Exfoliator for sensitive skin: what the AAD advises

The American Academy of Dermatology (AAD) says people with "dry, sensitive or acne-prone skin may prefer just a washcloth and a mild chemical exfoliator, as mechanical exfoliation may be too irritating for this skin type." This guide explains that advice: the two kinds of exfoliator, what to look for on a chemical exfoliator's label, how to use one gently, and the signs that it is too much. It is part of Skinli's guide to sensitive skin.

Skinli gives general education and is not a doctor. Skinli has tested no exfoliator, and no source read for this guide tested one on sensitive skin, so this page names no brand. How often to exfoliate is covered in how often to exfoliate your face. Skin that has had too much is covered in over-exfoliation and over-exfoliation bumps.

Does sensitive skin need exfoliating at all?

Exfoliating removes dead skin cells from the surface of the skin. The AAD is careful about it: "While some people believe that this improves the appearance of their skin, it's not for everyone. If not done properly, it could do more harm than good." No source read for this guide says sensitive skin needs it.

Several groups have a reason to skip it or keep it rare:

• Rosacea. The AAD's rosacea page says: "If you exfoliate your skin, stop." An AAD news release on rosacea advises against "rubbing or scrubbing your face, or using washcloths, facial sponges, or exfoliators". The guide skincare for rosacea covers rosacea care.
• Acne-prone skin. The AAD's acne tips say to "Avoid products that can irritate your skin, including astringents, toners, and exfoliants. These products can dry your skin and make acne appear worse." Another AAD acne page says: "Scrubbing can irritate acne-prone skin, which worsens acne." Acne treatment for sensitive skin covers gentler ways to treat acne.
• Skin already on retinol or benzoyl peroxide. The AAD says these products can make skin "more sensitive or peel", and that "Exfoliating while using these products may worsen dry skin or even cause acne breakouts." Retinol for sensitive skin explains how to start retinol slowly.
• Darker skin tones. The AAD says that for some people, especially those with darker skin, harsher forms of exfoliation can lead to more pigment, seen as dark spots.
• Skin that is cut or sunburned. "Never exfoliate if you have open cuts or wounds or if your skin is sunburned."

Using an exfoliator too often can harm any skin. The AAD's page on skin care in your 20s says: "When overused, an exfoliator can damage the protective layer called the skin barrier." The skin barrier is the top layer of skin that keeps water in and irritants out.

Two kinds of exfoliator

The AAD describes two methods.

Mechanical. "Mechanical exfoliation uses a tool, such as a brush, pad, or sponge, or a scrub to physically remove dead skin cells." Exfoliating gloves and textured pads belong here.

Chemical. "Chemical exfoliation uses chemicals, such as alpha and beta hydroxy acids, to dissolve dead skin cells."

For sensitive skin, the AAD points to the second kind, mild, used with just a washcloth. Its face mask page warns against two kinds of ingredient that are also used in exfoliators:

• "Physical exfoliants, like walnut shells or apricot kernels, that can cause small tears in your skin."
• "Strong exfoliating ingredients, like certain strengths of AHAs or BHAs, if you have sensitive skin."

Scrubbing itself is a problem. The AAD quotes a dermatologist: "Scrubbing usually irritates your skin and then makes it hard to tolerate helpful products." Its face washing page goes further: "Using a washcloth, mesh sponge, or anything other than your fingertips can irritate your skin." So even with the washcloth the AAD suggests for exfoliating, use it lightly.

Chemical exfoliants: AHAs and BHAs

The US Food and Drug Administration (FDA) has a page on each family of acids.

Alpha hydroxy acids (AHAs). "The most common AHAs in cosmetic products are glycolic acid and lactic acid." The FDA says: "AHA-containing products cause exfoliation, or shedding of the surface skin." How much depends on the product: "The extent of exfoliation depends on the type and concentration of the AHA, its pH, and other ingredients in the product." pH is the measure of how acidic a product is.

The FDA lists the problems people reported with AHA products, including "burning (45), dermatitis or rash (35), swelling (29), pigmentary changes (15), blisters or welts (14)". A 2018 review lists swelling, burning and itching as reactions to watch for, and concludes that whether AHAs help or harm the skin depends on how strong the product is.

