ArticleLiterature Review

Sensory, clinical and physiological factors in sensitive skin: A review

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Abstract

Certain individuals experience more intense and frequent adverse sensory effects than the normal population after topical use of personal care products, a phenomenon known in popular usage as sensitive skin. Consumer reports of sensitive skin are self-diagnosed and often not verifiable by objective signs of physical irritation. Companies who manufacture cosmetic and personal care products are challenged to provide safe products to an audience with tremendous differences in skin type, culture and habits. This review examines the still incomplete understanding of this phenomenon with respect to aetiology, diagnosis, appropriate testing methods, possible contributing host factors such as, sex, ethnicity, age, anatomical site, cultural and environmental factors, and the future directions needed for research.

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... The semi-subjective evaluation relies on subjects' report of cutaneous responses to stimuli, such as lactic acid stinging test (LAST), dimethyl sulphoxide, sodium lauryl sulphate, capsaicin and menthol [1,9]. The objective assessment is carried out using respective instruments to measure epidermal biophysical properties, including stratum coneum hydration (SCH), transepidermal water loss (TEWL), sebum content, pH, erythema indices [10][11][12][13]. Moreover, reflectance confocal microscopy and mobile-connected dermatoscope are used to facilitate the diagnosis of sensitive skin [14,15]. ...
... Clinical studies have shown that subjects with sensitive skin exhibit a defective epidermal permeability barrier and reduced SCH [10,13], whereas improvements in these epidermal functions alleviate both clinical signs and symptoms of sensitive skin, and lower LAST scores [10,26], suggesting, at least in some cases, a link between epidermal functions and LAST scores. A study showed a positive correlation between stinging responses and TEWL [27]. ...
... Clinical studies have shown that subjects with sensitive skin exhibit a defective epidermal permeability barrier and reduced SCH [10,13], whereas improvements in these epidermal functions alleviate both clinical signs and symptoms of sensitive skin, and lower LAST scores [10,26], suggesting, at least in some cases, a link between epidermal functions and LAST scores. A study showed a positive correlation between stinging responses and TEWL [27]. ...
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Background Lactic acid sting test (LAST) is a classical method to identify sensitive skin. However, some subjects with self‐perceived sensitive skins are negative for lactic acid sting test. Objective To determine whether LAST scores are associated with specific phenotype of sensitive skin. Methods A total of 292 subjects with self‐perceived sensitive skin were enrolled in this study. The Sensitive Scale was used to evaluate the severity of burning, stinging, itching, tautness, erythema and scaling based on 0 to 10 scale scores. In addition to assessment of LAST scores, epidermal biophysical properties were measured with an MPA system. Results The Sensitive Scale scores of stinging, itching, tautness and scaling were significantly different between LAST positive and negative group. However, burning and erythema scores did not differ between LAST positive and negative group. LAST scores correlated positively with stinging, itching, tautness and scaling Sensitive Scale scores, but not with burning and erythema scores. Moreover, LAST scores correlated negatively with stratum corneum hydration,but positively with TEWL rates. Conclusions LAST scores correlated positively with TEWL rates. LAST scores could be used to identify subjects with sensitive skin characterized mainly by stinging and itching, but not those mainly by burning and erythema. This article is protected by copyright. All rights reserved.
... Sensitive skin can affect all body locations, especially the face'. 2 This additional paper focuses on the pathophysiology and the management of sensitive skin. Independent reviews [3][4][5][6][7][8][9][10][11][12][13] and one book (two editions) 14,15 were previously published on this topic. Nonetheless, there is a need for a consensual approach after the publication of the consensual definition. ...
... 9 Without excluding other possible explanations, the role of the nervous system in the development of sensitive skin is crucial and a growing body of evidences supporting this hypothesis. 4,8,11 Skin hypersensitivity (as assessed by the Sensitive Scale) is more severe in patients with characteristics of neuropathic pain using the DN-4 (Douleur neuropathique, french name for neuropathic pain) questionnaire 45,46 or the Neuropathic Pain Sensory Inventory (NPSI). 46 In a recent epidemiological study on 5000 volunteers, very sensitive skin was twice as common in people with irritable bowel syndrome, 47 considered as secondary to peripheral nervous system alterations. ...
... But even patients without erythema or other signs of visible inflammation display hyper-reactivity of dermal blood vessels which can be measured by laser doppler velocimetry (LDV) or assessing skin colour with a chromameter. 11,52 Hence, testing of vasodilation of the skin may be an objective approach to test sensitive skin. Methyl nicotinate applied to the upper third of the ventral forearm for 15 s induces a strong vasodilation which can be measured with LDV. ...
... Based on the literature review, sensitive skin is defined as the subjective identification of skin discomfort in the absence of visible skin lesions. 3 However, some people may have adverse reactions to the use of certain products or irritants due to an exaggerated or higher sensitivity of their skin. 3 Sensitive skin refers to a sensory reaction triggered by contactors and/or environmental factors, usually, without a visible clinical manifestation. 1 Sensitive skin generally manifests in two forms-objective and subjective ( Figure 1). ...
... 3 However, some people may have adverse reactions to the use of certain products or irritants due to an exaggerated or higher sensitivity of their skin. 3 Sensitive skin refers to a sensory reaction triggered by contactors and/or environmental factors, usually, without a visible clinical manifestation. 1 Sensitive skin generally manifests in two forms-objective and subjective ( Figure 1). In the objective form, clinical lesions are visible such as erythema, papules, redness, and scaling. ...
... Endogenous factors are inherent potential host factors that may promote skin sensitivity. 3 Exogenous factors are external triggering factors for sensitive skin. 6 (Table 1) shows various endogenous and exogenous factors affecting sensitive skin. ...
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p class="abstract">In clinical practice, the ‘sensitive skin’ phenomenon, encompassing a wide range of signs and symptoms, is majorly a self-diagnosed condition. Various articles have given perspective on the heterogeneous concept of sensitive skin in varied ways. Cosmeceuticals, commonly used for sensitive skin, contain biologically active ingredients that deliver multifunctional skin benefits. Since no guidelines have been formulated for the use of cosmeceutical products in the management of sensitive skin, an individualized skin care regimen is usually adopted. Also, cosmeceutical products have been demonstrated to play a crucial role as add-on therapy in the management of dermatological disorders. However, there exists uncertainty about sensitive skin manifestation and well-defined use of cosmeceuticals for sensitive skin. This paper provides a consensus clinical viewpoint of expert clinicians, which will help clear the pathway for effective identification and management of sensitive skin using cosmeceuticals.</p
... However, there is no statistical evidence which can support this theory. It is thought that the differences observed between the various racial types would rather be due to other factors not directly related with ethnicity, for ins tance psychosocial and cultural factors [12,13] or diet. Thus, Asians react more intensely to spicy foods [13]. ...
... Environmental factors such as cold, sun, wind, heat, air pollution or air conditioner were identified as triggering factors of SSS [12]. The decrease in temperature and humidity characteristic in winter leads to a reduction in the water content of stratum corneum and may favour the manifestations of SSS [19]. ...
... Differences in the prevalence of sensitive skin could be attributed to varieties of habits, such as diet and body hygiene practices. Diets rich in spices, alcohol, coffee, etc… [17] such as shaving in men, excessive showers of excessive use of toiletries and fragrances may worsen SSS [12]. ...
Article
Full-text available
... To define the symptom profile and to address exogenous and endogenous factors which may elicit skin reactions, nonuniform questionnaires have been conducted in different populations [12][13][14] . Furthermore, various chemical and electrical provocations followed by noninvasive measurements of biophysical parameters of the skin have been widely appraised in persons having sensitive skin perceptions to quantify sensory irritation and to reveal the underlying mechanisms of sensitive skin [9,19,[21][22][23] . Various exogenous factors such as cosmetic ingredients and environmental conditions have been indicated to trigger sensitive skin reactions. ...
... Various exogenous factors such as cosmetic ingredients and environmental conditions have been indicated to trigger sensitive skin reactions. Many provocations used in experiments resulted in sensory skin reactions [19,21,22,24] . However, susceptibility to one provocative agent does not predict susceptibility to another [25][26][27][28] . ...
... Despite extensive research, a consensus on the definition of sensitive skin has not been reached and attempts to develop a valid diagnostic test to objectively identify the complete profile of sensitive skin have failed. Factors that impede the detection of sensitive skin are the heterogeneity of symptoms [17] , the subjectivity of sensory discomfort [29] and the absence of visible clinical features [17,21] . Updates have been published recently, but a systematic approach and a critical appraisal of published studies is still lacking [19,22,30,31] . ...
... 2 Sensitive skin may be defined as a noninflammatory response to cosmetics, characterized by stinging, burning, or itching, without visible skin changes. 3 Skin sensitivity is often determined by a stinging test, in which lactic acid or other irritants are applied to the nasolabial fold. 3 People with sensitive skin are likely to develop allergic contact Presentation at a scientific meeting: This work has not previously been presented in part or in full. ...
... 3 Skin sensitivity is often determined by a stinging test, in which lactic acid or other irritants are applied to the nasolabial fold. 3 People with sensitive skin are likely to develop allergic contact Presentation at a scientific meeting: This work has not previously been presented in part or in full. dermatitis or irritation to some cosmetic products. ...
... dermatitis or irritation to some cosmetic products. [3][4][5] The frequency of self-reported sensitive skin is increasing, with data from a European study 6 and a U.S. study 7 showing that 38% and 45% of subjects, respectively, described their skin as sensitive or very sensitive. It is important, therefore, that topical cosmetic products undergo clinical evaluation for their suitability of use for this population. ...
Article
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Background Topical cosmetic products can cause adverse reactions in some individuals, particularly those with sensitive skin who may develop irritations or allergic contact dermatitis. Evidence suggests that the frequency of self‐reported sensitive skin is increasing in the general population, placing greater importance on clinical testing of topical cosmetics for potential skin reactivity. Objectives To confirm the cutaneous acceptability under normal conditions of use of a moisturizing cream in individuals with sensitive skin. Methods This was a prospective, single‐center, open‐label, noncomparative clinical trial conducted in female subjects aged 18‐60 years with Fitzpatrick skin phototype I‐IV and confirmed sensitive skin. Subjects applied the moisturizer twice daily to the body and/or face for 21 ± 2 days. Product acceptability was based on the occurrence of adverse events, investigator assessment of skin adverse reactions, and subjects’ self‐reported feelings of skin discomfort. Results Thirty‐five female subjects initiated and completed the study; mean age was 43.2 years and most (89%) had Fitzpatrick skin phototype I‐III. No adverse events or skin adverse reactions of erythema, edema, or skin desquamation were observed. There were no participant reports of skin dryness, prickling, or stinging on any occasion. One subject reported a single event of mild itching, which was considered by the investigator as probably not related to study product. Conclusions These findings suggest that the moisturizing cream was well tolerated under normal conditions of use and appropriate for topical use on sensitive skin.
... Sensitive skin can affect all body locations, especially the face'. 2 This additional paper focuses on the pathophysiology and the management of sensitive skin. Independent reviews [3][4][5][6][7][8][9][10][11][12][13] and one book (two editions) 14,15 were previously published on this topic. Nonetheless, there is a need for a consensual approach after the publication of the consensual definition. ...
... 9 Without excluding other possible explanations, the role of the nervous system in the development of sensitive skin is crucial and a growing body of evidences supporting this hypothesis. 4,8,11 Skin hypersensitivity (as assessed by the Sensitive Scale) is more severe in patients with characteristics of neuropathic pain using the DN-4 (Douleur neuropathique, french name for neuropathic pain) questionnaire 45,46 or the Neuropathic Pain Sensory Inventory (NPSI). 46 In a recent epidemiological study on 5000 volunteers, very sensitive skin was twice as common in people with irritable bowel syndrome, 47 considered as secondary to peripheral nervous system alterations. ...
