Generally speaking, there are three different problem groups. There are individuals who show allergic reactions to certain substances. The most harmless reactions in this context are skin redness, blisters or wheals which however can escalate via breathing troubles and asthma attacks during inhalations to severe reactions like the anaphylactic shock that can also occur e.g. after insect bites. We are dealing here with a sensitization or allergic reaction that is triggered by an exaggerated immune response of the human body. The immune response can be clinically verified. However it often takes a good deal of detective instinct to identify the substances responsible for this reaction and to ban them from the individual life. Examples here are the widely used preservatives, certain groups of perfumes but also food like hazelnuts or soybean and milk proteins. In most cases the dermatologist uses a simple patch test to find out which substances will lead to these unwelcome reactions.
Irritations i.e. intolerance reactions that cannot be traced to certain substances but are triggered by the concentration or e.g. the pH level of a substance are not allergic reactions. Examples here are burning eyes after contact with salt or onion fumes, burning in cases of cracked skin after contact with urea (dermatological creams), acids or brine. In extreme cases it will lead to skin detachments (keratolysis) or chemical burns which may also happen after AHA acid treatments. Irritations are reversible processes and are quite different from allergic reactions.
Sensitive and ill skin
Individuals with an inherently specific skin condition due to heredity, metabolism disorders, enzyme defects, organic or mental disease belong to the second problem group. Their skin is extremely sensitive and will not tolerate every substance or substance combination. They belong to the estimated 5 to 10 percent of the population who have substantial difficulties with widely used but rather harmless substances.
Frequently inadequate skin care and above all excessive skin cleansing causes problems for these individuals. Thus the water-based skin cleansing will involve a washing out of the natural protective substances of the skin because of the effects of the tensides contained in cleansing products. It is still largely unknown that unconventional non-foaming cleansing products without re-fattening substances are gentler to the skin than foaming and re-fattening substances. So the first priority for sensitive irritation prone skin should be laid on less frequent and less intense skin cleansing procedures.
Also the emulsifiers contained in skin care products which are related to the cleansing tensides support the washing out of natural protective substances. So it turned that many of the neurodermatitis patients could be helped by providing emulsifier free skin care creams and by reducing the length and frequency of skin cleansings. In the same way that emulsifiers transport lipid substances into the skin they also wash out lipids and skin protective substances out of the skin as e.g. after a prolonged contact with water. The skin barrier of neurodermitics is rather susceptible for this process.
Individuals with sensitive skin should basically avoid all the additives in skin care products like perfumes, preservatives, mineral oils and silicones. Both the latter mentioned substance groups reduce the natural recovering ability of the skin. In summary it can be mentioned that many of the current skin problems and skin disorders of pre-disposed individuals are triggered or developed by inadequate skin care and hygienic procedures. Skin analysis, individual consultation and treatment by experienced professionals can perform miracles in this area and frequently stop the counterproductive dependence on cortisone creams.
Multiple chemical sensitivity
Far more complicated are circumstances with the third problem group i.e. individuals with multiple chemical sensitivity (MCS). These individuals show reactions like nausea, concentration loss, exhaustion, depression, breathing troubles, skin reactions, flush, running eyes and sleeping disorders specifically to scents and fumes of solvents, dyes, perfumes. The reactions can last from several hours up to several days. Things that just result in a tickling nose with normal individuals or even in a pleasant feeling (perfumes) may considerably affect their daily life and even lead to organ damages or chronic diseases in an advanced stage. Different from allergic reactions this kind of sensitivity which frequently is not specific to certain substances cannot be clinically verified as an immune reaction. In most cases the persons concerned try to protect themselves by avoiding the triggering substances they know insofar as they keep away from public events as perfumes are very popular there. In extreme cases they even carry breathing masks in their own apartment.
The intolerance to certain chemicals may extend to the food sector and also to pharmaceutical drugs. Sometimes it is impossible to take pain relievers as the gastrointestinal system responds to drugs with vomiting, stomach spasms and diarrhea and refuses any kind of food.
There are manifold reasons for MCS and they still have to be researched in detail.
Phobias do not belong to MCS disorders. The body of these persons translates certain sensory inputs like scents, flavors and body contact and also feelings which seem absolutely normal to other people into alarm signals. The consequences are irrational body or skin reactions. Comparable mechanisms are known of people suffering from agoraphobia. The reactions in case of agoraphobia are anxieties triggered by the sensory organs eyes and ears. Also in this case the sensitivity will continue to increase and considerably affect the quality of life of the persons concerned.
It is assumed that the nerve system of MCS afflicted persons in the narrowest sense has been directly damaged by chemicals. MCS frequently shows low dose effects of unspecific chemicals that will not activate the immune system or cannot stimulate a pre-damaged immune system but may have neurotoxic effects. The chemicals come in contact with a hypersensitive or pre-damaged nerve system with a strong feedback effect that transmits a previously specific stimulus to similar sensory substances, and thus will become more and more sensitive. Said mechanism is also called spreading phenomenon.
Several nerve toxins are able to invert olfactory sensations which means that the substances present only are perceived during an initial phase however after being removed the sensation again is noticed as it would still be there. Nerve toxins among others are chemicals belonging to the following substance groups: esters, ethers, halogenized, aliphatic and aromatic hydrocarbons, alkaloids and kresyl phosphates.
Medical drugs can relieve MCS to a certain extent and for a certain time but not for good. Desensitization as known from allergy treatments of course is not successful with MCS patients.
The only way to provide cosmetic or dermatological help for this group of persons is to apply products free of perfumes, preservatives and other potential trigger substances. As requirements for an individual cream composition may substantially differ modular systems have proved successful as they allow to prepare individual formulations that are adequately adapted to the specific skin condition and also well tolerated.
Conclusion
In this context, analytic skills and the experience of the general practitioner, dermatologist, beauty institute or non-medical practitioner are of decisive importance. In the sense of a holistic treatment a sure feeling for identifying the complex backgrounds of these intolerances and for providing comprehensive assistance, including the interdisciplinary approach, is needed. Unfortunately today's health care policy will not reward this assistance although this could involve enormous cost reductions within this sector. The individual person will appreciate it however.
Dr. Hans Lautenschläger | 
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