are cosmetically elegant (smell good and feel good)
7. Are approved from those who’ve used them
8. Are easily available for purchase

Your Skin And The Effects Of The Sun

Sun damage of the skin, also known as photo damage can be either acute, as in a sunburn or more commonly, chronic, seen as gradual changes in the skin caused by an accumulation of sun exposure throughout one’s life. Chronic photo damage results in either a cosmetic change in the skin’s appearance called photo aging, or changes that are of medical and health concerns such as pre-cancerous lesions and skin cancers. The evidence is very strong that ultra-violet light is the cause of most of the changes that we consider to be associated with aging of the skin.

Sunshine, although essential for health and well being, is certainly a hazard for the skin. For many people it feels good to spend time outdoors and this makes it difficult to avoid excessive exposure to the sun. Most of the sun exposure we accumulate throughout our lives, is thought to be the effect of multiple short periods of time outside. If the ozone depletion continues this may also increase our lifetime exposure.

Those living in sunny areas are clearly at risk for photo damage, as are those with occupations that require working outdoors. Activities such as skiing, sailing, and gardening can contribute to chronic photo damage. Even one-time sun exposure, causing a tan, results in damage to the skin. There is no such thing as a ’safe’ tan.

Individuals with fair skin are clearly at greater risk although sun damage can occur in all skin types. Tanning studios are popular amongst many and this also adds to an accumulation of photo damage.

Smoking is another environmental factor that contributes to premature aging of the skin. Early recognition of sun damage will provide a better chance of reversal of the cosmetic appearance as well as reducing the number of skin cancers.

Cold Sores and Fever Blisters

Read the facts about cold sores and the virus that causes them.

Fact: Cold sores are caused by a virus

• Cold sores are caused by the herpes simplex virus. There are two types of this virus and cold sores are usually caused by type 1 (known as HSV-1). The other type of herpes simplex virus, HSV-2, usually causes genital herpes
• In general, we are infected with HSV-1 when we are children; in the majority of these initial (“primary”) infections, there are no symptoms
• Usually, the virus infects our mouths. Some children experience mouth and gum symptoms (“gingivostomatitis”) or a sore throat (“pharyngitis”).

Fact: Cold sores are the result of the virus reactivating in our bodies

• Once HSV-1 has entered our bodies, it never leaves. The virus moves from the mouth to quietly reside (“remain latent”) in the central nervous system.
• In approximately one third of people, the virus can “wake up” or reactivate to cause disease
• When reactivation occurs, the virus travels down the nerves to the skin where it may cause blisters (cold sores) around the lips, in the mouth or, in about 10% of cases, on the nose, chin, or cheeks
• Many people who suffer from cold sores are aware in advance that a cold sore is about to break out — they have a tingling or burning feeling, redness, itching, or pain (“prodromal symptoms”) around their lips or mouth
• Cold sore outbreaks may be influenced by stress, menstruation, sunlight, sunburn, fever, or local skin trauma.

Fact: The virus that causes cold sores is infectious

• 30%-60% of children below 10 years of age are infected with HSV-1. They have acquired the virus from family and friends through sharing utensils or toothbrushes, and from kissing
• The virus is transmitted from cold sores and also when there are no symptoms, as it can make copies of itself on the skin in the absence of a blister. This phenomenon is called “asymptomatic shedding”
• By 50 years of age, 80%-90% of us harbour HSV-1 because we have caught it from someone close to us
• HSV-1 can sometimes be transmitted to newborn babies by family members or hospital staff who have cold sores; this can cause a severe disease called neonatal herpes.

