It is not uncommon for patients to present reporting they have sensitive skin.

Equally, it is common to see patients presenting after product overuse, or combining the wrong active ingredients and developing contact dermatitis or worse as a result.

One of the first things a skin consultation is designed to help us determine is whether a patient truly has sensitive skin (eg someone with a history of eczema) or sensitised skin, often due to overuse or incorrect use of skincare ingredients.

Some common culprits?

• many chemical exfoliants such as lactic, glycolic and salicylic, often found in washes, exfoliating formulations and even toners
• physical scrubs and exfoliators - yes apricot scrub is a no-no but there are others, with beads, gels and other ingredients. Equally, physical scrubs include battery operated exfoliating brushes as well as anything else that may rub against your skin and cause irritation such as even makeup remover wipes!
• retinols and other Vit A derivatives, well known for causing irritation in most of us, with time needed to build to daily use; these include all the over-the-counter Vit A derivatives - retinol, retinaldehyde as well as prescription retinoids such as tretinoin, adapalene and tazarotene.
• Vit C (ascorbic acid) again, may be irritant in many people with sensitive (and definitely sensitised) skin and may need careful progression to build use
• other examples of irritants include other brightening agents commonly found in skincare such as azelaic acid and kojic acid
• combinations of two or more potentially irritating actives eg an acid + retinol
• occasionally fragrance may also irritate your skin, and occasionally, the other ingredients used to formulate your skincare

It is completely understandable that you may want to try the latest skin trend, or ingredient on the market. For many however, combining ingredients without understanding your own skin, its needs or misdiagnosing its nature, can lead to multiple skin concerns and complaints which can then be costly in terms of time and money, to fix.

I commonly see people after weeks to months, sometimes years, of skin pathology often begun through an innocent enough treatment which led to an adverse outcome, which was attempted to be fixed by doing other things, leading to more irritation in a loop fashion.

In most cases, the longer the cycle of irritation continues, the longer it might take to fix the underlying concern and get skin back on track. Weeks, sometimes months.

The ingredients listed above are are well known, even in those with healthy skin, to cause problems and to need a slow buildup to daily use. For people with sensitive skin, some of them may be no-go and for those with damaged skin barriers we may need to take time to repair the barrier first before even considering adding in any active ingredients or in-clinic treatments. In these cases, it is best to start with a doctor who can oversee this for you, recognising that this will take time, effort and budgeting.

That said, there are often predictable reasons why a skin ingredient that gets rave reviews everywhere may wreak havoc on your skin. Read on to find out what they might be!

1. Active ingredients known to cause side effects

The common ingredients are listed above, and as you can see, it is not an exhaustive list, and most of us have at least some of these ingredients in our cleansers/ toners/ serums, so it is easy to see how, and why, most of us have, at some stage in our lives, experienced irritation or worse.

The problem is then compounded when we do not understand why this may have occurred and try to fix the initial problem with something else sold to us by advertisements, well meaning friends and so on, as being “the solution”. No! Stop, please. Stop using, and seek medical advice, please.

2. Damaged skin barrier

Reason 1 above leads, if disregarded, to reason 2 - a damaged skin barrier.

What does a damaged skin barrier feel/ look like? No two persons, faces or skins are the same, so your mileage may vary but I routinely ask patients during consultations what their skin FEELS like, to give me clues as to what might be going on and if what they are using works for them.

If it works for you, there is no need to buy “my” brand or “a” brand of product that is sold by your favourite shop/clinic/ influencer/ beauty blogger.

If you say yes to one or more of these, then maybe your routine needs some work:

• dry feeling skin after cleansing
• redness, irritation that does not settle
• stinging and burning after applying anything to the face
• tendency to acne/ pimples (which often leads to more use of anti-acne skincare)
• tight feeling skin
• tendency to tear easily

How many of these did you say yes to?

3. If less is good, more must be better!

If I had a dollar every time I get asked about the concentration of the chemicals I use in the peels that I use, or the number of times patients present with sunburn or contact dermatitis because we began an active ingredient and they decided to speed up the process because “if a little is good a lot must be better, amirite?”

Skin cannot be rushed. It is a living, breathing organ, and the largest one you have. It puts up with a lot of wear and tear on a daily basis to keep us healthy and safe - UV exposure, pollution, changing weather conditions, makeup and related to that, (multiple) daily cleanses, to name a few.

Good quality skin can take this and more in its stride, but too much of a good thing is still bad. Just as you cannot expect to show up and run 5km after being a couch potato your whole life, so it is with skin. It takes time for skin to adjust, and to respond, and by rushing you may actually be doing more harm than good.

There is a general principle in Medicine - the optimal dose for a patient to treat a condition must be high enough (ie above the minimal threshold) to be effective and at the lowest possible concentration to achieve the desired effect.

What does that mean?

- if you are an adult, the standard dose of paracetamol for a headache, for example, is 2 tablets, ie 1g. 1 tablet ie 500mg is likely below the threshold of efficacy - you risk potential side effects without any of the benefits. At the same time, if 1g is good for your headache 2g must be even better right? Wrong - too much, and you risk toxicity.

So my advice to patients is always, to find a trusted clinician who understand science and leave the numbers and doses to them. More can be less.

4. Lack of enough other measures

Adjunctive measures are super important, and cannot be stressed enough:

• daily sun protection - SPF 30+ daily, regardless of whether you think you‘ll go out; sun hat and sunglasses and protective clothing and seeking shade are the foundations of adequate sun protection
• sticking to a tried and tested skincare regimen that works for you instead of being tempted by the latest fad or trend. Why ruin a good thing?
• avoid mixing up too many active ingredients especially on naive skin
• add in new ingredients slowly and preferably, one at a time so if there is a reaction, you know what the likely culprit is.
• I usually pare skincare back to the basics when I see patients for skincare audits, especially if they have skin concerns. We can always add them in as needed down the track.
• for anyone with sensitive or sensitised skin, I tend to go very very slow with very inert ie bland ingredients. It is very boring, like watching paint dry, and may take weeks to months to repair the skin barrier, but there is no alternative to it; your skin will take as long as it takes.

5. Your skin may simply not like the ingredient

Last but not least, if all else has failed, including re-introducing an ingredient after a trial period off it, and your skin still breaks out, or does not cope, it may be time to acknowledge that you are unlikely to tolerate it.

A common example of this, is many prescription retinoids and some retinols. Some people with sensitive skin will simply not cope, and may have to forego it, or they may find a particular brand in a particular formulation that might work for them, mainly through trial and error.

My biggest advice would be - your skin is a living, breathing organ. Treat it as such and aim for beautiful, healthy and radiant skin by learning what works best for it.

It takes time to work out what your skin likes best, and once you do, stick to it, and seek medical advice for the rest. Be guided by your doctor on what might benefit your skin and then stick to it!