COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE in Visual Studio .NET

Paint QR Code ISO/IEC18004 in Visual Studio .NET COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE

COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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CHAPTER 17 Burning and Stinging Skin (Type 3 Sensitive Skin)
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Leslie Baumann, MD
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in their lives, with 23% of women and 138% of men having had a problem in the last 12 months1 Another study demonstrated that women showed a greater tendency toward being more sensitive to the subjective effects elicited by lactic acid than males2 about the effects of chemical agents upon the excitability of sensory units such as Merkel cells It is believed that those with a predilection toward stinging have an increased nerve response Capsaicin, the irritant ingredient found in red pepper and used commercially as pepper spray, causes pain and burning on skin contact on all subjects Its mechanisms of action have been studied in the pursuit of a better understanding of chemogenic pain Although it is not known if these same pathways play a role in the skin burning that patients feel when they apply skin care products, it is possible that these follow a similar mechanism; therefore, the actions of capsaicin will be explored here The C polymodal nociceptor is stimulated by capsaicin and other chemicals The effects of capsaicin are dependent on concentration Topical application of 1% capsaicin on intact skin typically produces sensitization to heat7 Findings of differential capsaicin effects on heat perception and mechanical stimuli perception have led to the belief in the existence of two categories of functionally different nociceptors in human skin8 Much more research needs to be conducted in this area; however, it is plausible that the heat-sensitive nociceptors play a role in this stinging and burning skin type VASODILATATION AND ITCHING Type 3 sensitive skin patients complain of abnormal sensations and may or may not exhibit vasodilatation C nonmyelinated
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MECHANISMS OF BURNING AND STINGING
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A subset of people feel stinging and burning when exposed to certain skin care products These people have traditionally been called stingers since Kligman coined the term in 1977 This skin type has also been called reactive skin, hyperreactive skin, intolerant skin, or irritable skin In the Baumann Skin Typing System, stingers are designated as having Baumann S3 sensitive skin (see 9); the 3 denotes burners and stingers rather than other types of sensitive skin that develop such as acne (S1), rosacea (S2), or contact dermatitis (S4) One patient can demonstrate one to four different types of sensitive skin For example, many rosacea (S2) patients are also burners and stingers (S3) Although this skin type is referred to as stingers in the context of applying chemical factors such as skin care ingredients, this skin type also includes those who feel the onset of a prickling, tingling sensation, or slight pain because of physical factors such as ultraviolet radiation, heat, cold, and wind Psychologic stress or hormonal factors such as menstruation may play a role as well It is important to know a patient s susceptibility to S3 sensitive skin because this may lead to noncompliance with certain medications and vehicles that cause discomfort to the patient Finacea is an example of a rosacea medication that causes stinging in a small proportion of users Retin A Micro contains benzyl alcohol (a derivative of benzoic acid) that can cause stinging in certain people This chapter will discuss what is known about the mechanisms of burning and stinging, what ingredients are most likely to cause it, and how to identify a potential stinger Stinging is a problem reported to occur primarily on the face, particularly on the nasolabial folds and cheeks The extreme sensitivity of this region is thought to be caused by a more permeable horny layer, a high density of sweat glands and hair follicles, and an elaborate network of sensory nerves3 There is specificity of the stinging response that is not understood In other words, an individual may be a lactic acid stinger, but not experience such a reaction to other ingredients such as benzoic acid and azelaic acid One study showed that there was no correlation between patients who stung from lactic acid and those who stung from azelaic acid4 This suggests that there is some sort of specificity involved that has not yet been deciphered
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