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Clinical Review on Sensitive Skin: History, Epidemiology, Pathogenesis and Management
... Indeed, a consensus for the definition of SS has still to be reached, despite a wide range of proposals. 13 As an example, a recent paper considered SS as; 'A syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally ...
... Structurally, at baseline, skin tissue of individuals reporting enhanced sensitivity has been associated with a thinner SC, reduced number of corneocytes, increased nerve fibre density and a higher number of sweat glands. 1,13,90 Functionally, it has been associated with an increased penetration of watersoluble chemicals, heightened inflammatory or vascular responsiveness, decreased hydration, decreased alkali resistance and less sebum production. 7,9,35,40,91 This review presents a table listing numerous biophysical and imaging measurement techniques available for characterization of such skin parameters ( Table 1) The review identifies OCT as a potential tool for assessing a range of structural and physiological skin parameters. ...
Background
Skin sensitivity (SS) is a commonly occurring response to a range of stimuli, including environmental conditions (e.g., sun exposure), chemical irritants (e.g., soaps and cosmetics), and mechanical forces (e.g., while shaving). From both industry and academia, many efforts have been taken to quantify the characteristics of SS in a standardised manner, but the study is hindered by the lack of an objective definition.
Methods
A review of the scientific literature regarding different parameters attributed to the loss of skin integrity and linked with exhibition of SS was conducted. Articles included were screened for mechanical stimulation of the skin, with objective quantification of tissue responses using biophysical or imaging techniques. Additionally, studies where cohorts of SS and non-SS individuals were reported have been critiqued.
Results
The findings identified that the structure and function of the stratum corneum and its effective barrier properties are closely associated with SS. Thus, an array of skin tissue responses has been selected for characterization of SS due to mechanical stimuli, including: transepidermal water loss, hydration, redness, temperature, and sebum index. Additionally, certain imaging tools allow quantification of the superficial skin layers, providing structural characteristics underlying SS.
Conclusion
This review proposes a multimodal approach for identification of SS, providing a means to characterise skin tissue responses objectively. Optical coherence tomography (OCT) has been suggested as a suitable tool for dermatological research with clinical applications. Such an approach would enhance the knowledge underlying the multifactorial nature of SS and aid the development of personalised solutions in medical and consumer devices.
... Патофизиология чувствительной кожи полностью не выяснена, однако признано, что это состояние не имеет иммунологического или аллергического происхождения. Учитывая тот факт, что кожа и нервная система развиваются из единого зародышевого листка и патогенез многих дерматозов имеет общие механизмы развития, то взаимосвязь каналов TRP-афферентных нейронов с ЦНС и кератиноцитами не вызывает сомнения [37]. Современные представления о патофизиологии чувствительной кожи рассматривают два взаимосвязанных фактора, определяющих повышенную чувствительность кожных покровов: изменение рогового слоя и особенности нервной системы. ...
Epidermis plays an important role in protecting the body from negative environmental influences. The horny layer plays a special role in carrying out these functions. Skin defense mechanisms are multistage and include 5 protective barriers responsible for maintaining the integrity and performing the main functions of the skin. The first one is a microbial barrier – determined by commensal flora which prevents contamination of pathogenic microorganisms; the second one is a physical barrier preventing mechanical skin damage, penetration of allergens and microorganisms; the third one is a chemical barrier achieved by forming pH and components of natural moisturizing factor as well as epidermal lipids; the fourth one – immune barrier – Langerhans cells, tissue basophils, lymphocytes etc.;
the fifth is the neurosensory barrier – numerous nerve endings transmitting signals of skin integrity damage and controlling metabolic processes and homeostasis maintenance. Epidermal barrier of newborns and infants is imperfect and differs in its structure and functional activity from that of adults. Children’s skin is prone to excessive dryness, irritation, allergic reactions and inflammation. For young children, it is very important to minimize the risk of these manifestations. Individual selection and use of emollients in the basic care of infants promotes the functional stability of five protective «frontiers» of the epidermal barrier: prevents skin damage when exposed to unfavorable environmental factors, reduces TEWL, supports the normal microbiome, has antipruritic and anti-inflammatory action. Modern emollients restore the hydrolipidic layer of the epidermis and prevent the development of dermatitis and skin infection in children. An important role when choosing an emollient is played by its texture, which can be represented by a lotion, cream, balm, ointment. Chemically, creams, lotions and balms are emulsions, i.e. they consist of two immiscible components – fat (oil) and water. In this case, one of the components is in the other in the form of tiny droplets. Most skin diseases faced by young children are related to the integrity of the epidermis, which is why daily care should be primarily focused on protecting the skin barrier
Background:
Sensitive skin is a common condition of hyper-reactivity to external stimuli, e.g. heat or abrasion. The symptoms are subjective but can be measured using validated emotional and technical methods. Avène water has several beneficial effects on the skin. In vitro studies indicated that the active component of this natural spring water, Aquaphilus dolomiae extract-G3 (ADE-G3), modulates cutaneous sensitivity via an anaesthetic-like mechanism.
Objectives:
To assess facial skin reactivity after repeated application of two formulations containing ADE-G3.
Methods:
In open-label studies, healthy subjects with sensitive facial skin applied cream or balm twice daily for 84 days. The severity of skin sensitivity was measured using the Sensitive Scale (based on quantifying visible or subjective signs). Subjective responses associated with pain or uncomfortable feeling were assessed by measuring electrodermal response (EDR). This involves measuring variations in skin electrical resistance due to non-conscious physiological changes in activity of the sympathetic nervous system. Subjects were also evaluated for beneficial effects according to a quantitative approach using semantic assessment of a question regarding their skin quality. Evaluations were performed before and after the first application, and after 29/30, 56 and 84 days of twice daily use.
