Dermatologists’ perspectives on daily gentle exfoliation for sensitive and oily/acne-prone skin: Insights from a national survey

INTRODUCTION

Sensitive skin, once considered a mere cosmetic concern, is now recognized as a distinct clinical phenotype requiring specialized dermatologic care. It is characterized by an increased propensity to experience discomfort such as burning, stinging, tightness, or dryness in response to stimuli that are otherwise non-irritating. These reactions typically occur without visible inflammation and are often attributed to underlying barrier dysfunction, neurosensory hyperactivity, or subclinical inflammation.^[1]

Globally, the prevalence of sensitive skin ranges from 50% to 70%, with evidence suggesting an increase due to urbanization and lifestyle changes.^[2] India ranks among the highest globally in self-reported skin sensitivity, with a mean sensitivity score of 3.4, surpassing the international average.^[3] Sensitive skin is a widespread dermatologic concern, affecting 60–70% of women and 50–60% of men.^[1,4] Over the past two decades, a 55% increase in individuals self-reporting sensitive skin has been observed, suggesting an upward trend potentially linked to urbanization, pollution, and increased cosmetic use.^[5]

Notably, 40% of patients with sensitive skin present without any identifiable underlying skin diseases, reinforcing the recognition of sensitive skin as an independent clinical entity.^[6,7] These findings underscore the need for targeted non-irritating skincare solutions that preserve skin barrier integrity and minimize the risk of exacerbating symptoms. In the Indian context, the burden of sensitive skin is compounded by environmental and dermatologic factors, such as high levels of ambient pollution, widespread use of hard water, prevalent phototypes IV–VI, and a growing market for unregulated cosmetic procedures.^[8] Chronic low-grade neurogenic inflammation plays a pivotal role in the pathophysiology of skin sensitivity. This persistent inflammation disrupts epidermal renewal, resulting in thickened epidermis, altered stratum corneum, and impaired desquamation, which gradually leads to uneven skin texture, roughness, patchy pigmentation, and increased barrier vulnerability.^[9]

Hyperpigmentation, particularly post-inflammatory hyperpigmentation (PIH), is a common sequela in Indian and other darker skin types and is closely linked to chronic inflammation. Inflammatory mediators activate melanocytes, leading to an increase in melanin production. Melanin is synthesized and stored in melanosomes,^[10-12] which are transferred to keratinocytes, where they accumulate, particularly when desquamation is impaired. Since melanin is not enzymatically degraded in humans, it can only be eliminated through cell turnover and exfoliation.^[13,14] This highlights the critical importance of controlled exfoliation in reducing the melanin burden and improving skin tone uniformity in pigmentation-prone populations.

For individuals with sensitive skin, chemical exfoliation must be gentle and precisely targeted to avoid exacerbating inflammation. Effective formulations are designed to act on the superficial stratum corneum without disrupting deeper layers. Gentle exfoliation enhances keratinocyte turnover, smooths skin texture, and reduces pigmentation by facilitating the removal of melanin-loaded keratinocytes, while preserving barrier function.^[15] The frequent and unregulated use of fairness products, harsh exfoliating scrubs, and depigmenting agents further aggravates barrier damage and pigmentation issues in Indian skin.^[16] Moreover, oily and acne-prone skin conditions are highly prevalent in India, with approximately 47% of individuals with sensitive skin also reporting acne. Post-acne sequelae, including PIH, textural irregularities, and scarring, are commonly observed and may persist long after the active lesions resolve.^[17]

Chemical exfoliation offers a strategic intervention to address these concerns. Alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), and polyhydroxy acids (PHAs) form the foundation of modern exfoliation regimens. AHAs such as mandelic acid and glycolic acid promote desmosomal loosening and corneocyte shedding; mandelic acid, owing to its larger molecular weight, is especially favored in sensitive skin because of its slow penetration and reduced irritancy. BHAs such as salicylic acid are lipid-soluble, allowing deeper follicular penetration, which is ideal for comedonal acne and seborrhea. PHAs such as gluconolactone and lactobionic acid provide hydrating and antioxidant benefits, further enhancing barrier resilience and offering a gentler alternative suitable for barrier-compromised skin.^[18]