... But even patients without erythema or other signs of visible inflammation display hyper-reactivity of dermal blood vessels which can be measured by laser doppler velocimetry (LDV) or assessing skin colour with a chromameter. 11,52 Hence, testing of vasodilation of the skin may be an objective approach to test sensitive skin. Methyl nicotinate applied to the upper third of the ventral forearm for 15 s induces a strong vasodilation which can be measured with LDV. ...
Article
The special interest group on sensitive skin of the International Forum for the Study of Itch previously defined sensitive skin 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. This additional paper focuses on the pathophysiology and the management of sensitive skin. Sensitive skin is not an immunological disorder but is related to alterations of the skin nervous system. Skin barrier abnormalities are frequently associated, but there is no cause and direct relationship. Further studies are needed to better understand the pathophysiology of sensitive skin – as well as the inducing factors. Avoidance of possible triggering factors and the use of well‐tolerated cosmetics, especially those containing inhibitors of unpleasant sensations, might be suggested for patients with sensitive skin. The role of psychosocial factors, such as stress or negative expectations, might be relevant for subgroups of patients. To date, there is no clinical trial supporting the use of topical or systemic drugs in sensitive skin. The published data are not sufficient to reach a consensus on sensitive skin management. In general, patients with sensitive skin require a personalized approach, taking into account various biomedical, neural and psychosocial factors affecting sensitive skin.
... Sensitive skin occurs as an abnormal sub-clinical sensory response including tingling, chafing, burning and/or prickling, and possibly pain or pruritus in facial skin to drugs, cosmetics and toiletries without visible signs of irritation [5,41]. Although the causes of sensitive skin are multifactorial, a decreased barrier function (increased cutaneous permeability) of the stratum corneum (SC), allowing potentially irritating substances to penetrate the skin leading to an acceleration of sensory nerve responses, has been suggested to be one of mechanisms involved [2,5,28,33,34,38,41,44,51]. ...
... Sensitive skin occurs as an abnormal sub-clinical sensory response including tingling, chafing, burning and/or prickling, and possibly pain or pruritus in facial skin to drugs, cosmetics and toiletries without visible signs of irritation [5,41]. Although the causes of sensitive skin are multifactorial, a decreased barrier function (increased cutaneous permeability) of the stratum corneum (SC), allowing potentially irritating substances to penetrate the skin leading to an acceleration of sensory nerve responses, has been suggested to be one of mechanisms involved [2,5,28,33,34,38,41,44,51]. Accumulating evidence has indicated that barrierdisrupted skin, generally being accompanied by dry skin, as seen with atopic dry skin in atopic dermatitis (AD) patients [1, 3,20,21,25,39,45], in the skin of the essential fatty acid deficiency rat [18] and in surfactant-induced roughened skin [16], is mainly associated with significantly altered ceramide profiles including decreased levels and ceramide species with shorter alkyl chain lengths in the SC [21,23]. ...
Article
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We determined whether compensating ceramides in the stratum corneum (SC) may ameliorate the impaired barrier function and subsequently attenuate the enhanced skin sensitivity. Treatment for 4 weeks with the ceramide complex cream or the placebo cream significantly ameliorated the intensity of lactic acid sensations in 39 female subjects with sensitive skin, the degree of which was attenuated to a greater extent at 1 week by the ceramide complex cream compared with the placebo cream. The amelioration of skin sensations was accompanied by a significant increase in total ceramide content in the SC elicited by the ceramide complex cream that was significantly more effective than the placebo cream at 4 weeks. Consistently, TEWL and conductance values were significantly decreased or increased at 1 and 4 weeks, respectively, to a greater extent by the ceramide complex cream than by the placebo cream. TEWL levels were significantly correlated with the increased levels of SC total ceramide in the ceramide complex cream-treated skin but not in the placebo cream-treated skin. Thus, the amelioration of lactic acid sensations by topical application of a ceramide complex cream, provides a deep insight into the pathophysiology of sensitive skin as a reduced barrier function-dependent sub-clinical sensory response.
... Sensitive skin is a condition of subjective cutaneous hyperreactivity to environmental conditions. 1 Subjects with sensitive skin may experience a noninflammatory response to products applied topically to the skin, characterized by sensorial reactions such as stinging, burning, or itching, in the absence of visible irritation-related skin changes or an active immune response/allergic reaction. [2][3][4] Sensitive skin may be more prone to adverse reactions to cosmetic products, 4 including irritation, burning sensation, redness, pruritus, and erythema at the product application site. 5 Substances known to trigger an irritation response in sensitive skin include benzoic acid, cinnamic acid, nonionic emulsifiers, sodium laurel sulfate, bronopol, lactic acid, propylene glycol, urea, and sorbic acid. ...
... Sensitive skin is a condition of subjective cutaneous hyperreactivity to environmental conditions. 1 Subjects with sensitive skin may experience a noninflammatory response to products applied topically to the skin, characterized by sensorial reactions such as stinging, burning, or itching, in the absence of visible irritation-related skin changes or an active immune response/allergic reaction. [2][3][4] Sensitive skin may be more prone to adverse reactions to cosmetic products, 4 including irritation, burning sensation, redness, pruritus, and erythema at the product application site. 5 Substances known to trigger an irritation response in sensitive skin include benzoic acid, cinnamic acid, nonionic emulsifiers, sodium laurel sulfate, bronopol, lactic acid, propylene glycol, urea, and sorbic acid. ...
Article
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Purpose This 3-week, open-label, noncomparative clinical study evaluated the skin acceptability of a cosmetic moisturizer in subjects with sensitive skin, by monitoring adverse events (AEs) and cutaneous discomfort related to normal usage. Materials and methods Female subjects aged between 18–60 years, with Fitzpatrick phototype classification I–IV and sensitive skin, verified by a positive reaction on the stinging test at screening, were included. Subjects applied the moisturizer to their face and body twice daily for 21±2 days at home and recorded study product usage and feelings of cutaneous discomfort (eg, dryness, prickling, stinging, and itching) in a diary; any AEs were reported to the clinic. At study end, skin acceptability of the moisturizer was investigator-assessed based on the nature of AEs and subjects’ self-reported feelings of discomfort, and by clinical evaluation of skin reactions in the area of moisturizer application (appearance of erythema, formation of edema, and skin desquamation; scored according to an adapted Draize and Kligman scale). Only subjects with a treatment compliance of ≥80% were included in the final analysis. Results In total, 35 subjects initiated and completed the study; all were compliant to the minimum study product usage. Per investigator clinical dermatological assessment at study end, none of the 35 subjects had skin reactions in the area of moisturizer application and there were no reported AEs. One subject reported sensations of mild prickling and itching immediately after applying the moisturizer (not classified as AEs), which spontaneously remitted after complete absorption of the product and were noted only in exposed areas. These events were considered by the investigator as being possibly/probably related to the use of study product; however, no clinical signs of skin reaction were observed in the exposed areas. Conclusion This cosmetic moisturizer appears generally well tolerated and suitable for topical use in subjects with sensitive skin.
... In fact several other agents, including exposure to UV light, general pollutants, chemicals or drugs can induce skin irritation 19 that can reduce for example compliance in drug assumptions, or reduce the application of dermatological products. 16,20 The efficacy of noninvasive treatments able to reduce skin effects induce by irritants is therefore needed. In this context, the results obtained in the present study show that a simple patch application can thermore, as it can be seen in Figure 6, in all 20 subjects analyzed there was an improvement of skin moisturization over basal level, while this effect was not observable in the untreated area. ...
Article
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BACKGROUND: Many chemical or environmental agents induce skin irritation. This can impact on general quality of life. The present study aimed at determining the activity of a simple patch application in reducing acute skin irritation. METHODS: Twenty healthy volunteers entered this study. The subjects received a single application of sodium lauryl sulfate (SLS) as acute irritant. Twenty-four hours after irritant application, a Profhilo® Figura Body Patch (IBSA Farmaceutici Italia Srl, Lodi, Italy) was applied and instrumental evaluations utilized to determine its ability to reduce skin redness and to increase skin moisturization. RESULTS: A single patch application was indeed able to improve skin moisturization and to reduce skin redness. The results were obtained after short time application of the patch. CONCLUSIONS: The positive results obtained indicate that the use of non-invasive patches have potential application in the treatment of local acute skin irritation. The application is likely to be extended to other non-SLS-induce forms of skin irritation, like for example those induced by topic injection of fillers in aesthetic treatments, that are widely used for the treatment of skin ageing.
... The most reported pathological form in industrialized countries is allergic contact dermatitis (ACD) [3] which is the clinical expression of a type IV hypersensitivity (delayed-type hypersensitivity) [4]. ...
... Fair skin phototypes were more frequently associated with sensitive skin, which is consistent with the results of previous studies (11,12). The relationship between sensitive skin and these photo types could be related to a smaller epidermal thickness and higher vascular reactivity in subjects with fair phototypes (13). In the current study, dark skin phototypes were poorly represented, which is explained by the location of patient recruitment for the study (Brittanny, France). ...
Article
Sensitive skin is commonly assessed on the basis of self-reports from patients, and sometimes questionnaires, such as the Sensitive Scale-10, are used. The severity of sensitive skin follows a continuum, from the absence of sensitive skin to very sensitive skin. The aims of this cross-sectional study were to compare subjects with and without symptomatic sensitive skin and to propose diagnostic criteria for sensitive skin. A total of 160 women, between 18 and 65 years of age, with and without sensitive skin, and without any associated skin diseases, were recruited. Mean age was 41 years old. Fifty-five percent of participants reported having “very sensitive” or “sensitive” skin. In the sensitive skin group, the participants mainly experienced skin irritability (100%), tautness (97.5%), discomfort (90%) and redness (90%). According to the receiver operating characteristic curve, a Sensitive Scale-10 (SS-10) cut-off value of 12.7 can be used to detect sensitive skin (with a sensitivity of 72.4% and specificity of 90.3%).
... Water, being the main component of a human body, is inv olved in numerous biochemical and biophysical processes occurring in human skin. Hydration of the upper layers of skin (stratum corneum and viable epidermis) is directly related to the aging processes [1] and skin sensitivity [2], whe reas the water content in dermis correlates with the mechanical elas ticity of skin [3]. Moreover, a change in the water concentra tion in tissues may also be a symptom of some serious dis eases, e. g., chronic heart failure or impaired renal function [4]. ...
... Active EPS SEAPUR ® by CODIF, an exopolysaccharide solution from fermentation of marine planktonic microorganism, considered a post-biotic, is suggested to re-equilibrate the S. epidermidis and C. acnes ratio, and decrease the inflammation induced by bacterial stress [182]. A study conducted in 2005 on 523 women and 483 men revealed that 59% of women and 44% of men declared to have sensitive skin [183], subjective skin hyper-reactivity to various environmental factors characterized by an overheating feeling, tingling, itching and redness [184,185], but not associated to any dysbiosis of aerobic cultivable bacteria [186]. ExpoZen ® by GREENTECH, a Halymenia durvillei extract enriched in low molecular weight polysaccharides, was evaluated on samples from 30 volunteers with reactive and sensitive skins. ...