Results:
There was a significant decrease in the EDR after stimuli immediately after the application of both ADE-G3 formulations, which continued to decrease over 84 days (40-50% decrease by D85). Likewise, all physical and functional signs of the Sensitive Scale were significantly decreased immediately after the first application and at all time points tested after treatment. Verbatim analysis revealed a semantic shift, from mainly negative terms on D1 to mainly positive terms at D85 for both tested products.
Conclusions:
These results demonstrated that two formulations containing ADE-G3 reduced skin sensitivity, indicating a decreased activation of the sympathetic nervous system associated with this condition.
Sensitive skin is a condition characterized by stinging, burning and itching sensations. The diagnosis, pathophysiology and treatment of sensitive skin are still under discussion. In the last years, studies on its epidemiology have been performed, showing a high prevalence and impact on quality of life. Brazilian population was also considered in these studies. Cosmetics, climate changes and skin barrier impairment are the main factors that contribute for skin hyperreactivity. New studies are trying to bring new knowledge about the theme. This review will describe data on epidemiology, triggering factors, pathophysiology, diagnosis and treatment.
Sensitive skin is a frequent complaint in the general population, patients, and among subjects with itch. The International Forum for the Study of Itch (IFSI) decided to initiate a special interest group (SIG) on sensitive skin. Using the Delphi method, sensitive skin was defined as "A syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. These unpleasant sensations cannot be explained by lesions attributable to any skin disease. The skin can appear normal or be accompanied by erythema. Sensitive skin can affect all body locations, especially the face". This paper summarizes the background, unresolved aspects of sensitive skin and the process of developing this definition.
Sensitive skin is a clinical syndrome characterized by the occurrence of unpleasant sensations, such as pruritus, burning or pain, in response to various factors, including skincare products, water, cold, heat, or other physical and/or chemical factors. Although these symptoms suggest inflammation and the activation of peripheral innervation, the pathophysiogeny of sensitive skin remains unknown. We systematically analysed cutaneous biopsies from 50 healthy women with non-sensitive or sensitive skin and demonstrated that the intraepidermal nerve fibre density, especially that of peptidergic C-fibres, was lower in the sensitive skin group. These fibres are involved in pain, itching and temperature perception, and their degeneration may promote allodynia and similar symptoms. These results suggest that the pathophysiology of skin sensitivity resembles that of neuropathic pruritus within the context of small fibre neuropathy, and that environmental factors may alter skin innervation.
Atopic dermatitis (AD) is a multifactorial heterogenous disease that arises as a consequence of gene–gene and gene–environment interaction. Recent findings point to an elevation of stratum corneum (SC) protease activity as a common mechanism by which genetic and environmental factors facilitate epidermal barrier disruption and initiate inflammation. A defective epidermal barrier is a primary event in the development of AD, and is responsible for the increased transepidermal water loss (TEWL) and increased susceptibility to allergen penetration characteristic of this condition. Both an epidermal barrier defect and subclinical inflammation are features of non-lesional skin and increase the propensity toward the development of flares of AD. Current research demonstrates the effectiveness of treating subclinical inflammation at prolonging the period of remission between flares of AD. Future studies should focus on the repair of the epidermal barrier as a strategy to avoid the development of cutaneous inflammation, and thereby potentially prevent the development of AD or reduce its severity.
Background: Sensitive skin, a phenomenon claimed by the majority of female consumers across the industrialized
world, is not well understood. Multiple studies investigating the biology of reported discomfort have been unable to
establish reliable diagnostic criteria. The influence of geographical and cultural influences, including health and beauty
product advertising, on perceptions of sensitive skin are increasingly being recognized.
Objective: To evaluate southern American women for the perception of sensitive skin and compare to results of
previous surveys in other regions of the US.
Patients/Materials/Methods: A written questionnaire for self-reported perception of facial, genital, and body skin
sensitivity was administered to 86 females in Mississippi (MS). Statistical analysis was performed on the data and
compared with previous results.
Results; Women in Mississippi reported any skin sensitivity at significantly higher rater than those in Ohio although
they reported very or moderately sensitive skin at rates lower than other regions of the US.
Conclusions: This study confirms previous studies that have shown that women across the industrialized world
report some degree of skin sensitivity at fairly high levels and that environmental factors such as weather can contribute
to the perception of sensitive skin. It is increasingly recognized that psychosocial influences as well as biological factors
can contribute to skin sensitivity. Cultural contributions to the perception of skin sensitivity, particularly in women, are
often ignored but should be considered as a likely component of sensitive skin perceptions.
Sensitive skin is common but until now there has been no scale for measuring its severity. The Sensitive Scale is a new scale with a 14-item and a 10-item version that was tested in 11 countries in different languages on 2,966 participants. The aim of this study was to validate the pertinence of using the Sensitive Scale to measure the severity of sensitive skin. The internal consistency was high. Correlations with the dry skin type, higher age, female gender, fair phototypes and Dermatology Life Quality Index were found. Using the 10-item version appeared to be preferable because it was quicker and easier to complete, with the same internal consistency and the 4 items that were excluded were very rarely observed in patients. The mean initial scores were around 44/140 and 37/100. The use of a cream for sensitive skin showed the pertinence of the scale before and after treatment.