AHAs also change how the skin reacts to the sun. The FDA reports: "After four weeks of AHA application, volunteers' sensitivity to skin reddening produced by UV increased by 18 percent." UV is the ultraviolet light in sunlight. The effect went away: "One week after the treatments were halted, researchers found no significant differences in UV sensitivity among the various skin sites."

Beta hydroxy acids (BHAs). The FDA names "salicylic acid (or related substances, such as salicylate, sodium salicylate, and willow extract)". Its advice is plain:

• "Test any product that contains a BHA on a small area of skin before applying it to a large area."
• "If you use cosmetics with BHAs and experience skin irritation or prolonged stinging, stop using the product and consult your physician."
• "Avoid using BHA-containing products on infants and children."
• "Use sun protection if you use a BHA product."

When salicylic acid is sold as an acne medicine, the FDA rule allows 0.5 to 2 percent. More on that ingredient is in salicylic acid side effects.

What to look for on an exfoliator label

Label point	Why it matters
The acid's name	Glycolic or lactic acid means an AHA. Salicylic acid, salicylate, sodium salicylate or willow extract means a BHA
The strength	The AAD warns against strong strengths of AHAs or BHAs on sensitive skin. An industry safety panel, as reported by the FDA, found glycolic and lactic acid products safe at 10 percent or less and a pH of 3.5 or more, with sun protection
A sunburn warning	The FDA suggests this label line for AHA products: "Use a sunscreen, wear protective clothing, and limit sun exposure while using this product and for a week afterwards."
Scrub pieces	Walnut shells or apricot kernels can cause small tears, the AAD says
"Gentle" or "for sensitive skin"	The FDA says no federal standard or definition stands behind "for sensitive skin". Check the ingredient list
Other active ingredients	Avoid stacking an exfoliator on retinol or benzoyl peroxide, the AAD says

The AAD's moisturizer page also says to "Avoid products with alcohol, alpha-hydroxy acid (AHA), and fragrance to help your skin retain its natural oils." That advice is for dry skin. Because the FDA says AHA products cause exfoliation, a moisturizer with an AHA in it also exfoliates.

How to exfoliate sensitive skin gently

1. Test first. The AAD says to test a new product on "a quarter-sized spot on your skin where the product won't be rubbed or washed away", twice a day for seven to 10 days. The AAD also says glycolic acid can irritate sensitive skin. The full method is in how to patch test a new skincare product.
2. Apply it gently. The AAD says to "apply the product gently using small, circular motions," and then to rinse well with lukewarm water.
3. Moisturize right away. "Apply moisturizer immediately after exfoliating to keep your skin healthy and hydrated."
4. Wear sunscreen. Both FDA pages advise sun protection while you use these acids.
5. Cut back in winter. The AAD warns that "people often make the mistake of exfoliating dry, peeling skin in the winter, further stripping it of moisture." Its winter page says many dermatologists advise using less glycolic acid, salicylic acid and retinol in winter.
6. Use one active product at a time. The AAD says to avoid masks "with active ingredients you use in other skin care products to avoid irritating your skin, particularly if you are already using retinol or acid-containing products."

Ingrown hairs bring a disagreement between sources. The NHS suggests "an exfoliating scrub to help release any trapped hairs" after shaving. The AAD's advice for sensitive skin points to a mild chemical exfoliator in place of a scrub.

Signs of too much exfoliation

"Be careful not to over-exfoliate, as this could lead to skin that is red and irritated," the AAD says. A product that irritates can also leave marks: the AAD's page on dark spots in darker skin tones says such a product "can cause dark spots on your skin." The NHS acne page says "do not scrub your skin as this can irritate it and make acne worse".

Stop the exfoliator and wash it off if your skin stings for a long time, burns, swells or blisters. The AAD's advice for any product is: "If you develop a skin reaction, gently wash the product off as soon as possible, and don't use it again." See a doctor if a rash spreads, blisters, lasts, or keeps coming back. Get medical care right away for swelling, nausea, vomiting or trouble breathing after using a product. The AAD lists these as signs of a life-threatening allergic reaction.