Despite sensitive skin being highly prevalent, no consensus on the definition and pathomechanism of sensitive skin exists. Here we report the results of a systematic literature review of diagnostic methods for sensitive skin at clinical, histological and biophysical levels. A systematic search revealed 27 out of 1,701 articles which we appraised in detail. Impaired skin barrier function and increased vascular reactivity are most often associated with sensitive skin. We identified key reasons causing an ambiguity around the sensitive skin phenomenon. We propose using standardized selection methods of subjects by a multifactorial questionnaire spanning a range of provocations, including those of chemical, mechanical and environmental origin, followed by clinical, histological and top-notch biophysical measurements. This could lead to a breakthrough in the understanding of the sensitive skin phenomenon, fueling advances of biomedical and dermatological science. © 2014 S. Karger AG, Basel

Keywords:
Sensitive skin, Biophysical measurements, Multifactorial questionnaires
1.
Berardesca E, Cespa M, Farinelli N, Rabbiosi G, Maibach H: In vivo transcutaneous penetration of nicotinates and sensitive skin. Contact Dermatitis 1991;25:35-38.
2.
Berardesca E, Maibach HI: Sensitive and ethnic skin. A need for special skin-care agents? Dermatol Clin 1991;9:89-92.
3.
Draelos ZD: Sensitive skin: Perceptions, evaluation, and treatment. Am J Contact Dermat 1997;8:67-78.
4.
Issachar N, Gall Y, Borell MT, Poelman MC: pH measurements during lactic acid stinging test in normal and sensitive skin. Contact Dermatitis 1997;36:152-155.
5.
Issachar N, Gall Y, Borrel MT, Poelman MC: Correlation between percutaneous penetration of methyl nicotinate and sensitive skin, using laser Doppler imaging. Contact Dermatitis 1998;39:182-186.
6.
Mills OH Jr, Berger RS: Defining the susceptibility of acne-prone and sensitive skin populations to extrinsic factors. Dermatol Clin 1991;9:93-98.
7.
Muizzuddin N, Marenus KD, Maes DH: Factors defining sensitive skin and its treatment. Am J Contact Dermat 1998;9:170-175.
8.
Paquet F, Piérard-Franchimont C, Fumal I, Goffin V, Paye M, Piérard GE: Sensitive skin at menopause; dew point and electrometric properties of the stratum corneum. Maturitas 1998;28:221-227.
9.
Seidenari S, Francomano M, Mantovani L: Baseline biophysical parameters in subjects with sensitive skin. Contact Dermatitis 1998;38:311-315.
10.
Simion AF, Rau AH: Sensitive skin: what is it and how to formulate for it. Cosmet Toiletries 1994;109:43s.
11.
Farage MA: How do perceptions of sensitive skin differ at different anatomical sites? An epidemiological study. Clin Exp Dermatol 2009;34:e521-e530.
12.
Guinot C, Malvy D, Mauger E, Ezzedine K, Latreille J, Ambroisine L, et al: Self-reported skin sensitivity in a general adult population in France: data of the SU.VI.MAX cohort. J Eur Acad Dermatol Venereol 2006;20:380-390.
13.
Misery L, Myon E, Martin N, Verriere F, Nocera T, Taieb C: Sensitive skins in France: an epidemiological approach (in French). Ann Dermatol Venereol 2005;132:425-429.
14.
Willis CM, Shaw S, De Lacharriere O, Baverel M, Reiche L, Jourdain R, et al: Sensitive skin: an epidemiological study. Br J Dermatol 2001;145:258-263.
15.
Sparavigna A, Di Pietro A, Setaro M: ‘Healthy skin': significance and results of an Italian study on healthy population with particular regard to ‘sensitive' skin. Int J Cosmet Sci 2005;27:327-331.
16.
Misery L, Myon E, Martin N, Consoli S, Boussetta S, Nocera T, et al: Sensitive skin: psychological effects and seasonal changes. J Eur Acad Dermatol Venereol 2007;21:620-628.
17.
Morizot F, Guinot C, Lopez J, LaFus I, Tschachler E: Sensitive skin: analysis of symptoms, perceived causes and possible mechanisms. Cosmet Toiletries 2000;115:83-89.
18.
Saint-Martory C, Roguedas-Contios AM, Sibaud V, Degouy A, Schmitt AM, Misery L: Sensitive skin is not limited to the face. Br J Dermatol 2008;158:130-133.