In recent decades, the prevalence of subjects with reactive skin has considerably increased in industrialised countries. 50% of women and 30% of men report cutaneous discomfort classified under reactive/sensitive skin. Several topical approaches have been proposed, in particular through improvement of galenic forms or protection of epidermal surface. We propose to act differently, deeply from inside the body via an innovative nutritional approach. To this purpose, Lactobacillus paracasei NCC 2461 (ST11) was selected because of its specific beneficial skin properties discovered in in vitro studies, i.e. diminution of neurogenic inflammation and promotion of the recovery of skin barrier function. We designed a randomised double-blind placebo-controlled clinical study with a two-month supplementation in two female treatment groups (n=32 per group). A capsaicin test was performed to monitor the time course of skin sensitivity. Moreover, transepidermal water loss was assessed to analyse the rate of skin barrier function recovery; dryness of the leg and roughness of the cheeks was investigated by a dermatologist as well as by self-assessment. The results of the present clinical trial show that oral supplementation with the probiotic decreases skin sensitivity and increases the rate of barrier function recovery. Thus, the data provide evidence that daily intake of ST11 could improve reactive skin condition.
Through the definition of novel biological activities of hormones and their diversity on different skin cell types, it has become apparent that the skin itself possesses the capacity to generate several hormones and substances with hormone-like activity. These substances appear to act through paracrine, autocrine, intracrine and endocrine mechanisms to fulfill their pleiotropic effects. Also new is the knowledge that the skin can metabolize hormones and produce derivatives with potentially systemic activity. These findings point towards novel concepts in our understanding of the role of skin and of its hormones as important players in homeostasis and disorders of the entire human organism. Finally, the scientists active in the field of dermato-endocrinology expect that their activities will exploit the pharmacological and therapeutic function of hormone mediators, their receptors and antagonists. The latter idea has already been realized for corticosteroids, androgens, estrogens, topical vitamin D analogues and retinoids which have today an established place in clinical dermatology.
There is increasing experimental evidence that the neurologic system can directly participate in cutaneous inflammation and wound healing. Recent studies indicate that neuropeptides released by cutaneous nerves such as c-fibers can activate a number of target cells including keratinocytes, Langerhans cells, mast cells, and endothelial cells. One such neuropeptide, substance P (SP), is able to specifically bind to murine and human keratinocytes and induce the release of cytokines such as interleukin 1 (IL-1). Other studies demonstrate that SP can also activate mast cells to produce the potent pro-inflammatory cytokine tumor necrosis factor alpha (TNF alpha). More recently, we examined the effect of cutaneous neuropeptides on human dermal microvascular endothelial cell (HDMEC) activities. Our studies indicate that the c-fiber-derived calcitonin gene-related peptide (CGRP) is capable of stimulating HDMEC to secrete the neutrophil chemotactic factor interleukin 8 (IL-8). In addition, SP is able to directly activate HDMEC to express high levels of the important cellular adhesion molecule vascular cellular adhesion molecule 1 (VCAM-1). Thus, these studies support the role that the neurologic system may play in mediating the biologic processes that occur during inflammation and wound healing in the skin.
There is a growing awareness that some individuals exhibit heightened skin sensitivity, particularly on the face, and have a high incidence of adverse reactions to cosmetics and toiletries.
To carry out an epidemiological study to assess the prevalence of sensitive skin and cosmetic-related adverse events in a U.K. population, and to examine possible factors that may be associated with sensitive skin.
Self-assessment questionnaires were sent out to 3300 women and 500 men, randomly selected, who were over the age of 18 years and lived within a 10-mile radius of High Wycombe (Bucks.). Fifty non-responder women were also questioned by telephone to ensure that the postal responders were representative of the population as a whole.
The response rates were 62% for women and 52% for men, with the incidence of self-reported skin sensitivity being 51.4% and 38.2%, respectively. Ten per cent of women and 5.8% of men described themselves as having very sensitive skin. Fifty-seven per cent of women and 31.4% of men had experienced an adverse reaction to a personal product at some stage in their lives, with 23% of women and 13.8% of men having had a problem in the last 12 months. Among the women, symptoms of cosmetic-induced subjective sensory skin discomfort (burning, stinging, itching etc.) occurred more commonly in the sensitive skin cohort (53%) than in those who regarded themselves as non-sensitive (17%). An atopic diathesis in women did not appear to be a predictive factor for sensitive skin, the incidence of self-perceived sensitive skin being equivalent for atopics (49%) and non-atopics (51%). Furthermore, some 34% of atopic women described themselves as being non-sensitive. Nevertheless, the incidence of atopy was higher among the women in the sensitive skin group (49%) than among those in the non-sensitive group (27%). Dry skin and a predilection for blushing/flushing were associated factors for sensitive skin.
Our survey indicates that sensitive facial skin is a common problem for women and men in the U.K. and points to the need for the development of personal products designed for this skin phenotype.
Sensitive skin is a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. The worldwide prevalence of sensitive skin is approximately 40%. Clinical, histological, biochemical and therapeutic data show that this condition is related to changes in epidermal nerve endings with subsequent hyper-reactivity and neurogenic inflammation; hence, sensitive skin is not a psychosomatic disorder, although psychological consequences are possible.
