Sensitive Skin vs Rosacea

[Guide]

Differential Diagnosis from Rosacea?
An article published in the Chinese Medical Journal states that Sensitive Skin (SS) should be a differential diagnosis from Rosacea, concluding, “The pathogenesis, medication, and prognosis of rosacea and SS are quite different, so it is necessary to find reliable non-invasive method to differentiate between the two conditions.” [1]

However, another paper states the following: 
"Cosmetics were the most frequent source of sensitization, followed by topical medications-notably corticosteroids and antifungal agents." [13]

Are you aware there is such a thin line between sensitive skin and rosacea? 

Skin Condition or Syndrome? 
"A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder." Wikipedia

"Sensitive skin is a skin condition in which skin is prone to itching and irritation experienced as a subjective sensation when using cosmetics and toiletries. When questioned, over 50% of women in the UK and US, and 38% of men, report that they have sensitive skin." [2]

"Using the Delphi method, sensitive skin was defined as 'A syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. These unpleasant sensations cannot be explained by lesions attributable to any skin disease. The skin can appear normal or be accompanied by erythema. Sensitive skin can affect all body locations, especially the face'." [3]. 

Some authorities propose listing SS as a syndrome, stating, "Moreover, the presence of erythema in patients with sensitive skin does not imply that the erythema is due to sensitive skin, as sensitive skin is sometimes associated with skin diseases, particularly atopic dermatitis (AD). AD is not the only dermatosis that can be associated with sensitive skin; in fact, some authors propose to define a subcategory of sensitive skin associated with dermatological diseases (for example: AD, rosacea, psoriasis, seborrhoeic dermatitis, acne, etc.)." [3]

"SS is defined as a syndrome defined by the appearance of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that would not normally cause such sensations..." [4]

"Sensitive skin syndrome (SSS) is a common and challenging condition, yet little is known about its underlying pathophysiology. Patients with SSS often present with subjective complaints of severe facial irritation, burning, and/or stinging after application of cosmetic products. These complaints are out of proportion to the objective clinical findings. Defined as a self-diagnosed condition lacking any specific objective findings, SSS is by definition difficult to quantify and, therefore, the scientific community has yet to identify an acceptable objective screening test...Defined as a self-diagnosed condition, SSS is by definition difficult to quantify. Some of the contradictions between investigators could be explained by flawed methodologies since the scientific community has yet to identify an acceptable objective screening test for sensitive skin...SSS is very common and poses a challenge to physicians and patients alike. We are still far from understanding the underlying mechanisms involved. Therefore, more basic science research is warranted. " [5]

Sensitive Skin vs Rosacea
It is common for rosaceans to complain of sensitive skin and the line between sensitive skin and rosacea is very thin. Do you want the RRDi to sponsor some investigative clinical research into sensitive skin and rosacea? Could 10K members of the RRDi each donate one dollar to sponsor such research?  

"A still unanswered question is whether improper formulations could also prove to be counterproductive in other types of sensitive skin, such as rosacea."

Tests for Sensitive Skin

Lactic acid sting test (LAST) [11]

Treatment

"A bakuchiol nature-based anti-aging moisturizer is well tolerated and effective in individuals with sensitive skin." [6]

Differin Detox + Soothe 2Step Face Mask [10]

Eau Thermale Avene Hypersensitive Skin Regimen Kit for Sensitive and Irritated Skin [7]

Eau Thermale Avene XeraCalm A.D Lipid-Replenishing Cream, Atopic Dermatitis, Eczema-Prone, Fragrance-Free, Pump [7]

Eau Thermale Avène Cicalfate+ Restorative Protective Cream [7]

Eau Thermale Avene Cicalfate Post- Procedure, Soothing Skin Recovery Lotion [7]

Flushing Avoidance Treatments 

REN Clean Skincare - Evercalm Anti-Redness Serum [8]

REN Clean Skincare - Evercalm Gentle Cleansing Milk [8]

REN Clean Skincare Stop Being So Sensitive Evercalm Value 3-Piece Set [8]

PCA SKIN Anti-Redness Serum [9]

PCA SKIN ReBalance Face Cream [9]

Rose Hip Oil 

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End Notes

[1] Chin Med J (Engl). 2020 Aug 5.  doi: 10.1097/CM9.0000000000001001. 
A predictive model for differential diagnosis between rosacea and sensitive skin: a cross-sectional study
Xiao-Yan Wang, Yun-Yi Liu, Yi-Xuan Liu, Wei-Wei Ma, Jia-Wen Zhang, Zi-Jing Liu, Juan Liu, Bing-Rong Zhou, Yang Xu

[2] Sensitive Skin, Wikipedia

Allergic Dermatitis Image Courtesy of Wikimedia Commons

[3] ActaDV
Definition of Sensitive Skin: An Expert Position Paper from the Special Interest Group on Sensitive Skin of the International Forum for the Study of Itch 
Laurent Misery, Sonja Ständer, Jacek C. Szepietowski, Adam Reich, Joanna Wallengren, Andrea W. M. Evers, Kenji Takamori, Emilie Brenaut, Christelle Le Gal-Ianotto, Joachim Fluhr, Enzo Berardesca, Elke Weisshaar

[4] Sensitive Skin and Rosacea

[5] Indian J Dermatol. 2012 Nov-Dec; 57(6): 419–423.doi: 10.4103/0019-5154.103059
The Sensitive Skin Syndrome
Hadar Lev-Tov and Howard I Maibach

[6] J Drugs Dermatol. 2020 Dec 01;19(12):1181-1183
Clinical Evaluation of a Nature-Based Bakuchiol Anti-Aging Moisturizer for Sensitive Skin.
Draelos ZD, Gunt H, Zeichner J, Levy S

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[8]

[9]

[10]

[11] Clin Cosmet Investig Dermatol. 2021; 14: 1215–1225.
Questionnaire and Lactic Acid Sting Test Play Different Role on the Assessment of Sensitive Skin: A Cross-sectional Study
Yao Pan, Xue Ma, Yanqing Song, Jinfeng Zhao, and Shiyu Yan 

[12] Optimizing Emollient Therapy for Skin Barrier Repair in Atopic Dermatiti

[13] "We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications." Contact Allergy in Patients With Rosacea

[Apurva Tathe]

Yes sensitive skin can't be defined by any other skin disorders in particular but other skin disorders like rosacea, atopic dermatitis have the properties of sensitive skin.