Article
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Dermatological and cosmetics fields have recently started to focus on the human skin microbiome and microbiota, since the skin microbiota is involved in the health and dysbiosis of the skin ecosystem. Amongst the skin microorganisms, Staphylococcus epidermidis and Cutibacterium acnes, both commensal bacteria, appear as skin microbiota sentinels. These sentinels have a key role in the skin ecosystem since they protect and prevent microbiota disequilibrium by fighting pathogens and participate in skin homeostasis through the production of beneficial bacterial metabolites. These bacteria adapt to changing skin microenvironments and can shift to being opportunistic pathogens, forming biofilms, and thus are involved in common skin dysbiosis, such as acne or atopic dermatitis. The current evaluation methods for cosmetic active ingredient development are discussed targeting these two sentinels with their assets and limits. After identification of these objectives, research of the active cosmetic ingredients and products that maintain and promote these commensal metabolisms, or reduce their pathogenic forms, are now the new challenges of the skincare industry in correlation with the constant development of adapted evaluation methods.
... The concept of sensitive skin was introduced by Frosch (1) and Thiers (2). Sensitive skin is characterized by the occurrence of sensations of tingling, prickling, heat, burning, pain, or itching, and occasionally by erythema in response to multiple physical (UV radiation, heat, cold, or wind), chemical (cosmetics, soaps, pollution, or water), psychological (stress), and/or hormonal (menstrual cycle) factors that should not provoke such sensations (3)(4)(5)(6). Sensitive skin is also called reactive, hyper-reactive, intolerant or irritable skin. The term "sensitive skin" mainly refers to facial skin, but this condition can also affect other areas of the body, such as the hands, scalp, or genital area (6)(7)(8). ...
Article
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Sensitive skin is a very frequent condition, the prevalence of this syndrome has been studied in different countries in Europe, in United States and in Japan. The aim of the study was to evaluate the epidemiology of sensitive skin in the Indian population, like this has never been studied in this country. A representative nationwide sample of the Indian population aged 15 and over was selected. Individuals were selected as per the quota method (based on sex, age, householder profession, rural/urban location, and region). In total, 27.9% of men and 36.7% of women declared having “sensitive” or “very sensitive” skin. The difference between the 2 sexes was very significant. Of these, 5.1% of men and 7.2% of women reported having “very sensitive” skin. The subjects complaining about “sensitive” or “very sensitive” skin were 2–4 times more likely to declare suffering from atopic dermatitis, acne, psoriasis, or vitiligo. They were 2 to 3 times more reactive to climatic factors, environmental factors, cosmetics and food intake. In conclusion, although less frequently reported than in other countries, sensitive skin is a frequent condition in India, affecting about one third of the population.
... Although the pathophysiology of SS remains unclear, the underlying direct mechanisms are not immunological or allergic. Several differences have been found between SS and non-sensitive skin (NSS) (3,4,(7)(8)(9). Classically, SS syndrome is considered a consequence of sensory neural changes and/or a skin barrier disruption that increases the permeability of the stratum corneum, resulting in an increase in transepidermal water loss (TEWL) (10)(11)(12). However, this impairment in the cutaneous skin barrier is not always present (9). ...
Article
Full-text available
In 2016, a special interest group from the International Forum for the Study of Itch defined sensitive skin (SS) as a syndrome that manifests with the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) after stimuli that should not cause a reaction, such as water, cold, heat, or other physical and/or chemical factors. The pathophysiology of sensitive skin is still poorly understood, but the symptoms described suggest inflammation and peripheral innervation. Only two publications have focused on sensitive skin transcriptomics. In the first study, the authors performed a microarray comparison of SS and non-sensitive skin (NSS) samples and showed differences in the expression of numerous genes in SS and NSS samples. Moreover, in the SS samples, two clusters of genes were identified, including upregulated and downregulated genes, compared to NSS samples. These results provide some interesting clues for the understanding of the pathophysiology of SS. The second study compared SS and NSS samples using RNA-seq assays. This method allowed the identification of long non-coding RNAs (lncRNAs) and differentially expressed mRNAs and provided a comprehensive profile in subjects with SS. The results showed that a wide range of genes may be involved in the pathogenesis of SS and suggested pathways that could be associated with them. In this paper, we discuss these two studies in detail and show how transcriptomic studies can help understand the pathophysiology of sensitive skin. We call for new transcriptomic studies on larger populations to be conducted before putative pathogenic mechanisms can be detected and analyzed to achieve a better understanding of this complex condition.
... Sensitive skin is characterized by uncomfortable sensations, such as prickling, burning, tingling, pain, or itchiness, and occasionally erythema or acne, in response to a number of physical or chemical factors, such as ultraviolet radiation, climate, or environment. 1, 2 The mechanism of sensitive skin has not been elucidated, but it is now believed that it is neither an allergy nor an immune response. 3 There are several possible mechanisms. ...
Article
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Purpose: Sensitive skin is characterized by uncomfortable sensations in response to a number of factors. We performed a large-scale study to investigate the prevalence of sensitive skin at all ages and the impacts of related factors across China. Methods: A nationwide sampling of the Chinese population aged over 18 was conducted. Subjects were categorized into sensitive and non-sensitive groups, and critical differences between these two groups were investigated. Results: In total, 22,085 questionnaires were collected from Chinese women with sensitive skin. The prevalence of sensitive skin is 49.6% and is associated with age, skin type, geographic area of subjects, and other factors. Heavy life stress and the application of several cosmetic products also affect the prevalence of sensitive skin. Conclusion: Having a combination or oily skin type, living in the municipalities, being under heavy stress, and applying several cosmetic products will increase skin stress and contribute to the occurrence of sensitive skin.
... Various aspects of the syndrome of sensitive skin have been reviewed recently by Barardesca et al. 1 In people with sensitive skin, reported symptoms after exposure to certain products or environmental conditions can include objective visual effects such as redness, dryness or papules or subjective sensory effects such as burning, itching or stinging. 2,3 Testing methods have been developed to evaluate the objective effects, including measurements of transepidermal water loss, hydration of the stratum corneum, redness, blood flow and surface pH. 4 However, the subjective effects are more difficult to quantify and have been less studied. ...
... In surveys in the United States, Europe, and Asia, almost half of people reported having sensitive skin (1)(2)(3)(4). The symptoms of sensitivity are varied, including stinging, redness, roughness, scaling, and itching (5)(6)(7)(8). Certainly, direct contact to skin irritants can trigger sensitivity responses. Also, airborne materials such as smoke and chemicals can become trapped in fabrics and, thus, elicit skin responses when the fabrics contact the skin (9)(10)(11)(12). ...
Article
The skin mildness of two commercial laundry detergents designed for sensitive skin, Tide Free and Gentle® (TFG) versus All Free Clear® (AFC), was compared in clinical studies, and the role of marked product pH differences was assessed. Two double-blind randomized human studies were conducted. Study 1 was a 1-day repeat insult forearm test, in which four exposures to solutions of TFG or AFC were performed to mimic direct exposure to dilute detergent during hand-laundering. Corneometer, erythema and dryness grading, transepidermal water loss (TEWL), and skin surface pH evaluations were carried out. Study 2 was a 21-day arm patch test of fabrics washed with TFG or AFC to mimic indirect contact to skin of detergent residues, with erythema grading. Separately, pH and reserve alkalinity were determined for each detergent. In Study 1, TFG was significantly milder than AFC in all measures except TEWL (no significant difference). In Study 2, the detergents were approximately equivalent in erythema grading. Analysis showed AFC was substantially more alkaline (pH 10.8) than TFG (pH 7.9) with higher reserve alkalinity. TFG was significantly milder than AFC in Study 1, which may be due in part to the increased skin surface pH seen with direct exposure to AFC's high alkalinity.
... Considering skin as an important shield from the entry of harmful substances, noninvasive assessment of skin biophysical properties is imperative to provide us a clue on the skin integrity [1]. Unlike other body parts, facial skin is unique because facial skin is sensitive and thinner [2][3][4]. Given such a distinctive characteristic and anatomical location, biophysical properties of facial skin are widely accepted to be different from other parts of the human body. ...
Article
Introduction: At present, there is a lack of baseline data on the facial skin biophysical profile of women in Malaysia. The implications related to the daily habits and facial skincare product use on the skin biophysical condition are, thus, unknown. In this study, we aim to evaluate facial skin biophysical parameters of Malaysian women and examine the influence of demographic characteristics, daily habits, and facial skincare product use on these parameters. Methods: Four skin biophysical parameters - transepidermal water loss (TEWL), melanin content, elasticity, and collagen intensity - were assessed on the cheek of the subjects (20-60 years). Demographic background, daily habits, and skincare product use were gauged through a survey. Only 197 from the 213 subjects recruited initially were used for analysis after the data were screened for normality. Results: The biophysical parameters were similar in different races, except a higher melanin content in Indian female individuals. Elasticity and collagen intensity reduced with age, while melanin content increased in the older age-groups. But no difference was observed in TEWL at different ages. Evaluating the influence of daily habits, we observed that exercise significantly lowered TEWL and increased melanin content, which may be associated with UV radiation exposure. Facial skincare products are popular among the female subjects (>85% users). Products with moisturizing, sunscreening, and other skincare functions (astringent, antiaging, and anti-wrinkle) were preferred by subjects of all ages. These product functions significantly improve skin elasticity and reduce melanin content in the young adults. While aged women recognized the importance of having an additional skin-lightening function in their skincare routine. Although the influence of individual skincare function on skin biophysical parameters was mostly positive, the alteration of these parameters varied at different ages. Conclusion: This is the first report of facial skin biophysical profile of Malaysian women. There is no difference among 3 major races saved for melanin content. This work demonstrated age-dependent influences on the biophysical parameters, except TEWL. The significance of skincare product use is well reflected in the improvement of these parameters at different age-groups based on individual skincare functions.
... Sensitive skins (that it should be better to name 'reactive' or 'hyperreactive' or 'hypersensitive' skins to avoid confusion) and irritated skins (orthoergic dermatoses), as well as sensitized (or allergic) skins are very different conditions in reaction to environmental factors (Misery, 2007). Table I (Farage et al., 2006, Misery et al., 2017, Stander et al., 2009, Talagas and Misery, 2019 about "skin irritation or sensitivity" with some ambiguity because these papers were rather related to sensitive skin Using the Delphi method, the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI) defined sensitive skin as follows: "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. ...
... Barrier function defects can lead to the activation of keratinocytes and Langerhans cells, inflammatory mediator release and the exposure of sensitive nerves, which can trigger vascular hyper-reactivity and sensory perceptions such as burning, stinging similar to that experienced in sensitive skin. 25 Participants reporting oily, or combination skin types, more frequently identified as having sensitive skin, in contrast to the dry/normal skin types that more frequently reported non-sensitive skin. Further investigation to establish the difference between dry skin type and normal skin type and to establish an association between barrier function and skin sensitivity is required. ...
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Background: Skin sensitivity characteristics and triggers have been identified in populations in previous studies. However, few have compared these characteristics among self-reported sensitive skin. Objective: The aim of the study was to evaluate and compare specific intrinsic and extrinsic triggers of skin sensitivity between individuals with self-reported sensitive skin and non-sensitive skin. Methods: A systematic literature review was undertaken to identify intrinsic and extrinsic factors associated with sensitive skin. A 167-item survey was developed on the basis of the literature review. The survey was completed online by a sample of adult participants drawn from the general United Kingdom population. Participants also completed sociodemographic and self-reported health questions. Results: A total of 3050 surveys were completed: 1526 participants with self-reported skin sensitivity and 1524 participants not reporting skin sensitivity. There was a decrease in self-reported skin sensitivity with increasing age (p<0.05), and proportionally more women reported sensitive skin. Smoking also led to a higher frequency of sensitive skin. All signs and symptoms of sensitive skin, such as itch, dryness/flakiness, roughness and flushing/blushing were more commonly reported by those with self-reported sensitive skin. These were frequently reported in association with external factors (cold/windy weather, clothes and fabrics), as well as internal factors such as pre-existing skin conditions and atopy. Conclusion: The study evaluated self-reported sensitive skin against a non-sensitive skin in order to identify common inherent and external triggers to distinguish between these groups in a large general population study in the United Kingdom. The key symptoms and signs of this syndrome identified in the literature were confirmed to be reported significantly more when compared with those without sensitive skin. However, no correlation or pattern of symptomology could be identified, reinforcing the complexity of this condition. Given the strong differentiation from the non-sensitive group, the results of this research could be utilised for the development of a clinically meaningful screening tool.