Background
More than 50% of adults report to suffer from sensitive skin. This common condition is characterized by subjective sensations such as prickling, burning, skin tightness or pruritus, and is often accompanied by objective symptoms like inflammation and erythema. Objective
The objective of this study was to develop an active ingredient concept for the treatment of sensitive skin. We tested compounds regarding their potential to (i) decrease the release of proinflammatory mediators, which among others induce erythema and (ii) counteract the hyperresponsiveness of nerve fibres and, thus, exert effects on cutaneous neurosensory dysfunction. Methods4-t-butylcyclohexanol, licochalcone A and acetyl dipeptide-1 cetyl ester were analysed invitro regarding their potential to (i) decrease the release of PGE(2) and activation of NFB and to (ii) inhibit TRPV1 activation or the release of neuronal CGRP. To assess subjective and objective symptoms of skin sensitivity invivo, two controlled, single-blind, randomized studies were conducted with 4-t-butylcyclohexanol and the combination with licochalcone A. ResultsIn vitro, 4-t-butylcyclohexanol significantly reduced TRPV1 activation, while acetyl dipeptide-1 cetyl ester had no effect on receptor activation. Licochalcone A significantly decreased NFB signalling and PGE(2) secretion, at lower concentrations than acetyl dipeptide-1 cetyl ester. A formulation containing 4-t-butylcyclohexanol showed a significant immediate anti-stinging/anti-burning effect invivo, and a cream base containing a combination of 4-t-butylcyclohexanol and a licochalcone A-rich licorice extract reduced shaving-induced erythema. Conclusion
In vitro and invivo data indicate that the combination of the TRPV1 antagonist 4-t-butylcyclohexanol and the potent anti-inflammatory licochalcone A provide an effective active ingredient concept for the treatment of sensitive skin, as the topical application resulted in an immediate relief from symptoms such as erythema and stinging.
Sensitive skin could be defined as the occurrence of erythema and/or abnormal stinging, burning and tingling sensations (occasionally pain or pruritus) in response to multiple factors, which may be physical (UV radiations, heat, cold and wind), chemical (cosmetics, soaps, water and pollutants) and occasionally psychological (stress) or hormonal (menstrual cycle). The diagnosis, pathophysiology, epidemiology and treatment are still under debate. Sensitive skin is most likely due to neurogenic inflammation after the enhanced activation of sensory proteins in keratinocytes and nerve endings. Skin sensitivity is a very frequent condition because it can be detected in approximately half of the population. The treatment is likely a cautious use of cosmetics or the use of cosmetics without preservatives and surfactants or containing inhibitors of neurogenic inflammation.
Using well-tolerated cosmetics or those with soothing effects is recommended to treat sensitive skin. However, we lack clinical studies. Two clinical trials were performed on sensitive skin in France and Thailand. The primary objective was to evaluate the preventive soothing effect. The secondary objectives were to evaluate the immediate soothing effect, product tolerance, and impact on quality of life. Evaluation methods included a stinging test and scoring erythema and stinging intensity. We also assessed tolerance, quality of life using the Dermatology Life Quality Index, and cosmetic qualities. The clinical trials were performed in France and Thailand to test efficacy in two different environments and on different ethnic skin. Interesting effects were observed in patients with sensitive skin in France and Thailand: a preventive soothing effect, a soothing effect on erythema, and an immediate soothing effect. In vivo biometrological, sodium lauryl sulfate, and capsaicin tests confirmed these data. A favorable effect on quality of life was also noted. The product was appreciated by volunteers for its efficacy, tolerance, and cosmetic qualities. A preliminary study on the effects on interleukin 8 was also included in the paper.
Acne is a common skin disease that involves the seborrheic area of the face and results from the obstruction of hair follicles followed by inflammation. Careful face washing helps to improve and prevent acne; however, intensive washing has a risk of inducing skin barrier impairment and dry skin, especially in sensitive skin. We hypothesized that skin care combining mild skin cleansing and intensive moisturizing ("combination skin care") may be effective in the care of acne in subjects with dry skin and/or sensitive skin. We developed a combination skin care with a weakly acidic foaming facial skin cleanser based on a mild detergent, an aqueous lotion with eucalyptus extract and a moisturizing gel containing pseudo-ceramide and eucalyptus extract. To optimize an ideal facial skin care system for mild acne on sensitive skin, we performed a 4-week clinical trial with 29 post-adolescent Japanese women with mild acne with dry and sensitive skin. The acne significantly decreased after this trial accompanied by the improvement of dry skin, a significantly increased endogenous ceramide level in the stratum corneum and an elongated alkyl chain length of the non-hydroxy acyl sphingosine type ceramide. No adverse events due to the test samples were observed. Based on diagnosis by a dermatologist, 97% of the subjects found the combination skin care to be "useful" or "slightly useful". Based on these findings, the combined use of a facial skin cleanser and moisturizers is safe and effective for the care of acne in post-adolescent Japanese women with sensitive skin.
© 2014 Japanese Dermatological Association.
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.
Background:
Sensitive skin is characterized by the occurrence of sensations of tingling, prickling, heat, burning, pain or itching and, on occasion, erythema, in response to multiple physical, chemical or hormonal factors that do not have irritant properties by themselves.
Objective:
We chose here to evaluate sensitive skin in two countries with very different populations, climates and lifestyles: Russia and Brazil.
Method:
Representative nationwide samples of the Russian and Brazilian populations aged 15 and over were selected. The same methodology was used: the individuals were questioned by telephone and selected as per the quotas method (sex, age, householder profession, rural/urban location and region).
