What is the etiology of rising skin hypersensitivity and its optimal treatment?

From the Guidelines

Rising skin hypersensitivity is primarily caused by increased exposure to allergens, environmental pollutants, stress, genetic predisposition, and disruption of the skin barrier function, and the optimal treatment involves a multi-faceted approach beginning with identification and avoidance of triggers. The etiology of rising skin hypersensitivity is complex and multifactorial, involving a combination of genetic, environmental, and lifestyle factors. Key factors include increased exposure to allergens, environmental pollutants, stress, and disruption of the skin barrier function 1.

Optimal Treatment Approach

The optimal treatment approach for skin hypersensitivity involves a multi-faceted strategy that includes:

• Identification and avoidance of triggers
• First-line pharmacological treatments such as topical corticosteroids (e.g., hydrocortisone 1% for mild cases, applied twice daily for 1-2 weeks) and antihistamines (e.g., cetirizine 10mg daily or fexofenadine 180mg daily) to manage itching 1
• Maintaining skin barrier function through regular use of fragrance-free moisturizers applied immediately after bathing
• Use of mild, soap-free cleansers, avoidance of hot water, wearing loose cotton clothing, and maintaining optimal humidity levels (40-60%) in living spaces
• For severe or persistent cases, immunomodulators such as tacrolimus ointment (0.03-0.1%) or pimecrolimus cream (1%) applied twice daily may be effective steroid-sparing alternatives 1
• Systemic therapies, including oral corticosteroids (e.g., prednisone 20-40mg daily with taper), cyclosporine (3-5mg/kg/day), or biologics, may be necessary under specialist supervision for severe cases unresponsive to topical treatments 1

Key Considerations

It is essential to note that the treatment approach should be individualized based on the severity and persistence of symptoms, as well as the patient's medical history and lifestyle.

• Patients should be educated on the importance of avoiding triggers, maintaining skin barrier function, and using gentle skin care products.
• Regular follow-up appointments with a healthcare provider are crucial to monitor the effectiveness of treatment and adjust the approach as needed.
• In cases where allergic contact dermatitis is suspected, patch testing may be necessary to identify specific allergens and guide treatment 1.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily

The etiology of rising skin hypersensitivity is not directly addressed in the provided drug labels.

• The labels mention various causes of skin irritation, such as eczema, psoriasis, insect bites, detergents, jewelry, cosmetics, and soaps.
• However, they do not provide information on why skin hypersensitivity may be increasing across generations.
• The optimal treatment for skin hypersensitivity is also not explicitly stated, but the labels suggest using hydrocortisone to temporarily relieve itching associated with minor skin irritations 2 2. The FDA drug label does not answer the question.

From the Research

Etiology of Rising Skin Hypersensitivity

• The etiology of rising skin hypersensitivity is complex and multifaceted, with various factors contributing to its development, including heightened neurosensory input, enhanced immune responsiveness, and diminished barrier function 3.
• Sensitive skin syndrome is a widely reported complaint, with epidemiological studies showing a high prevalence of sensitive skin among women (60-70%) and men (50-60%) 4.
• The relationship between skin sensitivity and skin irritations and allergies is not fully understood, but research suggests that active ingredients in cosmetic products can play a role in alleviating sensitive skin symptoms 5.

Optimal Treatment for Skin Hypersensitivity

• Personalized skin management is recommended for patients with sensitive skin syndrome, as no clinical studies have been conducted on specific treatment protocols 4.
• A rational approach to skin-care product selection is important, with considerations including products with a paucity of ingredients, absence of common sensitizers, minimum number of irritants, and absence of cutaneous sensory or vasodilatory stimulants 3.
• Topical corticosteroids have been shown to be effective in treating acute sunburn, with high-potency corticosteroids providing a clinically relevant reduction in redness when applied 30 minutes before UV-B exposure 6, 7.
• Simple skincare routines may be more relevant now than ever, as they can help to minimize skin irritation and alleviate sensitive skin symptoms, with a focus on gentle, fragrance-free products and minimal ingredient lists 3, 5.