Fact: The virus from cold sores can infect other areas of the body

• People can transfer the virus from their cold sores to other areas of the body, such as the eye, skin, or fingers; this is called “autoinoculation”
• Eye infection, in the form of conjunctivitis or keratitis, can happen when you rub the cold sore, then rub your eyes before washing your hands
• Finger infection (“herpetic whitlow”) can occur when a child with cold sores or primary HSV-1 infection sucks his/her fingers
• HSV-1 can infect your genital area if you engage in oral sex with a partner with a cold sore

Fact: Early treatment can help eliminate the cold sore

• Some products can accelerate healing if they are used at the prodromal stage of the cold sore
• Prescription drugs include acyclovir cream or capsules (Zovirax®) and penciclovir cream (Denavir®); also, Health Canada recently approved a one day course of 2 grams valacyclovir caplets (Valtrex®) for prodromal use
• Docosanol cream (Abreva®) can be bought without a prescription
• Frequent hand washing minimizes the risk of transferring the virus to other areas of your body

Rosacea 101

It is most commonly seen in those who have fair skin and is sometimes referred to as the “Curse of the Celts” or a “Peaches and Cream“ complexion.

Onset usually occurs between 20-40 years of age.

Rosacea is a long lasting, non-scarring skin condition of the face that is often misdiagnosed as adult acne. (See Acne Guide.ca if you think you may have acne) It varies in severity and does not always worsen with time. Typically, you will experience inappropriate flushing that is not usually associated with sweating and/or persistent facial redness. It is common to have broken blood vessels (telangiectasias) on your cheeks. You may also experience bouts of inflammation that cause red papules (small bumps) or pustules. However, comedones (blackheads and whiteheads) are not part of rosacea.

About 50% of those with rosacea suffer eye involvement, including such conditions as conjunctivitis, blepharitis, dry gritty eyes, and recurrent sties. Nose enlargement (rhinophyma) is uncommon and is mostly seen in men.

Do I Have Rosacea?

If you check of one or more of the following symptoms, you may have rosacea

• My face has a burning and/or stinging sensation
• When I blush, it develops into persistent redness
• I have what looks like “pimples” on my face
• I have “blood vessel lines” showing on my face
• My eyes feel gritty and uncomfortable.
• My skin feels likes it has thickened, particularly on my nose (rhinophyma)

The major goals of rosacea treatment are to:

• Understand the condition
• Identify and avoid the factors that cause flushing for you and that flare your rosacea
• Control the active symptoms and signs of rosacea
• Achieve optimum maintenance of this condition and its complications
• Understand that this is a chronic condition

Self Help:

1) Avoid factors that increase your core body temperature:

• Exposure to weather - sun, cold, wind
• Hot food, hot drinks, and alcohol
• Exercise (you should exercise in cool surroundings and avoid dehydration)
• Medications (you should avoid vasodilating drugs, that is, drugs that expand your blood vessels, and topical steroids)
• Cosmetics (you should avoid greasy, drying, or perfumed products)

2) Daily skin care:

• Avoid hot water, loofahs, and rough towels
• Avoid toners, exfoliating agents, and astringents
• Dandruff – Rosacea frequently coexists with sebhorreic dermatitis or dandruff

3) Cosmetics:

• Anti-redness cream or cosmetic cover-up can be helpful to some patients with rosacea

4) Patient support groups:

• Investigate patient support groups

Shaving Tips

Do you get nicks and in-grown hairs from shaving your legs? You are not alone; these are common complaints from women shaving their legs. Below are a few tips to help you get that smooth, clean shave that you want. For more information on skin care, please go to www.SkinCareGuide.ca.

Soften Those Hairs First: To get smoothly shaved legs, follow these hints. Shave a few minutes after your hair has softened in the shower, let your shaving product stay on your skin for a couple of minutes before starting to shave and make sure your blade/ razor is new.

Avoid Infection: Folliculitis is an infection of the hair follicles that often appears in areas that have been irritated by shaving or close-fitting clothes. Try shaving with an electric razor instead of a blade razor, keep your skin clean and avoid clothing that rubs against the skin and damages hair follicles. Read more on www.FungalGuide.ca

Avoid razor bumps! Ingrown hairs (sometimes called “razor bumps”) can be painful and are often prone to infection. To help prevent razor bumps, try shaving with the grain of the hair and use a very light touch. Also, don’t stretch the skin while shaving.