... Sensitive skin is considered to be unpleasant sensations stimulated by those that normally should not elicit such sensations, and which cannot result from lesions of any skin disease. 1 It is estimated that about 70% of the adult population declare that they are suffering from sensitive skin across the world. 19 As a complex and global skin problem, this condition has weak correlation between sensory symptoms and subjective signs, 20 making it difficult to be reliably predicted and diagnosed. In this study, it was demonstrated that the prevalence of sensitive skin was diagnostic method dependent, which was 50.2% and 66.0% by questionnaire and LAST, (Table 1). ...
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Background: Questionnaires and lactic acid sting test (LAST) are two widely used methods to identify sensitive skin. However, the self-perceived sensitive skin by questionnaires was not consistent with the determination of LAST. Objective: The aim of the study was to measure the biophysical properties noninvasively of sensitive skin evaluated by questionnaire and LAST and to investigate their correlations with the scores of questionnaire and LAST. Methods: A total of 209 healthy Chinese females completed the study. Self-assessment questionnaire and LAST were both performed to identify sensitive skin. Epidermal biophysical properties, including skin hydration, transepidermal water loss (TEWL), sebum content, erythema index (EI), a* value, L* value, skin elasticity, and skin pH, were measured with noninvasive instruments. Results: The frequency of sensitive skin was 50.2% and 66.0% by questionnaire and LAST, respectively. Subjects with self-assessed sensitive skin had a slightly higher LAST positive rate. Skin hydration, sebum content, a* and EI values were significantly higher in the self-assessed sensitive skin group, while TEWL, a* and EI values increased but L* value decreased with significance in the LAST positive group. The LAST stingers among sensitive skin subjects had higher EI but not in the healthy skin subjects. In addition, questionnaire scores positively correlated with skin hydration, sebum content, a* and EI values, while a positive relationship of LAST scores with TEWL, a* and EI values was observed. The scores of questionnaire and LAST both negatively related to L* value. Conclusion: Self-assessed questionnaire is associated with sensitive skin featured by oily and red face without impaired barrier function, whereas LAST is suitable to identify fragile skin barrier and enhanced blood flow on the face. Combination of both methods to diagnose sensitive skin might be more reliable.
... 4,10 An impaired skin barrier function seems to underlie this hyper-reactivity. [11][12][13][14][15] The diagnosis of sensitive skin can be assisted by several sensory testing methods. One of the most often used is the lactic acid stinging test (LAST). ...
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Background Sensitive skin is very common and distressing. Its diagnosis may be difficult with the tools/methods available at the moment. Aims To assess the reliability of a self-assessment questionnaire for the diagnosis of sensitive skin, using the results of lactic acid stinging test (LAST) as a reference for the identification of subjects suffering from this condition. A further objective was to identify the questionnaire cutoff score that better discriminates between subjects with or without sensitive skin. Patients/methods Among the adult volunteers included in this observational, cross-sectional study, both LAST-positive subjects, who were considered as having sensitive skin (“patients”), and negative ones (“controls”) completed the questionnaire. It consisted of a part for self-assessing and quantifying (0–10) sensitive skin and another one that included 10 items, each referring to a specific, potentially triggering stimulus. A cumulative score (questionnaire-based skin sensitivity score, 0–10) was calculated from the sum of all items considered capable of triggering unpleasant skin sensations in real-life experience. Results One hundred and sixty-two subjects were enrolled, 102 patients and 60 controls; 98 subjects thought they had sensitive skin. The mean questionnaire-based skin sensitivity score was significantly higher among patients than controls and correlated with skin sensitivity self-assessments. A cutoff value of 3 was set for the identification of LAST-positive subjects, with 79% accuracy. Conclusions The study self-assessment questionnaire seems to be a reliable tool for diagnosing sensitive skin in clinical practice. These results led us to identify a numerical cutoff for detecting propensity to experience sensitive skin.
... Active EPS SEAPUR ® by CODIF, an exopolysaccharide solution from fermentation of marine planktonic microorganism, considered a post-biotic, is suggested to re-equilibrate the S. epidermidis and C. acnes ratio, and decrease the inflammation induced by bacterial stress [182]. A study conducted in 2005 on 523 women and 483 men revealed that 59% of women and 44% of men declared to have sensitive skin [183], subjective skin hyper-reactivity to various environmental factors characterized by an overheating feeling, tingling, itching and redness [184,185], but not associated to any dysbiosis of aerobic cultivable bacteria [186]. ExpoZen ® by GREENTECH, a Halymenia durvillei extract enriched in low molecular weight polysaccharides, was evaluated on samples from 30 volunteers with reactive and sensitive skins. ...
Article
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ermatological and cosmetics fields have recently started to focus on the human skin microbiome and microbiota, since the skin microbiota is involved in the health and dysbiosis of the skin ecosystem. Amongst the skin microorganisms, Staphylococcus epidermidis and Cutibacterium acnes, both commensal bacteria, appear as skin microbiota sentinels. These sentinels have a key role in the skin ecosystem since they protect and prevent microbiota disequilibrium by fighting pathogens and participate in skin homeostasis through the production of beneficial bacterial metabolites. These bacteria adapt to changing skin microenvironments and can shift to being opportunistic pathogens, forming biofilms, and thus are involved in common skin dysbiosis, such as acne or atopic dermatitis.
... Facial skin is unique in that it receives far more exposure to the external environment than skin on other areas of the body. Paradoxically, the stratum corneum of the face is particularly sensitive and thinner than elsewhere in the body [1] with the eye region having a stratum corneum as thin as 6 μm [2]. Environmental influences contribute to drying of facial skin but also dam-age to the stratum corneum [3]. ...
Article
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Dry skin is one of the most important concerns of consumers worldwide. Despite huge efforts over several decades, the personal care industry still does not offer complete solutions that satisfy the unmet needs of consumers for moisturizing treatments. The paucity of data for the underlying biochemical problems in and the effects of moisturizers on facial skin biology and physiology may partly explain this. Our recent color mapping studies based on bio-instrumental evaluations of skin capacitance and transepidermal water loss have revealed the complexity of facial skin. However, the biomolecular reasons for these subtle differences in the different zones of the face are unknown so far. As the maturation of the stratum corneum is vital for skin moisturization and optimal barrier function, we believe that the protease / proteaseinhibitor balance particularly of the plasminogen system may be key in these processes. Thus, our aim was to develop a specific dual plasmin and urokinase inhibitor for topical application to barrier-impaired skin and demonstrate its efficacy.
... Moreover, long-term exposure to air pollution has been associated with the development of certain cancers and may affect some processes related to skin, including aging, and heighten the clinical manifestations of psoriasis, acne, and atopic dermatitis 6 . In fact, skin is considered the first barrier of human body to the external factors and is constantly exposed to harmful compounds existing in the surrounding environment 7 . ...
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Long-term exposure to air pollution has been associated with the development of some inflammatory processes related to skin. The goal of modern medicine is the development of new products with antiflammatory action deriving from natural sources to improve environmental and economic sustainability. In this study, two different humic acids (HA) were isolated from from lignite (HA-LIG) and composted artichoke wastes (HA-CYN) and characterized by infrared spectrometry, NMR spectroscopy, thermochemolysis-GC/MS, and high-performance size-exclusion chromatography (HPSEC), while their antiflammatory activity was evaluated on HaCaT cells. Spectroscopic results showing the predominance of apolar aliphatic and aromatic components in HA-LIG, whereas HA-CYN revealed a presence of polysaccharides and polyphenolic lignin residues. The HA application on human keratinocyte pre-treated with Urban Dust revealed a general increase of viability suggesting a protective effect of humic matter due to the content of aromatic, phenolic and lignin components. Conversely, the gene expression of IL-6 and IL-1β cytokines indicated a significant decrease after application of HA-LIG, thus exhibiting a greater antiflammatory power than HA-CYN. The specific combination of HA protective hydrophobic components, viable conformational arrangements, and content of bioactive molecules, suggests an innovative applicability of humic matter in dermatology as skin protectors from environmental irritants and as antiflammatory agents.
... The topical application of dermatological agents that cause adverse skin sensitivity or irritation is a common reason for poor treatment compliance and can restrict therapeutic options. Moreover, adverse skin reaction due to cosmetics and skin-care products is a significant problem affecting a large proportion of individuals, with 78% of people with sensitive skin reporting avoidance of dermatological products because of potential adverse effects (Farage et al., 2006). Currently, there are no physical or visual manifestations that define skin sensitivity, with 50% of adults reporting dermal sensitivity without any other clinical signs of inflammation (Stander et al., 2009). ...
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There are no physical or visual manifestations that define skin sensitivity or irritation; a subjective diagnosis is made based on the evaluation of clinical presentations including burning, prickling, erythema and itching. Adverse skin reaction in response to topically applied products is common and can limit the use of dermatological or cosmetic products. The purpose of this study was to evaluate the use of human skin equivalents (HSE) based on immortalised skin keratinocytes and evaluate the potential of a 22-gene panel in combination with multivariate analysis to discriminate between chemicals known to act as irritants and those that do not. Test compounds were applied topically to full thickness HSE or human ex vivo skin and gene signatures determined for known irritants and non-irritants. Principle component analysis showed the discriminatory potential of the 22-gene panel. Linear discrimination analysis, performed to further refine the gene set for a more high-throughput analysis, identified a putative seven-gene panel (IL-6, PTGS2, ATF3, TRPV3, MAP3K8, HMGB2 and MMP-3) that could distinguish potential irritants from non-irritants. These data offer promise as an in vitro prediction tool, although analysis of a large chemical test set is required to further evaluate the system.
Article
Background: Many epidemiological studies have been performed, but a potential increase in the prevalence of sensitive skin as well as its relationship with age and skin type and the impact of sensitive skin on quality of life are still debated. Objective: TO ANSWER THESE UNRESOLVED QUESTIONS: METHODS: An opinion poll was conducted on a representative French 5000-person sample. Results: Fifty-nine percent of the people declared very sensitive or fairly sensitive skin (together: sensitive skin), and women (66%) declared sensitive skin more frequently than men (51.9%). The results also showed that sensitive skin is more common (more than 60%) in younger people (<35 years old), and there was a decrease in the following age groups. The univariate analysis demonstrated that sensitive skin was more likely to be reported by people with fair skin (OR=1.83) and by people with an atopic predisposition (OR=2.51). The risk of sensitive skin is higher for people with dry skin (OR= 6.18 compared with normal skin), but sensitive skin can occur in other skin types (OR=2.45 for mixed skin and OR=2.16 for greasy skin). Quality of life was clearly altered in patients with sensitive skin, as assessed by SF-12 and DLQI. Conclusion: This large study demonstrates that sensitive skin can alter quality of life and is more common in young people and in women as well as patients with dry skin or fair skin or an atopic predisposition. It also suggests that there is an increase in the prevalence of sensitive skin. This article is protected by copyright. All rights reserved.
