Interview With a Dermatologist: Everything You’ve Wanted to Know About Sensitive Skin and the Skin Microbiome

What causes sensitive skin?

Dr. Garshick: Sensitive skin can be genetic and occurs when the skin barrier is compromised which leaves the skin more susceptible to irritation and reactivity. It can result in the skin appearing red and flaky and may be associated with stinging, burning or itching. While the skin can become more sensitive as a result of the environment or external factors, some individuals may be more predisposed to having sensitive skin.

I know it’s important to nurture a healthy gut microbiome—what does a microbiome have to do with my skincare?

Dr. Garshick: Healthy skin relies on a healthy skin microbiome and disrupting the skin microbiome can impact the skin barrier and leave the skin susceptible to different skin conditions. The skin barrier works to protect the skin and helps to keep moisture in and external irritants out and when it’s injured, it can leave the skin looking and feeling dry, red and sensitive. For this reason, it is important to support the skin’s microbiome in addition to a healthy gut microbiome.

Could you explain the relationship between your skin barrier and your skin microbiome?

Dr. Garshick: Your skin microbiome is a component of the skin barrier and helps to support the skin barrier but the skin barrier is also comprised of other factors that are key in keeping it healthy and strong. The skin barrier also relies on certain fatty acids and lipids to function to keep moisture in and keep external irritants out. 

I’ve heard about probiotics, prebiotics, and postbiotics—what’s the difference?

Dr. Garshick: Probiotics are considered live microorganisms that provides health benefits, so called good bacteria or yeast. When probiotics are ingested, they join the bacteria that has already been living in the gut and aim to keep the balance of good organisms and bad organisms in check.

Probiotics can be very hard to keep stable in skincare formulation as they are live bacteria, which is where prebiotics and postbiotics come in. Prebiotics help to feed, support and stimulate the growth and activity of existent bacteria in the body. Postbiotics are the compounds that living bacteria release after they are metabolized, which can have beneficial effects on the skin. Postbiotics are the key outputs from the healthy good bacteria living naturally on our skin and can help to hydrate, reduce inflammation and improve overall skin health. It is efficient because you are giving the skin the benefits of the bacteria without reintroducing the live version of the bacteria to the skin.

Wait, I thought I wanted to get rid of bacteria. Won’t bacteria cause breakouts?

Dr. Garshick: There are certain types of bacteria that live on our skin that can be problematic and contribute to certain types of skin conditions such as breakouts. However, there are also good bacteria that live on the skin that help to keep pathogens away and are protective. 

The microbiome refers to the microorganisms that live on the skin and comprise the skin flora which can actually be helpful to protect the skin, help boost immunity, keep pH in balance and more. As such, you don’t want to disturb the microbiome so we are now learning how to incorporate products that are gentle on the microbiome. 

How do I know if my skin microbiome is off balance?

Dr. Garshick: If the skin microbiome is disrupted, it can become dry, irritated and inflamed, more prone to injury and damage and because your skin barrier can be affected, it can impact the way your skin reacts to various products or to outside stressors.

It is thought that shifts in the microbiome can have a role in various skin conditions, including dry skin, eczema, acne and rosacea.

What might be the cause of a skin microbiome imbalance?

Dr. Garshick: Environmental stressors and external factors can impact the skin microbiome. Harsh soaps or astringents can disrupt the skin’s pH which can subsequently impact the skin’s microbiome and the skin barrier. Other factors include over-exfoliation, over cleansing, harsh astringents, antibacterial soaps and using a lot of products in a skincare routine.   

What kinds of skincare products should I avoid?

Dr. Garshick: The skin microbiome is different depending on the location on the body but in general, the skin microbiome is sensitive to use of antibiotics. This is not just the antibiotics that someone ingests, but topical antibiotics as well as use of antibacterial soaps. Some soaps can affect the microbiome through an antibacterial effect and some by affecting the pH of the skin. In general, the microbiome prefers an acidic environment and as soaps alter that environment, it can disrupt the microbiome. For this reason, it is important to use cleansers and washes that are gentle on the skin.

Should I avoid skincare with natural fragrance if I have sensitive skin?

Dr. Garshick: Although individuals with sensitive skin may be more likely to experience a reaction with fragrance, not all fragrance is bad for sensitive skin. Ultimately it comes down to the formulation but those with sensitive skin may be able to tolerate light fragrances. Furthermore, not everyone will react to the same type of fragrance so just because one fragrance causes a sensitivity doesn't mean all fragrances will.  Additionally, it can help to use products that are also working to support the skin barrier and nourish the skin which can help to strengthen the skin barrier and make it less likely to react to fragrance.

What can I do to restore my skin microbiome?

Dr. Garshick: Use gentle products and look for ingredients like postbiotics, vitamin E, hyaluronic acid and squalane. I recommend Andalou’s 1000 Roses collection because it is designed to support the skin’s microbiome through the use of postbiotics, to help support healthy skin, especially among those with sensitive skin. This collection incorporates fruit stem cell science, Alpine Rose Stem Cells, Postbiotics and Hyaluronic Acid to help soothe the skin, support the skin barrier and leave the skin feeling and looking healthy and hydrated. 

Thanks for answering all our questions about the skin microbiome, Dr. Garshick! 

Shop Andalou’s Sensitive 1000 Roses collection for dermatologically-tested skin care designed to support your skin’s delicate microbiome.