Exfoliation stimulates basal keratinocyte proliferation and epidermal turnover,^[19] clears pores of debris, enhances collagen production, and improves skin texture. However, over-exfoliation can induce microtrauma and exacerbate sensitivity, particularly in the skin of colored populations prone to PIH. Therefore, controlled exfoliation using appropriate agents and dosages is essential.^[19,20] Compared to mechanical methods, chemical exfoliation offers a more uniform and less traumatic means of enhancing skin turnover. Physical exfoliation, such as scrubs or microdermabrasion, is often too abrasive for sensitive skin and can lead to erythema and barrier disruption.^[19,21] AHAs, BHAs, and PHAs differ in their penetration profiles, making it possible to tailor exfoliation strategies to sensitive skin.^[21,22] Optimal regimens selectively target the superficial stratum corneum, minimizing inflammation and maintaining skin integrity.^[23-25]

The American Academy of Dermatology guidance for exfoliation at home includes the use of mild chemical exfoliants over mechanical methods for individuals with dry, sensitive, or acne-prone skin.^[25]

Although exfoliation offers significant clinical benefits, it must be customized for sensitive populations. Gentle chemical exfoliation using AHAs, BHAs, and PHAs, in the optimal doses, enables daily skin renewal while reducing the risk of inflammation. These principles form the basis of emerging skincare strategies focused on the sensitive, pigmented, and post-acne Indian skin types.

To explore real-world dermatological perspectives on daily exfoliation of sensitive Indian skin, a structured survey was conducted among dermatologists attending DERMACON 2025. This study aimed to evaluate the clinical positioning of the SA range, discern formulation preferences, and identify perceived challenges and opportunities. The questionnaire consisted of eight questions that explored its role in therapy, preferred formulation (cleanser, lotion, or both [in the same or different patients]), application in other indications, initial impressions, feedback, and any concerns or clinical reservations of a novel, gentle exfoliating formulation designed for Indian skin types.

To the best of our knowledge, this is the first nationwide survey in India to explore dermatologists’ perspectives on daily gentle exfoliation for sensitive and acne-prone skin, which is a population historically considered unsuitable for routine exfoliation due to barrier fragility and high pigmentation risk. It highlights a paradigm shift in clinical practice toward barrier-preserving exfoliation strategies, enabled by the use of a novel micro-dosed triple-acid (AHA–BHA–PHA) system. These findings provide unique insights into formulation preferences, therapeutic positioning, and emerging clinical behaviors, while addressing evidence gaps specific to Indian skin types.

MATERIALS AND METHODS

RESULTS

A total of 106 dermatologists participated in a structured questionnaire-based survey conducted at DERMACON 2025, subsequent to a scientific briefing on the Cetaphil Gentle Exfoliating SA range. The survey aimed to capture real-world perceptions regarding the therapeutic role, formulation preference, extended indications, and concerns related to daily exfoliation in Indian skin types. The results were presented across four domains: therapeutic role, formulation usage, expressed concerns, and key qualitative insights.

Preferred place in therapy

When queried about the most pertinent therapeutic applications of the SA range, most dermatologists identified oily and acne-prone skin (88.7%) as the primary indication, emphasizing the necessity for regular yet gentle exfoliation to manage sebum control, comedogenesis, and rough texture. Notably, 63.2% of the respondents also expressed comfort in recommending the product for sensitive skin (affecting any skin type), indicating an evolving perspective on exfoliation in previously cautious populations. This shift was attributed to the presence of mandelic acid and gluconolactone, both of which are known for their gentle exfoliating action and barrier-preserving properties. A few respondents also mentioned their potential use in keratosis pilaris, post-acne pigmentation, and rough and bumpy skin on the limbs, indicating clinical versatility [Table 1 and Figure 1].