Article
Background: Sensitive skin (SS) seems not to be a one-dimensional condition and many scholars concentrate on skin barrier disruption or sensorineural change, but few focus on its increased vascular reactivity. This study explored the possibility of using the different selection methods and measurement methods to verify a high vascular reactivity in SS without an impaired cutaneous barrier function. Methods: Sixty "self-perceived sensitive skin" volunteers were enlisted and each one completed three kinds of screening tests: assess cutaneous sensory using questionnaire survey and Lactic Acid Sting Test (LAST); assess barrier function using Sodium lauryl sulphate (SLS) skin irritation test and assess cutaneous vascular reactivity using 98% DMSO test and non-invasive measurement. Volunteers were divided into different groups based on response to SLS. The DMSO clinical score and the biophysical parameters obtained by non-invasive measurement were subsequently analysed. Results: (1) The positive correlations could be seen between sum LAST score and sum DMSO score regardless of the observation time; (2) The biological parameters (CBF、a*values and L* values) are all keeping with DMSO score; (3) If the participants were divided into SLS reactors and non-reactors, a composition ratio of DMSO score was significant difference in these two groups and in SLS non-reactors, there were still seven participants showed high reaction to DMSO. Conclusions: There is a sub-group of SS for characteristics of a high vascular reactivity without an impaired cutaneous barrier function. The DMSO test and novel non-invasive measurements which are conducive to assess cutaneous vascular reactivity, combined with SLS skin irritation test could help us to screen this kind of SS.
Article
b> Background/Aims: Aberrant skin barrier and intercorneocyte adhesion are potential contributors to the pathomechanism of sensitive skin (SS). Here we aimed to develop a novel and easy-to-apply method to analyze corneodesmosomes and to interrogate potential differences between corneocytes of subjects with SS and non-SS (NSS). Methods: Corneocytes of the volar forearm and upper outer quadrant of the left buttock of SS ( n = 10) and NSS ( n = 8) subjects were extracted as a function of depth using adhesive tape and stained with anti-desmoglein 1 (DSG1) antibody. The total area of corneocytes and the number and average size of cells per tape was estimated using image processing. Results: The total area of extracted corneocytes and the quantity of DSG1 decreased with depth. The level of decrease, total area of corneocytes, and average area of individual cells differed between anatomical locations. In SS, a larger total area of extracted corneocytes and a larger average cell size per tape was found at all inspected depths. Conclusion: The developed novel and easy-to-apply approach allows investigation of corneodesmosome components. We confirm a role of altered corneocytes in the pathomechanism of SS. The disclosed protocol can further be optimized in studies of skin conditions with strongly affected corneodesmosomes.
Article
Resumen Tradicionalmente, la piel sensible se ha considerado como un problema cosmético o como una alteración puramente psicosomática con un fuerte componente subjetivo. Sin embargo, diversos estudios científicos sobre sus procesos fisiopatológicos y su etiopatogenia han demostrado que se trata de una entidad compleja que ya diversos autores consideran un síndrome neurodermatológico. Sus características hacen que su diagnóstico y tratamiento puedan resultar complicados en la práctica clínica habitual, siendo necesarias herramientas sencillas que se puedan usar de rutina, tanto para identificar esta entidad, que puede presentarse acompañada de otra patología, como para su manejo independiente. En este trabajo realizamos una revisión práctica de los avances científicos más recientes el campo de la piel sensible que justifican su consideración individual y ofrecen herramientas para identificarla y tratarla. Proponemos algoritmos de diagnóstico y de tratamiento basados en las evidencias de la literatura y en la opinión de los expertos que firman este artículo.
Chapter
The quantitative assessment of skin barrier function has been approached in multiple ways, practically centered in transepidermal water loss (TEWL). However, in most cases its utility is limited by the exclusive use of single time and location (unique sampling) data susceptible to great variability (intrinsic as extrinsic) as reported. Only a few papers have been dedicated to this important aspect of in vivo skin barrier quantification. This chapter focuses on the application of compartmental analysis, a well-known strategy from pharmacokinetics, toward that goal. By a stress procedure using prolonged occlusion (the plastic occlusion stress test – POST), a bi-compartmental model is applied to the TEWL desorption curves obtained after patch removal, allowing to quantitatively describe the water elimination dynamics by kinetic parameters such as half-life times (t½evap) and the dynamic water mass (DWM) involved in the elimination process. This chapter also focuses on specific examples of the application of the model to different testing conditions in order to demonstrate its discriminative capacity and utility.
Article
Introduction. Allergic contact dermatitis (ACD) is a common occupational disease. Its diagnosis is essentially based on interrogation and patch tests. However, commercially available batteries are sometimes not appropriate for the working conditions and the handled products, which must then be tested. In Tunisia, no previous study has focused on the contribution of patch tests with handled products in the workplace. The objective of this study is to establish the sociodemographic and occupational profile of the patients benefiting from patch tests with handled products in the workplace to identify the characteristics of these products as well as to evaluate the relevance of their positivity and their contributions in terms of aetiological diagnosis of occupational ACD. Methods. This is a retrospective descriptive epidemiological study conducted for a period of 10 years from January 1st, 2006, to December 31, 2015, among patients exercising a professional activity and consulting the Dermato-Allergology Unit of the Occupational Medicine ward of the University Hospital Farhat Hached of Sousse for the exploration of ACD. Results. During the study period, 113 patients received patch tests of handled products in the workplace with a prevalence of 7.3% of patch-tested patients during the same period. The mean age was 35.79 ± 9.45 years with a male predominance (sex ratio = 1.35). The most represented activity sectors were the health sector in 30.1% and the textile sector in 21.2%. The majority of patients were professionally active (61.9% of the study population) with an average professional seniority of 10.28 ± 8.49 months. In total, 138 patch tests with handled products were carried out of which 46 tests were positive (33.3%). After the analytical study, variables independently significantly associated with the positivity of patch tests with handled products in the workplace were the male gender and the working in the plastics industry. An occupational disease was declared to the National Health Insurance Fund for 8 patients, i.e., 7.1% of cases. Conclusion. Patch tests with handled products in the workplace can provide strong arguments for the professional origin of the ACD.
Article
Résumé Les peaux sensibles (ou peaux réactives) se définissent comme un syndrome se manifestant par la survenue de sensations déplaisantes (picotements, brûlures, douleurs, prurit, fourmillements) en réponse à des stimulus qui, normalement, ne devraient pas provoquer de telles sensations. Ces sensations déplaisantes ne peuvent pas être expliquées par des lésions attribuables à une maladie cutanée spécifique. La peau peut apparaître normale ou être accompagnée d’un érythème. Les peaux sensibles peuvent atteindre toute localisation cutanée mais en particulier le visage. Les peaux sensibles sont très fréquentes puisqu’elles concernent environ la moitié de la population, avec une intensité variable. Le diagnostic se fait essentiellement par l’entretien avec le (la) patient(e). La physiopathologie commence à être mieux comprise : il s’agirait d’une hyperréactivité du système nerveux cutané, liée en particulier à l’activation de protéines sensorielles présentes sur les kératinocytes et les terminaisons nerveuses. La prise en charge reste encore assez spéculative.
Article
Background: The worldwide prevalence of "sensitive skin" group is estimated at being close to 40%. The main trigger for sensitive skin is the misuse of cosmetics products. Majority of the in vitro studies on cosmetic ingredients developed for topical application to the skin are not able to describe sensory irritation, such as stinging, burning, itching, and tingling. Besides, most of the in vivo tests often encounter problems such as limited number of subjects and usage scenarios deviate from reality. Objective: A gradient boosting algorithm is adopted in our context to integrate multisource of information including skin types, sensory response, and cosmetics ingredients to predict sensory irritation. Method: In this study, online comments were preprocessed to construct a multi-dimensional structured data including skin types, sensory response, and cosmetics ingredients. A gradient boosting regression model was developed where sensory response was predicted based on the abovementioned structured input. The predictions were validated by in vivo test and were shown favorably when comparing with the state-of-the-art results from related works. Result: 46 007 samples were collected after data cleaning and were used in model developing. Results showed that the model was capable to predict the sensory response of 16 skin types to different ingredients (R = 0.71, P < 10-10 ). In addition, this model was validated using data from in vivo studies and presented a value of 75% on specificity, 88.9% on sensitivity, and 82.4% on accuracy. Conclusion: Our approach that is based on a variant of the gradient boosting algorithm provided an adequate solution for understanding the sensory irritation of cosmetic ingredients.
Article
Sensitive skin has traditionally been viewed as a cosmetic problem or as a purely psychosomatic alteration with a major subjective component. Different studies of its pathophysiologic etiology, however, have shown it to be a complex entity that several authors now consider to be a neurodermatological syndrome. Because of this complexity, skin sensitivity can be difficult to diagnose and treat, particularly considering that it may present with another disease. Simple tools applicable to clinical practice are thus necessary to identify and manage this disease as an independent entity. In this study, we perform a practical review of the most recent scientific advances in the area of sensitive skin that justify it being considered an individual entity, and provide tools for its identification and treatment. We propose diagnostic and treatment algorithms based on evidence from the literature and our experience and expertise.
Article
Sensitive skin syndrome is a widely reported complaint but a diagnostic challenge because of its subjective symptoms and lack of clearly visible manifestations. Epidemiological studies have shown the prevalence of sensitive skin to be as high as 60–70% among women and 50–60% among men. Patients with this syndrome usually have unpleasant sensations when exposed to physical, thermal, or chemical stimuli that normally cause no provocation on healthy skin. Recent studies and newly accepted position papers have provided a more in-depth understanding and consensus of its underlying pathophysiology, associations, diagnosis, and treatment. Since no clinical studies have been conducted about specific treatment protocols, patients with this condition should be provided with personalized skin management. Given this updated knowledge, our review offers an approach to sensitive skin syndrome, with differential diagnoses, and interventions targeting its pathophysiology.
Article
Background Sensitive skin manifests itself as a syndrome defined by the occurrence of unpleasant sensations such as stinging, burning, and pruritus. Though not life‐threatening, it can negatively impact the quality of people's lives because of symptoms and clinical signs. Although some skin care products can alleviate symptoms of sensitive skin, a product that can improve multiple abnormalities of sensitive skin are largely unavailable. Aims To assess the efficacy of a newly developed herbal cream in reducing erythema. Methods A randomized double‐blind and self‐controlled trial was carried out on a total of 35 volunteers. The test cream (A) was applied topically to one side of the face twice‐daily, while the control cream (B) was applied to the other side of the face. Parameters were evaluated prior to, 14, and 28 days after topical applications. Primary endpoints included changes in erythema area, erythema index (EI), and a* value. Transepidermal water loss rates (TEWL), stratum corneum (SC) hydration, and lactic acid sting test (LAST) score, as well as the L* value, served as secondary endpoints. Result Treatments with either cream A or B markedly reduced erythema area, EI, and a* value. Significant reductions in both TEWL and L* value were also observed following topical applications of either cream A or B. Moreover, cream A decreased LAST score. Finally, the satisfaction rate of cream A was higher than that of cream B. Conclusion The new herbal cream improves cutaneous biophysical properties in subjects with sensitive skin, especially in reducing erythema.
Chapter
Irritant contact dermatitis (ICD) is more common than allergic contact dermatitis (ACD). It ranges from acute irritant reactions to chronic forms, often morphologically indistinguishable from ACD. Numerous exogenous and endogenous factors are involved in the pathogenesis of ICD. Major irritants are water, detergents, and acidic and alkaline substances of various natures. Mechanical, thermal, and climatic influences are important contributory or sometimes even causative factors. In particular chronic ICD is a diagnostic challenge and may be complicated by secondary sensitization to environmental allergens. Therapy and prevention require identification of irritants followed by elimination or reduction of skin contact, e.g., by personal protective equipment, organizational, or technical measures. Some topical medications and skin care products may cause subjective discomfort (“stinging”) without clinical signs of irritation. This is considered to be a special form of neurosensory irritation.