Results:
In the Brazilian population, 22.3% versus 45.7%, in favour of women, reported having a "sensitive" skin. Significant differences were only observed by geographic residence. In the Russian population, 25.4% versus 50.1%, in favour of women, reported having a "sensitive" skin. Significant differences were observed in skin sensitivity according to social-professional categories, region of residence and subject age. The same results were found in both populations for sensitivity to cosmetics and food intake.
Conclusion:
Respondents with rather sensitive or very sensitive skin are 2 or 3 times more reactive to climatic, environmental factors, cosmetics and food intake.
Sensitive skin is a relatively common dermatologic condition and no optimal treatments have been established so far. Low-level laser/light therapy (LLLT) has been used for its biostimulative effect in various clinical settings. The purpose of this study was to investigate whether low-level laser/light therapy can improve sensitive skin clinically and to evaluate the effects of LLLT on skin in vitro. Twenty-eight patients complaining of sensitive skin were treated with low-level polarized light, and clinical results were evaluated using subjective and objective method. To investigate possible working mechanism of LLLT on skin, cultured human keratinocytes pretreated with nontoxic concentration of sodium lauryl sulfate (SLS) were used. Cytokines released from irritated keratinocytes after LLLT were analyzed. All patients showed subjective and objective improvement after treatment. No adverse effects were reported. The average number of LLLT sessions required to achieve clinical improvement was 9.9, and cumulative dose of LLLT was 71.3 J/cm(2) on the average. Erythema index decreased significantly after LLLT treatment (p = 0.017). In vitro assay showed that LLLT significantly reduced the release of VEGF from SLS-pretreated keratinocytes (p = 0.021). Our results suggest that LLLT could be a useful and safe treatment modality for sensitive skin, and modification of inflammatory cytokines released from irritated keratinocytes may be considered as one of plausible mechanisms in sensitive skin treated with LLLT.
Sensitive skin syndrome (SSS) is a common and challenging condition, yet little is known about its underlying pathophysiology. Patients with SSS often present with subjective complaints of severe facial irritation, burning, and/or stinging after application of cosmetic products. These complaints are out of proportion to the objective clinical findings. Defined as a self-diagnosed condition lacking any specific objective findings, SSS is by definition difficult to quantify and, therefore, the scientific community has yet to identify an acceptable objective screening test. In this overview we review recent epidemiological studies, present current thinking on the pathophysiology leading to SSS, discuss the challenges SSS presents, and recommend a commonsense approach to management.
To investigate the effectiveness of pimecrolimus cream 1% for sensitive skin in adult women and its underlying mechanisms.
The changes of subjective symptoms and signs were evaluated before and after the application of pimecrolimus cream 1% based on the severity of pruritus (SP) and severity of burning sensation (SB) scores, and on a basic syntax and molecular substrate (molecular psychophysics) of nociception and pruriception established by temperature-sensitive transient receptor potential (TRP) channels.
The SP and SB scores were significantly decreased in 32 patients with sensitive skin after using topical pimecrolimus cream 1% (P<0.05). Twenty (62.5%) patients showed positive capsaicin-like response (i.e. burning with consequent rapid amelioration of pruritus or burning sensation) and 6 (18.8%) showed positive camphor-like response (i.e. warming with consequent rapid amelioration of pruritus) on application sites after using the topical pimecrolimus cream 1%, and 6 (18.8%) showed negative capsaicin-like response and/or negative camphor-like response.
Pimecrolimus may rapidly inhibit or alleviate itch or burning sensation of patients with sensitive skin. The therapeutic effect of pimecrolimus is relevant to the mechanisms that activate or sensitize transient receptor potential vanilloid 1 (TRPV1) and desensitizes TRPV1 in the skin sensory afferents.
Synopsis
Sensitive skin is a condition of subjective cutaneous hyper‐reactivity to environmental factors. Subjects experiencing this condition report exaggerated reactions when their skin is in contact with cosmetics, soaps and sun screens, and they often report worsening after exposure to dry and cold climate. Although no sign of irritation is commonly detected, itching, burning, stinging and a tight sensation are constantly present. Generally substances that are not commonly considered irritants are involved in this abnormal response.Sensitive skin and subjective irritation are widespread but still far from being completely defined and understood. A correlation between sensitive skin and constitutional anomalies and/or other triggering factors such as occupational skin diseases or chronic exposure to irritants has been hypothesized. Recent findings suggest that higher sensitivity can be due to different mechanisms. Hyper‐reactors may have a thinner stratum corneum with a reduced corneocyte area causing a higher transcutaneous penetration of water‐soluble chemicals. Alterations in vanilloid receptors and changes in neuronal transmission have been described. Monitoring skin parameters such as barrier function, proclivity to irritation, corneocyte size and sensorial transmission can also be useful to identify regional differences in skin sensitivity.
Sensitive skin is a complex dermatological condition, defined by abnormal sensory symptoms. The aim of this epidemiological survey was to assess the prevalence of sensitive skin and collect data on sensitive skin in the US population.
A phone survey was conducted in the USA by a poll institute in 2007. A sample was drawn from a representative national cohort of the American population at least 18years of age through the quota method. Data on demographic characteristics, environmental and climatic factors, skin characteristics, dermatological disorders, cosmetics use, and visits to the dermatologist were collected.
Of 994 subjects who answered (495 men and 499 women), 44.6% declared having "sensitive" or "very sensitive" skin. Women were more concerned than men (50.9% vs. 38.2%, P<0.0001). There was no significant difference related to geographic localization, age, or ethnic distribution. Subjects with sensitive skin had mainly dry (34.5%) or mixed skin (35.7%), fair phototypes, dermatological disorders, higher skin reactivity to cosmetics and various environmental factors in comparison with subjects who stated having only a "slightly" sensitive or not sensitive skin. The dermatologist had a strong influence on subjects with "sensitive" or "very sensitive" skin through the prescription of skin care products.