Will more hair grow back? Contrary to popular belief, shaving will not cause your hairs to grow back darker or thicker. They may look that way, particularly at first. But over time, you’ll see that they have the same appearance and feel as the hairs that came before.

Curly hair? You are at greater risk of getting ingrown hairs after shaving, as the hairs are more likely to curl around and loop back into the skin. You’ll want to take extra care when shaving.

What to use to shave: All out of shaving cream - yet you need to shave your legs? Try using your hair conditioner or body cleanser: they’ll soften the hairs on your skin for a smooth, close shave.

Sensitive skin? Try fragrance-free shaving creams that contain emollients as these will be less irritating to your skin.

Keep them soft. Don’t forget to moisturize! Applying moisturizer after shaving and straight from your shower, will keep your skin feeling soft and supple.

Folliculitis and Skin Infections

Folliculitis is an infection of the hair follicle that is most commonly bacterial, but can occasionally be caused by a fungus. It can be either superficial in the follicle or deep in the skin.

There are also forms of folliculitis which are non-infectious such as those caused by tars, oils and greases that come into contact with the skin.

When, Where, And Who Gets Folliculitis?

Superficial staphylococcal folliculitis is quite common and is seen in people of all ages. It is probably more common in those who have eczema and diabetes. You might see it on your face, scalp, upper trunk, buttocks, or as a sty on your eyelids.

Deeper staphylococcal folliculitis is uncommon and may be seen as boil-like lesions in diabetics. There is also a condition called sycosis, which is a pustular folliculitis, particularly in the bearded area of men.

Gram-negative folliculitis is only rarely seen, usually on the face of those who have been taking antibiotics on a long-term basis for acne. Gram-negative folliculitis is most often seen in people who have been in a hot tub or whirlpool that has been contaminated by the bacteria pseudomonas.

Fungal Folliculitis:

Trichophyton folliculitis is mostly seen in women who shave their legs, presumably spreading this from their athlete’s foot fungal infection.

Pityrosporum folliculitis is usually located on the upper back and shoulder of young people. It is more common in individuals who are immunosuppressed.

Candida folliculitis can be seen on the scalp and in occluded moist areas, such as under the breasts and in the groin areas of people who are obese.

Lab Tests:

Swabbing the skin, then sending it to a laboratory for bacterial and yeast cultures will confirm the infection.

A skin biopsy may be required to confirm deep fungal of yeast folliculitis.

Blood sugar tests and/or HIV testing should be done for those who have repeated infections or an infection that does not have the typical symptoms

What Can I Do About My Folliculitis?

Self help:

Good hygiene with regular hand washing is a must to minimize the risk of staph infections. Keeping your skin healthy and avoiding factors that can over-dry your skin, causing it to crack should be avoided. Picking and squeezing the skin causes minor damage, which in turn makes it easier for infection to set in. A skin that is clean and intact with no abrasions or sites of friction or irritation is less likely to become infected. In some circumstances, there may be a role for antibacterial cleansers. Hot tubs need to be checked regularly for pH and antiseptic levels.

Medical treatment:

If you think you have folliculitis, the most important thing for you to do is to see your doctor in order to confirm the diagnosis, so that you can seek folliculitis treatment. Ideally, the organism causing the infection should be identified and its sensitivity to antibiotics should be established.

Sometimes, your doctor will treat an infection based on his or her clinical suspicion, especially if the appearance is typical.

Bacterial folliculitis can be caused by the following bacteria

• Staphylococcus aureus
• Gram-negative bacteria

Pseudomonas (hot tub folliculitis)

• E. coli
• Klebsiella
• Fungal /yeast folliculitis
• Candida albicans
• Pityrosporum ovale
• Trichophyton rubrum

Topical treatments:

Topical antibiotics and antifungal creams to treat staphylococcal folliculitis:

The choice of folliculitis treatment will depend on the cause of the infection as well as how deep and extensive it is. Topical antibiotics should be used in the short term to minimize the risks of bacterial resistance.