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Findings obtained on objective assessments to evaluate sensitive skin do not correlate well with the symptomatology. We utilized reflectance confocal microscopy (RCM) to compare transepidermal application of zinc in sensitive and non-sensitive skin. Thirty-six subjects participated in this study. They were divided into groups based on lactic acid sting test (LAST):‘stinger’ and ‘non-stinger’; transepidermal water loss (TEWL) measurements; and sensitivity self-assessments: ‘sensitive’ and ‘non-sensitive’. RCM images were taken to visualize transepidermal application of topically-applied zinc. The intensity of zinc reflectance at different depths was measured by ImageJ software. Based on LAST scores, the ‘stinger’ group showed significantly higher reflectance of zinc at 8 µm (stratum corneum) [face ( P < 0.001), forearm ( P = 0.004)], and at 80–104 µm (dermo-epidermal junction layer) on the face. High-TEWL group showed increased zinc reflectance at 8–24 µm (tight junction layer, P < 0.001). There were no significant differences amongst subjects self-reporting ‘sensitive’ and ‘non-sensitive’ skin. RCM demonstrates that in sensitive skin, there is deeper and higher reflectance of zinc at multiple depths. Structural differences are also visualized. We suggest that RCM is a useful tool for evaluating skin barrier integrity.
Article
This article deals with skin care of sensitive, irritated skin. Application of the daily basic skin care products improves the effectiveness of treatment and quality of life of patients with sensitive skin.
Article
Sensitive skin is a self-diagnosed condition and is usually not accompanied by any obvious physical signs of irritation. Patients with this syndrome usually have unpleasant sensations whenever exposed to any physical, thermal or chemical stimuli that normally cause no provocation on healthy skin. Cosmetics, skin barrier impairment, and climate changes are the main contributing factors for skin hyperactivity. Although diagnosis is challenging due to lack of any specific or preferred diagnostic methods and interventions, recent studies on different clinical aspects of sensitive skin have provided new approaches to the diagnosis, management and interventions targeting the pathophysiology and treatment of sensitive skin syndrome. In general, patients with sensitive skin need an individual approach, keeping in view the various biomedical, neural, and psychosocial factors affecting sensitive skin.
Article
Quantitative non-invasive assessment of water content in tissues is important for biomedicine. Optical spectroscopy is potentially capable of solving this problem, however, its applicability for clinical diagnostics remains questionable. The presented study compares diffuse reflectance spectroscopy, Raman spectroscopy, and multispectral imaging in characterization of cutaneous edema. The source-detector geometries for each method are selected based on Monte Carlo simulations results to detect the signal from the dermis. Then, the kinetics of the edema development is studied for two models. All methods demonstrate synchronous trends for histamine-induced edema: the water content reaches maximum one hour after histamine application and then gradually decreases. For the venous occlusion, a 51% increase in water content is observed with Raman spectroscopy. The differences in water content estimation by three methods are explained based on the light propagation model. The obtained results are essential for introducing quantitative optical water measurement technology to the clinics. This article is protected by copyright. All rights reserved.
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Topical drug delivery systems have been shown to overcome difficulties in drug delivery, especially orally. A topical patch is a drug-containing adhesive patch that is attached to the skin, and a specific dose of drug can be delivered to the blood through the skin. It promotes the healing of an injured area of the body. Advantages of the drug delivery route through the skin compared to other routes such as oral, topical, intravenous, etc. is a patch that allows a controlled release of medication into the patient, usually through a porous membrane that covers a drug reservoir or by body heat melting thin layers of medication embedded in an adhesive.The main disadvantage of the topical delivery system is that the skin is a very effective barrier, so only drugs with small molecules that can easily penetrate the skin can be delivered by this method. This review article describes introduction, physiology of skin, criteria for drug selection of topical patch, which conditions topical patches are used/not used, advantages, disadvantages, Factor affecting topical drug delivery system, Components of Topical Drug Delivery System, a general clinical considerations in the use of tdds, methods of preparation of tdds, evaluation parameter.
Article
Background and Aims Photomodulation is a non-photothermal effect that mobilizes energy and regulates cell activity at the mitochondrial level, and has been used to treat sensitive skin (SS) in recent years. Based on the photomodulated effect of optimal pulse technology (OPT), we developed a novel treatment mode (advanced OPT with low energy, three pulses, long pulse width, AOPT-LTL) for the treatment of facial SS and evaluated its effectiveness. Methods A total of thirty Chinese women with SS were included in this study. Patients were received different times of AOPT-LTL treatment with an interval of 2 to 4 weeks depending on the severity. Clinical improvement was evaluated by comparing baseline and post-treatment photographs. In addition, the skin objective signs and subjective symptoms, as well as adverse events and patient satisfaction were also analyzed and tabulated. Results All included patients completed the treatment and follow-up period. After one course of treatment, 76.7% of patients had a Symptom Score Reducing Index (SSRI) >20%, suggesting that the treatment was effective. Within two courses of treatment, all patients had SSRI >20%, demonstrating significant improvement in skin sensitivity. The analysis of clinical photographs showed that facial dryness, desquamation, flushing, and skin color significantly improved, capillary density decreased, the dilated capillaries were retracted. During the treatment period, no obvious adverse reactions occurred in any patients, and the patients’ satisfaction was high. Conclusions This novel technique of AOPT-LTL might be an effective and safe modality for the treatment of SS.
Article
Sensitive skin is a common condition, affecting about half of the general population. This condition is characterized by a number of unpleasant skin symptoms (tingling, burning, pain, and itching) that occur in response to triggers that usually do not cause such reactions. Severe dryness of the skin is often observed in patients with sensitive skin. Nowadays, treatment of the condition of sensitive dry skin comes down to the use of moisturizing care products. We conducted a study of the clinical effectiveness of moisturizing products, which included 50 volunteers. According to the study data, a signifcant effect was achieved by the 21st day of using moisturizers. However, long-term use for more than 2 months allowed to maintain normal values of corneometric parameters even after cancelation moisturizers.
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Sensitive skin involves a lower threshold for sensory reactions to a number of often nonspecific, different factors. The concept is poorly defined, but the symptom is very common and hence of relevance to skin testing. A number of tests have been used to study it, and because of the absence of inflammation in this condition, the core test is the sensory test. This test exposes a panel of test persons to potentially stinging substances, usually lactic acid, in a standardized setting; the response is assessed within minutes of application at predetermined times, and the subjective response is graded on a simple scale. The sensitivity of the test person is inversely correlated with the time to reaction and the concentration of the test substance, that is, reactions are seen sooner and to weaker concentrations in the sensitive. Similarly, an early strong reaction is seen even in less sensitive individuals if a stronger irritant is used.
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The skin compatibility of a new surface covering for feminine hygiene pads was assessed by 1) skin irritation patch tests, 2) the Human Repeat Insult Patch Test, and 3) a test protocol for assessing mechanical irritation that uses repeated application to the popliteal fossa (“behind-the-knee” test). The pad covering is a fabric-like apertured film with a soft and supple tactile impression. Testing was designed to assess the effects of topical contact as well as friction. All studies showed the new material to be as mild as other commercially available materials used on the surface of feminine hygiene pads. Induction of delayed contact hypersensitivity was not found. The test methods used can be applied to the safety assessment of other products that involve topical skin contact and frictional effects.
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Specimens from four regions of oral mucosa (palate, buccal mucosa, lateral border of the tongue, and the floor of the mouth) and of abdominal skin were taken from 58 individuals at autopsy, for determination of permeability constants (Kp) to tritium-labeled water. Comparisons between fresh specimens and those stored at -80 degrees C revealed no significant effect on Kp as a result of freezing; similar results were found with use of specimens from corresponding regions of the pig. Values for Kp were significantly different for all of the tissue regions examined and ranged from 44 +/- 4 x 10(-7) cm/min for skin to 973 +/- 33 x 10(-7) cm/min for the floor of the mouth, which was the most permeable region. Similar differences were evident among corresponding regions of porcine oral mucosa and skin. Moreover, the Kp values obtained for human tissues were not significantly different from those of the pig, except for the floor of the mouth, which was more permeable in human than in pig tissue. The results reveal interesting differences in the permeability of human oral mucosa that might be related to susceptibility to mucosal disease in those conditions where local extrinsic etiological agents are implicated.
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The lipids of mammalian stratum corneum are known to be important regulators of skin permeability. Since the human stratum corneum displays remarkable regional variations in skin permeability, we assessed the total lipid concentration, the distribution of all major lipid species, and the fatty acid composition in Bligh-Dyer extracts from four skin sites (abdomen, leg, face, and sole) that are known to display widely disparate permeability. Statistically significant differences in lipid weight were found at the four sites that were inversely proportional to their known permeability. In all four sites, among the polar lipids, the stratum corneum contained negligible phospholipids, but substantially more cholesterol sulfate (1-7%) than previously appreciated. As in the stratum corneum from other mammals, the bulk of the lipids consisted of neutral (60-80%) and sphingolipids (15-35%). Of the neutral lipids, free sterols (4- to 5-times greater than esterified sterols), free fatty acids, triglycerides, and highly nonpolar species (n-alkanes and squalene) predominated. n-Alkanes, which were present in greater quantities than previously appreciated, comprised a homologous series of odd- and even-chained compounds ranging from C19 to C34. The sphingolipids comprised over 80% ceramides vs. lesser quantities of glycosphingolipids. In all four sites, the sphingolipids were the major repository of long-chain, saturated fatty acids. The neutral lipid:sphingolipid ratio generally was proportional to the known permeability of each site: higher neutral lipids and lower sphingolipids generally were associated with superior barrier properties. These studies provide: 1) the first detailed, quantitative analysis of human stratum corneum lipids and 2) information about the variability in lipid composition at four skin sites with known differences in permeability. The latter results suggest that variations in neutral lipids, rather than sphingolipids, may underlie local variations in skin permeability.
Article
In order to estimate the influence of occlusion and sweating on forearm and vulvar skin surface water loss (SSWL), both were measured simultaneously and continuously for 30 min in 8 healthy women. Vulvar SSWL decreased significantly during the measuring period from 24.9 +/- 5.2 gm-2 h-1 (mean +/- standard error of the mean) in the first 5 min, to 13.4 +/- 1.7 gm-2 h-1 in the last 5 min (p less than 0.05), whereas no significant changes were observed in forearm SSWL. The vulvar SSWL decay curve followed a logarithmic equation of the form y = a*tb. Irregular SSWL increases ('bursts') were observed in vulvar (but not in forearm) skin of 7 out of 8 women. These SSWL bursts were considered to be caused by sweating. The study shows possible causes of systematic errors in vulvar irritation studies. Methods for error reduction are discussed
Article
There is currently a resurgence of interest in the oral mucosa as a route for drug delivery. The relative scarcity of human oral mucosa for in vitro permeability studies, and the fact that vaginal mucosa is histologically similar and more abundant than the former, caused us to compare these 2 tissues with respect to their barrier properties to water. Specimens of fresh, clinically-healthy human Vaginal and buccal mucosa from non-smokers were taken from excised tissue obtained during Vaginal hysterectomies and Various oral surgical procedures. Biopsies from each specimen were mounted in flow-through diffusion cells and their permeability to tritiated water determined using a continuous flow-through perfusion system. Specimens were examined histologically before and after permeability experiments and similarities between vaginal and buccal tissues verified. No statistically significant differences between mean steady state flux Values (10-16 h) for vaginal and buccal mucosa, respectively, were found. Human vaginal mucosa is therefore as permeable as buccal mucosa to water, and these results warrant further investigation with other compounds to establish whether vaginal mucosa may be a useful model for buccal mucosa for drug permeability studies.