This study, based on a representative sample of the American population, reveals a high prevalence of sensitive skin in the USA. Sensitive skin is mainly associated with dry skin, fair phototype, reactivity to climatic and environmental factors, and cosmetics. American dermatologists seem largely involved in the care of this condition.
The phenomenon of 'sensitive skin' is a relatively recent complaint in which certain individuals report more intense and frequent adverse sensory effects than the normal population upon use of cosmetic (personal-care) products. Originally defined as a minority complaint, sensitive skin is now claimed by a majority of women in industrialized countries and nearly half of men. Sensitive skin is self-diagnosed and typically unaccompanied by any obvious physical signs of irritation, and the number of individuals who claim sensitivity has risen steadily with the number of consumer products targeted towards this supposedly uncommon group. Believed by many dermatologists, therefore, to be a 'princess and the pea' phenomenon, the problem of sensitive skin has largely avoided focussed research. Over the last few years, however, the evidence of documentable biophysical changes associated with the largely sensory symptoms of this disorder has accumulated, including some gained by improved methods of identifying subclinical signs of skin irritation. Although the understanding of the aetiology of this phenomenon is as yet incomplete, existing research now supports a biophysical origin for this disorder. Effective methods of diagnosis, intrinsic and extrinsic contributors to exaggerated neural sensitivity, and the specific mechanisms of the discomfort associated with the compliant are required, as are appropriate means of prevention and treatment.
Tacrolimus is an immunosuppressant drug currently used for the treatment of atopic dermatitis and pruritus. This topical therapy is effective and safe, but transient burning, stinging and itch are frequently reported.
To understand the mechanisms underlying these burning sensations.
We examined the impact of tacrolimus on substance P (SP) release in an in vitro model of cutaneous neurogenic inflammation. Because phosphorylation of TRPV1 (transient receptor potential subtype vanilloid 1) plays a role in the induction of pain, we investigated whether tacrolimus regulates the phosphorylation state of TRPV1. Finally, we used a macropatch to evaluate the impact of tacrolimus on voltage-gated calcium currents of sensory neurons.
Tacrolimus was able to induce initial SP release by extracellular calcium influx and inhibited SP release induced by capsaicin after 1, 24 and 72 h of pretreatment. Analysis of TRPV1 phosphorylation by Western blot confirmed the capacity of tacrolimus to favour phosphorylation. An electrophysiological study showed inhibitory effects on calcium currents.
The efficacy of tacrolimus in pruritus, as well as the sensory side-effects, could be explained by a direct effect on neurons through an effect on calcineurin, possibly by a desensitization of TRPV1 and calcium currents through the PIP(2) regulation pathway.
According to epidemiological studies, up to 50% of adults report facial sensitivity with various distinctive symptoms, such as prickling, burning, tingling, pain or itching. This is termed sensitive skinand represents a syndrome of physiological reactions rather than a disease entity. In this review, we discuss the currently available literature on this syndrome and describe the possible underlying neuronal pathomechanisms. The sensory receptors expressed on unmyelinated nerve fibres and keratinocytes involved in nociception, such as TRPV1 and endothelin receptors, are hypothesized to play a role in the induction of sensitive skin. Furthermore, we discuss the role of neurotrophins and the influence of stress on sensitive skin.
Sensitive skin appears as a very frequent condition, but there is no comparative data between countries.
To perform an epidemiological approach to skin sensitivity in different European countries.
An opinion poll was conducted in eight European countries: Belgium, France, Germany, Greece, Italy, Portugal, Spain and Switzerland. This sample (4506 persons) was drawn from a representative sample of each population aged 15 years or older.
Sensitive or very sensitive skin was declared by 38.4% and slightly or not sensitive skin by 61.6%. Women declared more sensitive skin than men. A dermatological disease was declared by 31.2% of people with very sensitive skin, 17.6% of those with sensitive skin, 8.7% of those with slightly sensitive skin and 3.7% of those who do not have sensitive skin. A history of childhood atopic dermatitis was more frequent in patients with sensitive or very sensitive skin. The interviewees who declared that they had dry or oily skin also reported significantly more frequently sensitive or very sensitive skin than those with normal skin. Sensitive and very sensitive skins were clearly more frequent in Italy and France.
This study is the first study that compares skin sensitivity in European countries. Prevalence is high, but significant differences are noted between these countries. Dermatological antecedents (or treatments?) could be involved in the occurrence of skin sensitivity.
For two decades, we have staffed a Contact Dermatitis Clinic for the diagnosis and management of exogenous dermatoses. This unique clinical experience presented many patient-oriented opportunities, only some of which have been reasonably explored. The dermatologist quickly thinks of overt irritant or allergic dermatitis from cosmetics. Classic examples consist of acute allergic dermatitis to hair dyes, fragrances, preservations, and other cosmetic ingredients. This chapter refers not to these overt dermatoses but to more occult arcane difficulties.
