Sensitive Skin: Neurosensory Dysfunction Explained

Sensitive skin affects millions of people, but the underlying cause is often misunderstood. In most cases, sensitivity is directly connected to barrier dysfunction.

Pathophysiology

Primary Issues

Impaired barrier function

Decreased ceramides and sphingolipids

Elevated skin pH (alkaline environment weakens barrier)

Increased serine protease activity (degrades barrier lipids)

Enhanced neurosensory input (exaggerated sensations)

The pH Dysregulation Cascade

Alkaline pH → ↑ serine proteases

Proteases → ↑ PAR-2 activation → pruritus (itching)

Ceramide degradation → barrier breakdown

↑ penetration of irritants → inflammation

Cytokine release → further barrier damage

Cycle repeats → chronic sensitivity

Common Triggers

Product-Related

Fragrance (natural and synthetic)

Essential oils

Alcohol (denatured)

Harsh surfactants (SLS, SLES)

High-concentration actives

pH-inappropriate products

Environmental

Temperature extremes

Low humidity

Wind exposure

Pollution

Hard water

Lifestyle

Stress

Lack of sleep

Poor diet

Dehydration

Treatment Approach

1. Restore Acidity

Use pH-balanced products (4.5-5.5)

Avoid alkaline cleansers

Consider pH-adjusting toners

2. Rebuild Barrier

Ceramides, cholesterol, fatty acids (C.C.F.)

Niacinamide (stimulates ceramide production)

Panthenol (promotes healing)

3. Minimize Irritants

Fragrance-free formulations

Simple ingredient lists

Patch test new products

4. Soothe Inflammation

Centella asiatica

Licorice extract

Aloe vera

Oat extract

5. Gentle Cleansing

Low-pH cleansers

No foaming agents

Lukewarm water only

Building a Sensitive Skin Routine

Morning

Splash with lukewarm water (or gentle cream cleanser)

Centella/cica serum

Niacinamide moisturizer (4%)

Mineral sunscreen (zinc oxide)

Evening

Gentle oil cleanser

Cream cleanser (pH 5.5)

Panthenol serum

Ceramide-rich moisturizer

Squalane or facial oil (optional)

Ingredients to Avoid

Introducing New Products

The Patch Test Protocol

Apply small amount behind ear

Wait 24 hours

If no reaction, apply to inner arm

Wait another 24 hours

If clear, try on a small area of face

Gradually expand use over 1-2 weeks

When to See a Dermatologist

Persistent redness that doesn't improve

Burning or stinging with most products

Eczema-like patches

Suspected rosacea

Reactions getting progressively worse

The Bottom Line

Sensitive skin is usually a barrier issue, not a permanent skin type. By restoring pH balance, rebuilding the lipid barrier, and avoiding irritants, most people can significantly reduce their sensitivity over time.