Article
A considerable number of people complain about enhanced skin sensitivity. The aim of this study was to investigate the characteristics of subjective statements and objective measurable parameters in subjects with self-estimated enhanced skin susceptibility. Four-hundred-and-twenty volunteers completed a questionnaire form with a self-estimation of skin susceptibility, possible triggering factors and other skin problems. In addition, basal values of transepidermal water loss, cutaneous blood flow and skin hydration were measured. One-hundred and fifty-two volunteers were also patch-tested with sodium lauryl sulphate 0.5% on the forearm and evaluated by bioengineering methods. We found no correlation between self-estimated skin susceptibility and bioengineering values, neither basal nor after sodium lauryl sulphate testing. These findings, along with interpretation of the questionnaire form, suggest that self-estimated enhanced skin susceptibility is a subjective problem mostly reported by women and of all ages.
Article
The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.
Article
The purpose of this study was to determine whether a significant difference exists between Negroes and Caucasians in cutaneous irritant reaction to CS, and to try to localize to a specific layer of skin any relative protective principle which Negro skin might have. A determination as to whether racial difference exists in the symptomatic response of the skin was also sought. Standardized exposures were given on the volar surface of the forearm and the back by an occlusive patch-test technique, utilizing duration of exposure as the variable. A range of exposures, low to high, was given each subject, and the minimal perceptible erythema (MPE) was read. The impression that Negroes are less susceptible to irritant determatitis from CS2 was confirmed. On both forearm and back, the production of MPE required approximately twice the exposure time on Negroes as on Caucasians. The racial difference in reactivity is lost if stratum corneum (the barrier layer) is removed. Neither is there a racial difference in the stinging sensation, which is caused by CS that penetrates by the transappendageal route. It is proposed that the difference in the melanin content of the stratum corneum between the two races may account for the difference in reactivity; i.e., that melanin exerts a protective influence, possibly by reacting with CS. (Author)
Article
Stratum corneum from Negroes and Caucasians has been compared with respect to facility of tape stripping, numbers of cell layers, and density. Significantly more strips were required for removal of stratum corneum, and significantly more cell layers were present in the stratum corneum from Negroes as compared to Caucasians. The buoyant density of abdominal stratum corneum, as determined in organic solvent systems, is less in Negroes than in Caucasians. The reverse is true when density in air is determined and when isopyknic sucrose density gradient ultracentrifugation is employed. We believe the latter values portray the true relationship of Negro and Caucasian stratum corneum, since detipidization does not occur, and since a greater density of Negro stratum corneum is consonant with its greater microscopic compactness.
Article
: Two groups of healthy volunteers, one black, one white, were tested with a topically absorbed mixture of lidocaine and prilocaine in a water base. A visual analog pain scale (VAPS) was used to quantify the level of relative anesthesia. At 1 hour after the placement of the mixture under an occlusive dressing, the cream was wiped off. The group of white patients experienced a 70% reduction (per VAPS) in pain sensation to pin prick, while the black patients experienced only a 40% pain reduction. At 11/2 hours, the white patients had a 90% reduction while the black patients had less than an 80% reduction. Over the subsequent hour and a half, virtually all of the members of the white group experienced complete anesthesia, while those of the black group had a leveling off of the anesthetic effect at less than 80%. It appears that there are racial differences between the onset of action and ultimate clinical effectiveness of a cutaneously absorbed mixture of local anesthetics. Several architectural differences between the structure of the skins of black patients and whites are cited and discussed as possible explanations. (C)1986 American Society of Regional Anesthesia and Pain Medicine
Article
Japanese, and Chinese subjects. In this 2nd study, no differences were seen in the acute or cumulative irritation responses between the Japanese and Caucasian subjects. The Chinese subjects showed a heightened response to 10% acetic acid (after 4 h of exposure), but otherwise displayed a similar response profile in the acute irritation test. They showed a slower and less severe response in the cumulative irritation test compared to the Caucasian or Japanese subjects. These divergent results underscore the difficulty in ascribing true population-based differences in skin reactivity based upon studies in limited subject populations. It may be possible to detect differences in individual studies, but repeat testing may fail to confirm a consistent trend. These findings may be indicative of the wide variation in skin responsiveness across human subjects in general.
Background: Users of cosmetics and skin care products often report adverse reactions ranging from itching and dryness to intense inflammatory responses such as erythema or wheal and rash. Self-assessment is not always an accurate parameter for categorizing skin as sensitive or nonsensitive, although it can be valuable. For this reason, it is important to define sensitive skin by more objective factors. Objective: Studies were undertaken to determine if objective biophysical measurements could detect differences in barrier function between those individuals who identified themselves as having sensitive skin and those self-identified as having normal skin. In addition, the effects of treatment on barrier functions of individuals with sensitive skin were determined. Methods: Three main factors that contribute to cutaneous reactivities were observed for the estimation of skin sensitivity: barrier functions, reactivity to irritants, and neuronal responses manifested as sensory reactions. Barrier functions of the skin was tested by gentle removal of the stratum corneum with simple cellophane tape stripping followed by measurement of transepidermal water loss (TEWL) as a marker of barrier loss. The onset and intensity of skin reaction against an irritant, balsam of Peru, was tested on the same individuals to observe the reactivity of their skin. Using the lactic acid sting test, additional information regarding skin sensitivities was obtained. Results: Sensitive skin individuals exhibiting easy barrier damage possess delicate skin that is also highly reactive to irritants. When these individuals used a regimen of products that contained minimal preservatives and no surfactants for 8 weeks, the skin barrier and reactivity changed such that it was similar to nonsensitive skin. Conclusions: Skin sensitivity is observed because of a combination of factors, including a disrupted barrier and a tendency to hyperreact to topical agents. Treatment with special topical skin care formulations can reduce overall skin sensitivity.
Article
Adverse skin reactions cover many types of response: toxic, irritant, allergic, urticarial, sensory, etc. The relationships between an individual's tendency to develop different types of skin response are not well-described. We examined whether those who perceive stinging might be more likely to experience urticarial, sensory and irritation reactions in skin. A panel of 86 volunteers was tested with 10% lactic acid in the nasolabial fold to assess their ability to perceive stinging. At the same time, their capacity to develop non-immunologic contact urticaria was evaluated using chemicals of different structural type and urticant ability: methyl nicotinate, benzoic acid, cinnamic acid, cinnamaldehyde and dimethyl sulfoxide (DMSO). DMSO was also used to assess sensory effects and skin irritation. 44 were classes as "stingers" and 42 as "non-stingers". The pattern of urticant reactivity in the stingers and non-stingers was essentially the same, with neat DMSO generating the strongest reactions in both groups. Sensory reactions to DMSO (stinging, itching, tingling or burning) were similar in stingers and non-stingers; although the former may have reacted more quickly, a smaller proportion reacted (64% versus 76%). The skin irritation response to DMSO was also identical in stingers and non-stingers and the intensity of the urticant response in an individual did not correlate with the intensity of their subsequent irritant reaction. In conclusion, this study demonstrated that an individual's ability to perceive skin stinging does not give a general indication of their susceptibility to other types of non-immunologic skin response. Indeed, there appeared to be little evidence of correlations between any of the skin effects studied.
Article
The photoprotective role of melanin was evaluated by comparing the transmission of ultraviolet (UV) radiation through skin samples of blacks and Caucasians, using both biologic and spectroscopic techniques. UVA transmission was measured using fluoranthene, which causes a phototoxic response to UVA wavelength. UVB was measured by monitoring erythema produced by either a 150-watt xenon arc or FS-20 sunlamps. It was found that on the average, five times as much ultraviolet light (UVB and UVA) reaches the upper dermis of Caucasians as reaches that of blacks. Differences in transmission between the stratum corneum of blacks and of Caucasians were far less striking. The main site of UV filtration in Caucasians is the stratum corneum, whereas in blacks it is the malpighian layers. Melanin acts as a neutral density filter, reducing all wavelengths of light equally. The superior photoprotection of black epidermis is due not only to increased melanin content but also to other factors related to packaging and distribution of melanosomes. Not only are these data consistent with epidemiologic evidence, but they also may indicate why blacks are less disposed to phototoxic drug responses as well as less susceptible to acute and chronic actinic damage.
Article
To better understand the cutaneous reactivity of vulvar skin, two chemical irritants were applied topically to 21 subjects. The forearm of each subject served as a comparative control. Test sites remained open and were read at 24 hours. A significantly increased response to the irritants was noted on the vulvar skin.
Article
Vulval itch and discomfort are often intractable symptoms and the response to standard therapy can be unsatisfactory. There is some evidence that vulvar sensitivity to irritants is higher than that of forearm skin, but the incidence of relevant allergic contact sensitivity amongst this patient population is unknown. The patch-test data over a 5-year period of 135 patients with persistent vulval symptoms were reviewed and 63 patients had positive results. Of these, 39 had positive results considered to be relevant to their clinical condition. Medicaments and their constituents were responsible for most of these reactions and more than half the patients had multiple allergies.
Article
Age-related changes in the human peripheral sudomotor neuro-effector system have been investigated in six 80-year-olds and six young adults. Histochemical and immunohistochemical studies on forearm skin biopsies showed diminished vasoactive intestinal polypeptide (VIP) and calcitonin gene related peptide (CGRP)-like immunoreactivity and a virtual absence of acetylcholinesterase in the elderly sudomotor nerve endings compared to the young. Reduced size of nerve bundles and decreased density of sympathetic nerve endings adjacent to the sweat glands of old people were shown by the neuronal marker, protein gene product (PGP 9.5), and by electron microscopy. Image analysis techniques were also used to demonstrate a marked regression in secretory coil size with age. Functional decrements accompanying the neurochemical and morphological changes in the neuro-effector system were measured in ten 80-year-olds by local quantitative nicotine axon reflex responses and compared with 12 young adults. These studies demonstrate marked regressive changes in both the nerve endings and target cells in old age and appear to express a significant loss of vigour in trophic interactions.
Article
It is well known that spontaneous desquamation and corneocyte size can reflect respectively stratum corneum cohesiveness and epidermal cell proliferation. The influence of skin pigmentation on these parameters has been investigated on the upper-outer arm of black, white and oriental volunteers, using the detergent scrub method. We found no difference between race in corneocyte surface area, a mean size of 900 microns 2 agreeing closely with that generally encountered in Whites on the upper-outer arm. By contrast, spontaneous desquamation is increased in black vis-à-vis white and oriental skin (factor 2.5, p less than 0.001). Taking into account the importance of the intercellular cement for the cohesion between corneocytes, racial differences in epidermal lipid composition should be investigated.
Article
In order to identify and define differences in percutaneous absorption and microcirculatory sensitivity between forearm and vulvar skin we studied the response of human forearm and vulvar (labium majus) skin to topical methyl nicotinate (MN) in 11 healthy premenopausal volunteers. MN-induced erythema was assessed by laser Doppler velocimetry (LDV). The following parameters were compared: 1) basal cutaneous blood flow, 2) the time to peak response, 3) the magnitude of LDV peak response, 4) the area under the LDV response-time curve and 5) the decay time to 75% of peak response. Basal cutaneous blood flow at the vulva was higher than at the forearm (P less than 0.05); the magnitude of peak response was lower at the vulva than at the forearm (P less than 0.01); the area under the curve was lower at the vulva than at the forearm (P less than 0.001); the decay time to 75% of peak response was shorter at the vulva than at the forearm (P less than 0.001). The time to peak response showed no significant differences between sites. The results indicate that the MN-induced vasodilatation is less intense and lasts shorter in vulvar compared to forearm skin.