There is increasing evidence that the cutaneous nervous system modulates physiological and pathophysiological effects including cell growth and differentiation, immunity and inflammation as well as tissue repair. Both cutaneous nervous fibers and inflammatory cells are able to release neuromediators and thereby activate specific receptors on target cells in the skin or transient immunocompetent cells. Cutaneous neuromediators include classical neurotransmitters such as catecholamines and acetylcholine being released from the automatic nervous system or cutaneous cells. On the other hand neuropeptides including substance P, calcitonin gene related peptide (CRGP), vasointestinal peptide (VIP) or proopiomelanocortin (POMC) derived peptides such as alpha melanocyte stimulating hormone (alphaMSH) may be released from sensory or autonomic nerve fibers and several epidermal as well as dermal cells. Neuropeptides are known to activate a variety of cutaneous cells through high affinity neuropeptide receptors or by direct activation of intracellular G-protein signalling cascades. Via the modulation of transcription factor activation (NF-kappaB, AP-1, STAT-3) they regulate the expression of adhesion molecules and proinflammatory cytokines in different cells and thereby function as modulators of immune and inflammatory reactions. Accordingly, neuropeptides such as CGRP or alphaMSH in vitro were found to downregulate costimulatory molecule expression on dendritic cells and in vivo via the generation of suppressor T-lymphocytes to induce hapten specific tolerance. Proteinases such as tryptase or neural endopeptidase inactivate neuropeptides in the extracellular space or at the cell surface thereby terminating neuropeptide induced inflammatory or immune responses. Proteinase-activated receptors (PAR) are recently described receptors that may have high impact in regulating cutaneous neurogenic inflammation. In the skin PAR-2 being expressed on sensory neurons and endothelial cells is self activated by tethered peptide ligands that are exposed after extracellular amino-terminal cleavage by trypsin or mast cell tryptase. PAR-2 agonists were found to induce the release of CGRP and SP which mediate vasodilation, plasma extravasation as well as the expression of adhesion molecules on vascular endothelial cells and thus elicit neurogenic inflammation. These findings indicate that the neuromediator network including neuropeptide receptors as well as proteinases play an important role in the maintenance of tissue integrity and the regulation of inflammatory and immune responses in the skin.
There exists within the population subsets of individuals who display heightened skin reactivity to materials the majority find tolerable. In a series of investigations, we have examined interrelationships between many of the endpoints associated with the term 'sensitive skin'. In the most recent work, 58 volunteers were treated with 10% lactic acid, 50% ethanol, 0.5% menthol and 1.0% capsaicin on the nasolabial fold, unoccluded, with sensory reactions recorded at 2.5 min, 5 min and 8 min after application. Urticant susceptibility was evaluated with 1 m benzoic acid and 125 mM trans-cinnamic acid applied to the volar forearm for 20 min. A 2 x 23-h patch test was also conducted using 0.1% and 0.3% sodium dodecyl sulfate, 0.3% and 0.6% cocamidopropyl betaine and 0.1% and 0.2% benzalkonium chloride to determine irritant susceptibility. As found in previous studies, increased susceptibility to one endpoint was not predictive of sensitivity to another. In our experience, nasolabial stinging was a poor predictor of general skin sensitivity. Nevertheless, it may be possible to identify in the normal population individuals who, coincidentally, are more generally sensitive to a range of non-immunologic adverse skin reactions. Whether such individuals are those who experience problems with skin care products remains to be addressed.
The vanilloid receptor subtype 1 (VR1)/(TRPV1), binding capsaicin, is a non-selective cation channel that recently has been shown in human keratinocytes in vitro and in vivo. However, a description of VR1 localization in other cutaneous compartments in particular cutaneous nerve fibers is still lacking. We therefore investigated VR1 immunoreactivity as well as mRNA and protein expression in a series (n = 26) of normal (n = 7), diseased (n = 13) [prurigo nodularis (PN) (n = 10), generalized pruritus (n = 1), and mastocytosis (n = 2)], and capsaicin-treated human skin (n = 6). VR1 immunoreactivity could be observed in cutaneous sensory nerve fibers, mast cells, epidermal keratinocytes, dermal blood vessels, the inner root sheet and the infundibulum of hair follicles, differentiated sebocytes, sweat gland ducts, and the secretory portion of eccrine sweat glands. Upon reverse transcriptase-polymerase chain reaction and Western blot analysis, VR1 was detected in mast cells and keratinocytes from human skin. In pruritic skin of PN, VR1 expression was highly increased in epidermal keratinocytes and nerve fibers, which was normalized after capsaicin application. During capsaicin therapy, a reduction of neuropeptides (substance P, calcitonin gene-related peptide) was observed. After cessation of capsaicin therapy, neuropeptides re-accumulated in skin nerves. In conclusion, VR1 is widely distributed in the skin, suggesting a major role for this receptor, e.g. in nociception and neurogenic inflammation.
Sensitive skin is a frequent disorder, but its effects and its variability are unknown.
To investigate the effects of sensitive skin first on quality of life and the psyche, and secondly, on seasonal changes.
The French Opinion Poll Institute (IPSOS) conducted two opinion polls in March and July 2004. Samples included, respectively, 1006 and 1001 individuals, from a representative national sample of the French population aged 15 years or older. The polling subjects were interviewed by phone and selected by the quota method (gender, age, occupation of household head, type of geographical area and region). Questions about their perception of their sensitive skin and about potential aggravating factors were asked. Quality of life was assessed using the SF-12 questionnaire and depressive symptoms using the Hospital Anxiety and Depression (HAD) rating scale.