19.
Primavera G, Berardesca E: Sensitive skin: mechanisms and diagnosis. Int J Cosmet Sci 2005;27:1-10.
20.
Diogo L, Papoila AL: Is it possible to characterize objectively sensitive skin? Skin Res Technol 2010;16:30-37.
21.
Farage MA, Katsarou A, Maibach HI: Sensory, clinical and physiological factors in sensitive skin: a review. Contact Dermatitis 2006;55:1-14.
22.
Farage MA, Maibach HI: Sensitive skin: closing in on a physiological cause. Contact Dermatitis 2010;62:137-149.
23.
Kligman AM, Sadiq I, Zhen Y, Crosby M: Experimental studies on the nature of sensitive skin. Skin Res Technol 2006;12:217-222.
24.
Farage MA: Enhancement of visual scoring of skin irritant reactions using cross-polarized light and parallel-polarized light. Contact Dermatitis 2008;58:147-155.
25.
Basketter DA, Griffiths HA: A study of the relationship between susceptibility to skin stinging and skin irritation. Contact Dermatitis 1993;29:185-188.
26.
Coverly J, Peters L, Whittle E, Basketter DA: Susceptibility to skin stinging, non-immunologic contact urticaria and acute skin irritation; is there a relationship? Contact Dermatitis 1998;38:90-95.
27.
Lammintausta K, Maibach HI, Wilson D: Mechanisms of subjective (sensory) irritation. Propensity to non-immunologic contact urticaria and objective irritation in stingers. Derm Beruf Umwelt 1988;36:45-49.
28.
Marriott M, Holmes J, Peters L, Cooper K, Rowson M, Basketter DA: The complex problem of sensitive skin. Contact Dermatitis 2005;53:93-99.
29.
Green BG: Measurement of sensory irritation of the skin. Am J Contact Dermat 2000;11:170-180.
30.
Berardesca E, Farage M, Maibach H: Sensitive skin: an overview. Int J Cosmet Sci 2013;35:2-8.
31.
Lev-Tov H, Maibach HI: The sensitive skin syndrome. Indian J Dermatol 2012;57:419-423.
32.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Bull World Health Organ 2007;85:867-872.
33.
Quatresooz P, Piérard-Franchimont C, Piérard GE: Vulnerability of reactive skin to electric current perception - a pilot study implicating mast cells and the lymphatic microvasculature. J Cosmet Dermatol 2009;8:186-189.
34.
Frosch PJ, Kligman AM: A method for appraising the stinging capacity of topically applied substances. J Soc Cosmet Chem 1977;28:197-209.
35.
Bowman JP, Floyd AK, Znaniecki A, Kligman AM, Stoudemayer T, Mills OH: The use of chemical probes to assess the facial reactivity of women, comparing their self-perception of sensitive skin. J Cosmet Sci 2000;51:267-273.
36.
Querleux B, Dauchot K, Jourdain R, Bastien P, Bittoun J, Anton JL, et al: Neural basis of sensitive skin: an fMRI study. Skin Res Technol 2008;14:454-461.
37.
Roussaki-Schulze AV, Zafiriou E, Nikoulis D, Klimi E, Rallis E, Zintzaras E: Objective biophysical findings in patients with sensitive skin. Drugs Exp Clin Res 2005;31(suppl): 17-24.
38.
Cho HJ, Chung BY, Lee HB, Kim HO, Park CW, Lee CH: Quantitative study of stratum corneum ceramides contents in patients with sensitive skin. J Dermatol 2012;39:295-300.
39.
Wu Y, Wang X, Zhou Y, Tan Y, Chen D, Chen Y, et al: Correlation between stinging, TEWL and capacitance. Skin Res Technol 2003;9:90-93.
40.
An S, Lee E, Kim S, Nam G, Lee H, Moon S, et al: Comparison and correlation between stinging responses to lactic acid and bioengineering parameters. Contact Dermatitis 2007;57:158-162.
41.
Distante F, Rigano L, D'Agostino R, Bonfigli A, Berardesca E: Intra- and inter-individual differences in sensitive skin. Cosmet Toiletries 2002;117:39-46.
42.
Marriott M, Whittle E, Basketter DA: Facial variations in sensory responses. Contact Dermatitis 2003;49:227-231.
43.