Article
As reviewed in this article, the stratum corneum must now be accorded the respect due to a structurally heterogeneous tissue possessing a selected array of enzymatic activity. The sequestration of lipids to intercellular domains and their organization into a unique multilamellar system have broad implications for permeability barrier function, water retention, desquamation, and percutaneous drug delivery. Yet, the functions and organization of specific lipid species in this membrane system are still unknown. Certain novel insights have resulted from comparative studies in avians and marine mammals. Further elucidation of the molecular architecture and interactions of lipid and nonlipid components of the stratum corneum intercellular domains will be a prerequisite for a comprehensive understanding of stratum corneum function.
Article
The reactivity of forearm and vulvar skin to low-concentration sodium lauryl sulfate (SLS) was studied in 20 healthy women, 10 before and 10 after menopause. SLS at concentrations of 0.1%, 0.5% and 1.0% was applied to the forearm and labium majus for 24 hours. Skin changes were monitored with transepidermal water loss (TEWL), capacitance (CAP) (as an indicator of stratum corneum hydration) and visual scoring (VS). In forearm skin, irritant dermatitis developed in most subjects, as indicated by a VS and TEWL increase, with the reaction in premenopausal women significantly more intense than in postmenopausal women. In vulvar skin, however, irritant reactions were not observed. CAP increased significantly in the forearm of premenopausal but not postmenopausal women, whereas it decreased significantly in postmenopausal vulvar skin. Thus, vulvar skin was less reactive to SLS at low concentrations than was forearm skin. However, SLS did affect vulvar skin stratum corneum hydration. The irritant response in the forearm decreased with age for all parameters studied, whereas in vulvar skin age-related differences in irritant reaction were limited to stratum corneum hydration.
Article
This study evaluated the vasodilation induced in young whites and blacks by topical application of two nicotinates, methylnicotinate (MN) and hexylnicotinate (HN) at the same concentration and in the same vehicle. To assess the influence of skin surface lipids and water content of the stratum corneum on the penetration of the substances, the drugs were applied on the back, on untreated skin and pre-occluded and pre-delipidized sites. Skin blood flow was monitored with laser Doppler velocimetry. The initial response recorded at 15 min (IR), the peak response (PR) and the area under the curve (AUC) were used to characterize the pharmacodynamic response. Statistically significant racial differences in the penetration of nicotinates were detected for the area under the response curve in the untreated and occluded sites, for the initial response and peak response in the pre-occluded site. Occlusion increased (even though not significantly) penetration, except for blacks in the methylnicotinate experiment. Delipidization elicited significantly lower responses for the IR and PR in the MN study, rendering the penetration similar in the two groups. No major differences were recorded between the two nicotinates. The effect of delipidization was most noticeable in blacks in the MN study. We suggest that there are racial (blacks vs. whites) differences in percutaneous penetration of nicotinates, with decreased levels in black skin recorded in all sites investigated.
Article
The effect of prolonged drying on transepidermal water loss (TEWL), capacitance and pH of vulvar and forearm skin was studied in 15 healthy female volunteers. A desiccation chamber that absorbed water evaporating from the skin surface was applied to the forearm and labia majora skin daily for 4 days. Skin TEWL, capacitance and pH were measured daily and 4 days after removal of the desiccation chamber at the site of drying and at a symmetrical control site. Under desiccation, TEWL both of forearm and of vulvar skin showed an increase during the first days of drying, followed by a gradual decrease. After 4 days of drying, forearm TEWL was reduced to 91% of the control value, without reaching significance. Vulvar TEWL was significantly reduced to 80% of the control value. Although relative reduction of vulvar TEWL was higher than that of forearm TEWL, the absolute of value of vulvar TEWL after drying remained significantly higher than that of forearm TEWL. Skin capacitance significantly decreased under drying both in forearm and vulvar skin. Skin pH was significantly reduced by drying at the vulva, but not at the forearm. It is concluded that although changes in physiological parameters during drying seem to be more pronounced in vulvar than in forearm skin, differences suggest that the specific properties of vulvar skin are not explained by anatomically related occlusion alone.
Article
Transepidermal water loss (TEWL), capacitance, pH, blood flow and color reflectance were evaluated for quantifying the irritant response of vulvar and forearm skin to 3% sodium lauryl sulfate in 9 healthy premenopausal women. TEWL, capacitance, pH, blood flow, and all parameters of color reflectance changed significantly in forearm irritant dermatitis. In vulvar irritant dermatitis, however, significant changes were observed only for blood flow and the color reflectance parameters a* and b*. Using the combination of TEWL, capacitance and blood flow, forearm irritant dermatitis was detected with a sensitivity of 84% and a specificity of 100%. In this study, the best combination of parameters to detect vulvar irritant dermatitis was pH, blood flow, a* and b*, which had a sensitivity of 78% and a specificity of 75%. It is concluded that available bioengineering techniques are less suitable to quantify irritant dermatitis in the vulva than in the forearm.
Article
The dynamic friction coefficient between skin and a Teflon probe and its correlation with age, body weight, height, transepidermal water loss and skin capacitance was studied in vulvar and forearm skin of 44 healthy female volunteers. The friction coefficient of vulvar skin was 0.66 +/- 0.03 (mean +/- SEM) compared to that of forearm skin of 0.48 +/- 0.01. The difference was highly significant (p less than 0.001). Multiple-regression analysis showed that the vulvar skin friction coefficient was significantly correlated with capacitance as an indicator of stratum corneum hydration (p less than 0.01) but not with age, weight, height or transepidermal water loss. It is concluded that the high friction coefficient of vulvar skin may be due to the increased hydration of vulvar skin. Age-related differences seem to exist for transepidermal water loss and friction coefficient in forearm but not in vulvar skin.
Article
To investigate differences in response to irritation according to age and site seven young-adult and eight elderly females were exposed to 0.25% sodium lauryl sulphate (SLS) under patch-test occlusion for 24 h. Ten anatomical regions were tested: forehead, upper arm, volar and dorsal forearm, postauricular, palm, abdomen, upper back, thigh, and ankle. The skin responses were evaluated 24 h post-patch removal by visual scoring and by transepidermal water loss measurements (TEWL). Non-treated symmetrical anatomical regions served as controls. SLS induced a mild erythematous reaction on most anatomical regions except the palm and TEWL was significantly increased as compared with controls. The elderly group demonstrated significantly less susceptibility to SLS-induced irritation for most regions of the body as indicated by visual scores and TEWL measurements. In addition, evaluation of the stratum corneum water content following SLS irritation demonstrated lower responses in the old age group for most regions. The thigh had the highest reactivity and the palm the lowest, in both age groups. These data suggest that young adult skin is more sensitive to SLS than old skin and that SLS irritation varies considerably with respect to region. Moreover, objective TEWL measurements seem to be a better indicator of irritant susceptibility, especially in the elderly, than clinical evaluation by visual scoring.
Article
The response of human skin to topical methyl nicotinate (MN) has been monitored in black, oriental, and caucasian subjects. The study aimed to address the question: "Do racial differences in percutaneous absorption and microcirculatory sensitivity exist?" MN-induced vasodilatation was assessed visually and by laser Doppler velocimetry (LDV). At three dose levels, in the three subject populations, four parameters were compared: (a) the diameter of the maximum visually perceptible erythematous area (Emx); (b) the area under the erythematous diameter versus time curve (AUE); (c) the maximum LDV response (Lmax); and (d) the area under the LDV response versus time curve (AUL). At p less than 0.05, AUL (black) greater than AUL (caucasian) for all MN concentrations; AUL (oriental) greater than AUL (caucasian) for the higher dose levels. Emx, AUE and Lmx showed no significant differences between races within concentrations. For all subjects, Emx, AUE, and AUL were significantly dependent on MN dose whereas Lmx was not. The results suggest that some racial differences in response to topical MN exist and that perception of these distinctions may depend upon the method of measurement.
Article
Intercellular lipid lamellae in the stratum corneum constitute the barrier to water diffusion and may also play a role in cohesion between corneocytes. The lamellae arise from stacks of lamellar disks that are extruded from the granular cells and then fuse edge-to-edge to form sheets. It has been proposed that each lamellar disk is formed from a flattened vesicle, and therefore consists of two lipid bilayers in close apposition. In the present study, electron microscopic examination of ruthenium-tetroxide-fixed stratum corneum from mouse, pig, and human skin revealed that the double bilayer pattern persists in the intercellular lamellae. In addition, distinctive patterning of the intercellular lamellae has led us to propose novel molecular arrangements of the intercellular lipids. These include interlamellar sharing of lipid chains to produce lipid monolayers between pairs of bilayers. The pattern reflects the provenance of the intercellular lamellae from lamellar granule disks and the nonrandom orientation of the lamellar lipids.
Article
Preliminary experiments have been performed to determine whether there are age and racial differences in the response of human skin to the topically applied vasodilator methyl nicotinate. With the use of a constant stimulus (a 15-second exposure to a 100 mM aqueous solution of drug), the subsequent time-course of the vasodilatation response was followed noninvasively and objectively with the optical technics of laser Doppler velocimetry (LDV) and photoplethysmography (PPG). Three groups of subjects were considered: young white subjects (20 to 30 years of age), elderly white subjects (63 to 80 years old), and young black subjects (20 to 30 years old). Analysis of the results shows that the time to peak response, the area under the response-time curve, and the time for the response to decay to 75% of its maximum value are statistically indistinguishable for all three groups at the p = 0.05 level of significance. Only the magnitude of the peak response revealed some significant differences between the cohorts (young greater than black, determined by PPG; young greater than old, determined by LDV). The data suggest, therefore, a remarkable similarity in response across a wide range of skin types. The origin of this consistency may, however, be complex and is not revealed by these experiments.
Article
In vivo transepidermal water loss studies are characterized by large inter-individual variability and biased by environmental effects and eccrine sweating. An in vitro technique for measuring transepidermal water loss (TEWL) was used to compare TEWL in two racial groups--blacks and whites. In both groups a significant correlation between skin temperature and increased TEWL was found (P less than 0.01). Furthermore, black skin had a significantly higher mean TEWL than white skin, corrected log TEWL 2.79 and 2.61 micrograms/cm2/h, respectively. The difference in TEWL between the groups could because measurements were made in the absence of eccrine sweating and other vital functions. The higher TEWL in black skin could be explained on the basis of a thermoregulatory mechanism. The anatomical and physiological differences in the stratum corneum between different races are discussed.
Article
Water permeability constants (Kp) were determined with skin from human cadavers. No difference was seen in Kp values from unfrozen skin or from skin frozen for a few days. Human skin could usually be stored at -20 degrees C for up to a year with no change in water permeability, but in some cases apparent deterioration of the barrier was observed. A rapid procedure was developed for checking barrier integrity of skin in diffusion cells before a penetration study. The percent of the water dose absorbed after 20-min contact with skin correlated with water Kp values. Changes in water permeation through human skin agreed with changes in the absorption of seven test compounds of varying solubility properties (acetylsalicylic acid, benzo(a)pyrene, cortisone, DDT, nicotinic acid, propylene glycol, and testosterone). Water permeation is therefore considered to be a good indicator of potential changes in the barrier integrity of human skin. No correlation was observed in Kp values and other characteristics of the donor skin samples such as age, sex, race, and length of time before skin harvest.