The characteristics of the two samples were strictly similar. Persons with sensitive skin and very sensitive skin were more numerous in summer than in winter. In both surveys, the degree of sensitivity was significantly higher in the female population. Quality of life was worse in people with sensitive or very sensitive skin, above all in its psychological component - the more sensitive the skin, the more the quality of life deteriorated. There was no significant relationship between depressive symptoms and skin sensitivity in the 'very sensitive' or 'sensitive' groups.
Our study was the first to show seasonal changes in skin reactivity and to study the psychological impacts of sensitive skin.
During dermal injury and the associated trauma a number of compounds are released that can mediate the inflammatory response. Determining the cellular mechanisms that initiate the inflammatory responses to acute keratinocyte damage is important for understanding the regulation of epidermal inflammation. The recently cloned vanilloid receptor-1 (VR1) is a polymodal receptor, responding to thermal, pH, or vanilloids such as capsaicin stimulation. Although VR1 has been localized only on sensory neurons and within the central nervous system, recent evidence suggests a functional VR1 is expressed in human skin and epidermal cells. Using reverse transcription-polymerase chain reaction and immunoblotting we report that human keratinocytes and the human keratinocyte cell line HaCaT express VR1. Consistent with neuronal VR1, activation of epidermal VR1 by capsaicin induced a calcium influx. Treating HaCaT cells with capsaicin resulted in a dose-dependent expression of cyclooxygenase-2 (COX-2), whereas pretreatment with the VR1 receptor antagonist capsazepine abolished the capsaicin-stimulated increase in COX-2 expression. Furthermore, the capsaicin-induced expression of COX-2 was dependent on extracellular calcium. Activation of the epidermal VR1 by capsaicin also resulted in an increased release of interleukin-8 and prostaglandin E2, and the stimulated release was attenuated by capsazepine. The finding that VR1 is expressed by keratinocytes is of great importance because it expands the putative role of VR1 beyond that of pain perception. Our results suggest that VR1 expression in keratinocytes may have a role in the inflammation that occurs secondary to epidermal damage or insult, and thus may function as a sensor for noxious cutaneous stimulation.
Sensitive skin (or reactive or hyper-reactive skin) is defined as skin that reacts by erythema and/or subjective symptoms (pricking, burning, pain, pruritus etc.) to stimuli that are not pathogens in themselves (e.g. wind, heat, cold, water, cosmetics, stress). This phenomenon is very frequent, occurring in about 50% of the European population.
Sensitive skin is always reported on the face. The aim of our study was to determine if it can occur in other localizations.
We have performed this study in two centres. One was a department of dermatology in a university hospital while the other one was a centre for cosmetological studies. A questionnaire was given to women aged > 15 years. The questions were: Do you have sensitive skin? If yes, in which localization? What are the symptoms and triggering factors?
Four hundred subjects were included in the study (200 in each centre). The two populations were similar in terms of age, sex, and most of the results. The mean age was 40 years. Eighty-five per cent of the 400 subjects declared that they had sensitive skin on the face, and 70% had sensitive skin in another area: hands (58%), scalp (36%), feet (34%), neck (27%), torso (23%) or back (21%). Triggering factors included cold (66%), heat (28%), stress (61%), sun exposure (51%), wind (42%), water from a shower (29%) or a swimming pool (40%), soaps (42%), cosmetics (28%) and pollution (18%). Friction from clothes was reported in 28% of cases. Sensitive skin was observed as redness in most cases along with various subjective symptoms.
The proportion of subjects presenting with sensitive skin is probably overestimated. However, the main result of this study is that sensitive skin is not restricted to the face but rather it is also present at other localizations, mainly the hands, and often the scalp and feet.
The concept of the 'sensitive scalp' is vague. However, the 'sensitive skin syndrome' is probably not limited to the face.
To evaluate and analyse sensitive scalp conditions.
1011 individuals, representative of the French population, were investigated.
44.2 % declared suffering from a 'sensitive scalp' (47.4% of women versus 40.8% of men). Of these subjects, 11.5% reported having an associated scalp disease versus 1.1% of non-sensitive subjects. Hair loss was significantly associated with scalp sensitivity. The scalp was dry for 24%, normal for 58%, greasy for 16% and mixed for 1%. 13% complained of prickling, 25% of itching and 2% of burning or pain. These symptoms were more frequent among those with a 'sensitive scalp'. The main triggering factors were considered to be pollution, heat, emotions and shampoos. No other area of skin sensitivity was specifically associated with scalp sensitivity.
'Scalp sensitivity' exists and occurs frequently. Triggering factors are numerous. Symptoms appear different from those of facial skin sensitivity. Further studies to define and assess sensitive scalp conditions are needed.
The Pivotal Role of the Transient Receptor Potential (TRP) Ion Channels in the pathogenesis of sensitive Skin
- Ktm Chan
Chan KTM (2017) The Pivotal Role of the Transient Receptor Potential
(TRP) Ion Channels in the pathogenesis of sensitive Skin. Research J of
Nervous System 1: 1.
Keratinocytes can modulate and directly initiate nociceptive responses
- K M Baumbauer
- J J Deberry
- P C Adelman
Baumbauer KM, DeBerry JJ, Adelman PC (2015) Keratinocytes can
modulate and directly initiate nociceptive responses. eLife 4: e09674.
Comparative study of normal and sensitive skin aerobic bacterial populations
- M Hillon
- L Mijouin
- T Jaouen
- M Barreau
- P Meunier
Hillon M, Mijouin L, Jaouen T, Barreau M, Meunier P, et al. (2013)
Comparative study of normal and sensitive skin aerobic bacterial
populations. Microbiology Open 2: 953-961.