Topical antibiotics can clear superficial localized infections. The affected area should be treated with the appropriate cream or ointment two or three times a day. Chronic staph can be carried inside the nose, and can be a factor if the infection recurs. In such a case, nightly application of the ointment inside the nose will clear the reservoir of the bacteria. Oral antibiotics will be required if there is an inadequate response.

1) Fusidic acid:

Fusidic acid is an antimicrobial that was isolated by Godtfredsen, et al, in Europe from the fermentation of Fusidium Coccineum. It was introduced into clinical practice in 1926, as an oral drug. About twenty years later, it was introduced in Canada as a topical drug.

How do I use this medication?

Fusidic acid is available both as a cream and as an ointment. You should apply it thinly on to the infected area 3-4 times daily.

How does it work?

Fusidic acid inhibits protein synthesis in the bacteria and without that capacity, the bacteria will die. The topical formulation penetrates a damaged, infected horny layer better than intact skin. It is related to the cephalosporin, an antibiotic produced by Cephalosporium, a genus of fungi.

Will there be side effects?

Side effects from the topical preparations are very uncommon. There have been no human tests done during pregnancy and lactation, but there have been no adverse reports.

Can I take other medications?

There are no interactions from the topical formulation of fusidic acid.

Which brands are available?

• Fucidin® 2% cream and ointment available as well as Fucidin HCl®, which is combined with 1% hydrocortisone acetate
• Fucidin Intertulle® - impregnated into a gauze
• IV, tablets and oral suspension (250mg/5ml) are available, IM and subcutaneous administrations are too irritating

2) Mupirocin:

A natural product of Pseudomonas fluorescens that has antibacterial actions against gram-positive bacteria such as Staphylococcus and Streptoccus. It has some activity against gram-negative organisms. It is inactive against anaerobic bacteria chlamydia and fungi.

How do I use this medication?

Mupirocin is available both as a cream and an ointment. You should apply it thinly on the affected area 3 times a day for up to 10 days. It may be used on all ages except for in the USA where the Bactroban nasal ointment is not recommended for children under the age of 12.

How well does it work?

Mupirocin is easy to apply and is very effective against the common skin pathogens such as Staphylococcus and Streptococcus. It works well for impetigo as well as bacterial folliculitis. The incidence of resistance remains low. For localized impetigo it works as well as oral antibiotics in 90% of cases. It is not effective against Pseudomonas or fungi. It is useful in the treatment of chronic Staph carriage in the anterior nares (nose).

How does it work?

It is unlike other antibiotics in that it inhibits bacterial isoleucyl transfer-RNA synthetase blocking protein synthesis. It is bacteriostatic at low concentrations and bacteriocidal at high concentration. There is virtually no systemic absorption via intact skin and anything that is becomes metabolized to monic acid and quickly removed by the kidneys.

Will there be side effects?

Local:

Dry skin, swelling, burning pain itch and rash. The effects are usually mild. Allergic reactions are rare. Polyethylene glycol will be irritating if the ointment is used around the eyes.

Systemic:

Renal toxicity from absorption of the polyethylene glycol vehicle (ointment only) if large amounts are used in open wounds or burns.

Which brands are available?

• Bactroban ointment 2% mupirocin (polyethylene glycol base)
• Bactroban cream 2% mupirocin (oil-water based emulsion)
• Bactroban Nasal - for the nose and is in a white paraffin/glycerin base (not available in Canada)

What conditions are treated by this medication?

• Skin staphyococcal infections including impetigo, folliculitis, burns, and wounds
• It is also used to treat streptococcal infections

Mild Cleanser Basics

Why Cleanse the Skin?

Skin cleansing is necessary for skin health, hygiene and well being. Without effective cleansing, your skin’s surface can accumulate debris, sweat, air pollution, excess oil and bacteria. Cleaning the skin also helps to reduce the growth of microorganisms and reduce infection.