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Figure 1:

Preferred therapeutic indications for exfoliation among health care professionals (HCPs) .

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Table 1: Preferred place in therapy.

Therapeutic Indication	% of respondents	n=106
Oily/acne-prone skin	88.7	94
Sensitive skin (affecting any skin type)	63.2	67
Keratosis pilaris	29.2	31
Do not prefer exfoliation	5.7	6

Other indications (open-ended responses)

Dermatologists provided open-ended responses on additional use cases where they would consider recommending the SA range. These reflect dermatologists’ openness to prescribing tolerable, gentle exfoliation as part of texture correction, post-inflammatory pigmentation management, and maintenance regimens for skin tone irregularities in Indian skin. Other indications are included in [Table 2].

Table 2: Other indications.

Additional indication	Mentions
Post-acne treatment (following conclusion of retinoid therapy)	17
Post-inflammatory hyperpigmentation	14
Dull/photodamaged skin	11
Bumpy/rough texture on limbs/body	9

DISCUSSION

The findings from this dermatologist survey conducted at DERMACON 2025 underscore a significant shift in clinical dermatology toward gentle, daily exfoliation, even in populations traditionally considered unsuitable, such as those with sensitive or pigmented skin. Historically, exfoliation has been met with caution in Indian practice because of concerns about barrier disruption, PIH, and treatment non-adherence in melanin-rich phototypes.^[26] However, the Cetaphil gentle exfoliation SA range appears to challenge and reframe these conventions.

A notable insight from the survey is the broad acceptance of exfoliation in oily, acne-prone skin (88.7%), aligning with the clinical priorities of managing comedogenesis, sebum excess, and uneven texture. Remarkably, 63.2% of dermatologists also expressed clinical comfort in recommending the SA range for sensitive skin. This represents a considerable paradigm shift, likely facilitated by the product’s micro-dosed triple-acid system, a blend of an AHA, BHA, and PHA, each selected for its balance of efficacy and tolerability. Respondents cited this innovation as critical for reintroducing exfoliation into care plans for patients who were previously deemed intolerant or high-risk.

Nearly half of all respondents (46.2%) preferred a dual regimen of cleansers and lotions, indicating an evolving preference for layered skincare strategies that combine exfoliation with cleansing and hydration. Dermatologists favoring the combined use noted synergistic benefits: the cleanser initiates deep cleansing and exfoliation, whereas the lotion sustains contact time and reinforces hydration. Conversely, dermatologists who favored the cleanser alone cited patient simplicity and greater ease of integration into daily acne management routines. Only a minority (5.7%) avoided exfoliation altogether, typically in patients with active dermatitis or barrier-compromised skin.

Insights from the survey suggest that while oily and acne-prone skin remains the primary indication, there is notable openness among dermatologists to extend their use to sensitive skin types, reflecting increased clinician trust in micro-dose formulations [Table 5]. However, concerns persist regarding potential misuse, overlapping active agents, and a lack of India-specific clinical data. These insights underline the critical need for healthcare education, prescribing guidance, and evidence generation to support the appropriate use of exfoliation products. Overall, feedback positions the Cetaphil SA range as a potential staple exfoliant in Indian dermatology, provided its introduction is coupled with clinical framework support and physician education.

The Cetaphil Gentle Exfoliating SA Collection includes two key products: A gentle exfoliation SA cleanser and a gentle exfoliating SA lotion formulated for daily use to promote epidermal renewal without compromising skin comfort. They employ a triple acid “trifoliator system” combining mandelic acid (AHA), salicylic acid (BHA), and gluconolactone (PHA). Mandelic acid, with a larger molecular weight (152 g/mol), demonstrates reduced skin penetration, contributing to its milder exfoliation profile.^[27] Salicylic acid, with its lower molecular weight (138 g/mol), penetrates deeper into pores to manage oil production and comedogenesis, while remaining well-tolerated at low concentrations.^[28] Gluconolactone, a PHA (178 g/mol), provides gentle exfoliation with additional hydration and antioxidant benefits.^[29]