Robinson MK, Perkins MA: Evaluation of a quantitative clinical method for assessment of sensory skin irritation. Contact Dermatitis 2001;45:205-213.
44.
Jourdain R, Bastien P, de Lacharriere O, Rubinstenn G: Detection thresholds of capsaicin: a new test to assess facial skin neurosensitivity. J Cosmet Sci 2005;56:153-166.
45.
Clapham DE: TRP channels as cellular sensors. Nature 2003;426:517-524.
46.
Dhaka A, Viswanath V, Patapoutian A: TRP ion channels and temperature sensation. Annu Rev Neurosci 2006;29:135-161.
47.
Kueper T, Krohn M, Haustedt LO, Hatt H, Schmaus G, Vielhaber G: Inhibition of TRPV1 for the treatment of sensitive skin. Exp Dermatol 2010;19:980-986.
48.
Loffler H, Dickel H, Kuss O, Diepgen TL, Effendy I: Characteristics of self-estimated enhanced skin susceptibility. Acta Derm Venereol 2001;81:343-346.
49.
Pinto P, Rosado C, Parreirao C, Rodrigues LM: Is there any barrier impairment in sensitive skin? A quantitative analysis of sensitive skin by mathematical modeling of transepidermal water loss desorption curves. Skin Res Technol 2011;17:181-185.
50.
Kim SJ, Lim SU, Won YH, An SS, Lee EY, Moon SJ, et al: The perception threshold measurement can be a useful tool for evaluation of sensitive skin. Int J Cosmet Sci 2008;30:333-337.
51.
Schliemann S, Antonov D, Manegold N, Elsner P: Sensory irritation caused by two organic solvents - short-time single application and repeated occlusive test in stingers and non-stingers. Contact Dermatitis 2011;65:107-114.
52.
De Jongh CM, Verberk MM, Withagen CE, Jacobs JJ, Rustemeyer T, Kezic S: Stratum corneum cytokines and skin irritation response to sodium lauryl sulfate. Contact Dermatitis 2006;54:325-333.
53.
Aramaki J, Kawana S, Effendy I, Happle R, Loffler H: Differences of skin irritation between Japanese and European women. Br J Dermatol 2002;146:1052-1056.
54.
van de Vijver LPL, Boelsma E, Rausch-Goldbohm RA, Roza L: Subjective skin condition and its association with objective skin measurements. Cosmet Toiletries 2003;118:45-54.
55.
Nouveau-Richard S, Zhu W, Li YH, Zhang YZ, Yang FZ, Yang ZL, et al: Oily skin: specific features in Chinese women. Skin Res Technol 2007;13:43-48.
56.
Kim E, Kim S, Nam GW, Lee H, Moon S, Chang I: The alkaline pH-adapted skin barrier is disrupted severely by SLS-induced irritation. Int J Cosmet Sci 2009;31:263-269.
57.
Sparavigna A, Pietro A, Setaro M: Sensitive skin: correlation with skin surface microrelief appearance. Skin Res Technol 2006;12:7-10.
58.
de Campos Dieamant G, Velazquez Pereda MDL, Eberlin S, Nogueira C, Werka RM, Queiroz MLS: Neuroimmunomodulatory compound for sensitive skin care: in vitro and clinical assessment. J Cosmet Dermatol 2008;7:112-119.
59.
Berardesca E, Abril E, Serio M, Cameli N: Effects of topical gluco-oligosaccharide and collagen tripeptide F in the treatment of sensitive atopic skin. Int J Cosmet Sci 2009;31:271-277.
60.
Davis JA, Visscher MO, Wickett RR, Hoath SB: Role of TNF-polymorphism-308 in neurosensory irritation. Int J Cosmet Sci 2011;33:105-112.
61.
Lee E, An S, Lee TR, Kim HK: Development of a novel method for quantitative evaluation of sensory skin irritation inhibitors. Skin Res Technol 2009;15:464-469.
62.
Lee BH, Park CK, Kim HO, Jo HJ, Park CW, Lee CH: The skin irritations of corrosive and non-corrosive irritants in patients with sensitive skin. Korean J Dermatol 2007;426:551-559.
63.
Kucharekova M, Lieffers L, van de Kerkhof PC, van der Valk PG: Dithranol irritation in psoriasis treatment: a study of 68 inpatients. J Eur Acad Dermatol Venereol 2005;19:176-179.
© 2014 S. Karger AG, Basel
2014
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