Washing with water alone will rinse some of the dirt and debris away, alone it’s not quite enough. Plain tap water will only remove about 65 percent of the oil and dirt on your skin, and will not effectively remove makeup. Skin cleansers, however, work as emulsifiers and help remove dirt, excess sebum (natural skin oils), bacteria, cosmetics and exfoliated surface skin cells.

Cleansers are especially important for those who use cosmetics, have sensitive or irritated skin, or use topical skin treatments.

Where Dirt and Debris Collect

When we cleanse our skin, we’re targeting the outermost layer of the skin called the epidermis. This outermost layer of the epidermis is composed of a tough protein-fat structure that produces a protective outer film, the skin moisture barrier. Part of the function of the epidermis is to waterproof the skin. While this film shields skin cells from the environment, it also traps and holds dust, pollutants, smoke, bacteria, cell debris, sweat and cosmetics.

Washing the embedded dirt off of your skin also removes some of this outer protective film and can irritate your skin, although mild cleansers have been developed to restore and maintain this protective covering.

Cleansing History

Today many people use the term “soap” to refer to any cleaning agent regardless of its chemistry.

Traditionally soap is a simple combination of fats, oils and salt with a history stretching back to the ancient Romans. In fact, the word “detergent” is derived from “to wipe off” in Latin.

Soaps as we know them were first used about 600 BC by the Phoenicians who combined goat fat, water and potassium carbonate ash to form a solid soap. More recently, in 1878, Harley Procter developed a new type of soap in collaboration with his cousin, James Gamble. They whipped air into a solution and created Ivory Soap, a product still sold today.

Cleanser Ingredients

Skin cleansers are formulated for a wide variety of needs and take many forms, from basic bar soaps to foaming liquid cleansers and antibacterial washes.

Surfactants (surface-acting agents) are the major ingredients in most cleansers, making up 30 to 70 per cent of the product. New synthetic cleansers with silicone surfactants are less irritating to the skin.

Most cleansers contain a combination of some of these ingredients:

• Water
• Surfactants (to emulsify dirt and debris)
• Moisturizers (to hydrate and maintain the skin barrier)
• Binders (to stabilize the cleanser’s ingredients)
• Lathering agents
• Fillers (used to harden bar soaps and cleansers)
• Preservatives (to prevent growth of microorganisms)
• Fragrance (usually to mask the odour of surfactants)
• Dyes or pigments

Cleansing naturally

Most cleansers, makeup, and other beauty products are full of harsh synthetic chemicals that may be harmful to skin. Natural solutions for healthy skin care are better for you, support a cleaner environment and natural techniques work at least as well.

Essential oils are some of nature’s best helpers in almost every aspect of health. Many times more potent than dried herbs, essential oils contain all the healing properties of a plant in a very concentrated form. For this reason, they are best used in tiny amounts and are often diluted for skin care.

Sea salt is the world’s most mineral-rich exfoliant. The minerals in sea water are known to nourish and heal skin. The same minerals can be found in unprocessed, mineral-rich sea salt, and the coarseness of salt makes it a perfect exfoliant. Try the following whole-body sea salt scrub.

- 1 Cup Sea Salt

- 2 Tablespoons Apricot or Almond Oil

- 5-6 Drops Peppermint Essential Oil

1. Put salt in a bowl and add the oils.

2. Mix well.

3. Store in covered container until ready to use.

This recipe is best used in the shower after washing. Rub a small handful of the salt scrub all over your body in brisk circular motions. Afterwards, use a moisturizing anti aging skin care product.

Fatty oils restore skin’s moisture and flexibility. Part of the benefit of the salt scrub recipe is the apricot or almond oil it contains, which leaves a nice glow and moisture in the skin.

Using an oil cleansing method, surprisingly, is a simple and effective way to clean your face. Using olive oil, castor oil, and hot water leaves a lasting glow. Fatty vegetable oils can be used as moisturizers, makeup remover, cleansers if you want to stay all natural.

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