The strategic selection of acids is critical. Larger molecular weight agents, such as mandelic acid and gluconolactone, penetrate more slowly and superficially, minimizing irritation risks compared to smaller acids such as glycolic acid (76 g/mol) or lactic acid (90 g/mol).^[1,30] In addition, the formulations incorporate foundation ingredients – glycerin, panthenol (pro-Vitamin B5), and niacinamide (Vitamin B3) – to further bolster barrier support and skin hydration.^[27]

The combination of exfoliation and barrier support aims to achieve progressive, mild exfoliation while minimizing inflammatory responses, which is a crucial balance for sensitive skin management.^[27,28] In vitro and clinical data has demostrated that this formulation strategy enables safe, effective exfoliation even in individuals with skin sensitivity.^[30]

In a comprehensive study involving 723 participants across multiple ethnicities, the Cetaphil gentle-exfoliated SA cleanser and lotion were evaluated for clinical safety and tolerability. The mean participant age was 52 years (range, 18–71 years), and 84% were female. Importantly, 36% self-reported sensitive skin, and 57% had Fitzpatrick Skin Type III, with representation from Types IV, V, and VI – populations with heightened PIH risk. No significant local tolerability issues or adverse events were reported with any of the products.^[30] The high level of subject acceptance reinforces that daily exfoliation can be safely achieved in sensitive skin when appropriately formulated products are used.

The present study offers novel insights into the evolving landscape of exfoliation practices for sensitive and acne-prone Indian skin, addressing both scientific and clinical gaps in existing literature. The current research is the first systematic, single-center national survey (DERMACON 2025) to capture real-life dermatologists’ views on daily chemical exfoliation, going beyond earlier studies that mainly assessed efficacy or tolerability. The focus on sensitive, pigmented, and acne-prone skin, a population historically approached cautiously due to barrier fragility and heightened risk of PIH, highlights a paradigm shift toward barrier-preserving exfoliation strategies. Importantly, clinical evaluation of a novel micro-dosed triple-acid system (AHA–BHA–PHA), comprising low concentrations of mandelic acid, salicylic acid, and gluconolactone, was identified as a key innovation enabling safer daily use. Survey findings further reveal that a majority of dermatologists (63.2%) are now comfortable recommending daily exfoliation for sensitive skin, with nearly half favoring dual-regimen strategies (cleanser plus lotion), reflecting evolving clinical behaviors. Collectively, these findings begin to bridge a critical evidence gap specific to the Indian context, providing guidance on the differentiation of scientifically formulated exfoliants from conventional cosmetic products and informing practical usage recommendations.

This favorable safety profile is particularly significant given that sensitive skin populations, especially those with higher Fitzpatrick phototypes, are typically excluded from conventional exfoliation regimens because of concerns over irritation and pigmentation. The ability to provide a daily exfoliation regimen without these risks positions the Cetaphil Gentle Exfoliating SA Collection as a valuable advancement for sensitive skin management.

CONCLUSION

The Cetaphil Gentle Exfoliating SA range was well received by dermatologists at DERMACON 2025, with a strong preference for its use in acne-prone, oily, and sensitive skin populations that often struggle with the tolerability of traditional exfoliants. The range’s micro-dosed AHA-BHA-PHA combination, distributed across a cleanser and a lotion, provides a unique opportunity to integrate exfoliation into daily, barrier-safe routines. Dermatologists valued the synergistic dual-use regimen, and many indicated a readiness to recommend the range across multiple dermatologic presentations, including comedonal acne, seborrheic skin, PIH, and even keratosis pilaris.

The findings signal a growing demand for functionally formulated skincare with clinical tolerability and underscore the potential of micro-dosing strategies to redefine exfoliation practice in Indian dermatology. To fully realize this opportunity, focused efforts are needed in generating India-specific data, offering clear regimen guidance, and ensuring differentiation from cosmetic exfoliants.