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. 2020 Nov 24;20(7):2058–2061. doi: 10.1111/jocd.13829

Does sensitive skin represent a skin condition or manifestations of other disorders?

Lihong Chen 1, Jie Zheng 1,✉
PMCID: PMC8359429  PMID: 33159415

Abstract

Sensitive skin or cutaneous sensory syndrome is defined as a skin condition that is hypersensitive to stimuli, presented with itching, irritant, erythema, and dryness. However, is it associated with more than impairment of epidermal functions, psychological stress and topical medication or products? We think that it can be a skin condition or manifestation of other cutaneous or extracutaneous disorders. In this paper, we brief relation of sensitive skin syndrome with cutaneous and extracutaneous disorders, clinically, and pathophysiologically.

Keywords: Sensitive skin, skin condition, systemic disorder

Editor,

Sensitive skin or cutaneous sensory syndrome is defined as a skin condition that is hypersensitive to stimuli, which normally do not cause problems in normal subjects.1 Although this definition has been widely accepted for years, a line of evidence suggests that sensitive skin could be manifestations and/or condition of a variety of disorders, associated with not only impairment of epidermal functions (elevated transepidermal water loss rates, reductions in the stratum corneum hydration, increased skin pH levels, and so on), psychological stress, neuroimmunological dysfunction, but also other cutaneous, and extracutaneous disorders. Here, we brief relation of sensitive skin syndrome with cutaneous and extracutaneous disorders.

1. SENSITIVE SKIN CAN BE A CUTANEOUS MANIFESTATION OF SKIN DISORDERS

Epidemiological studies have demonstrated a higher prevalence of sensitive skin in subjects with certain cutaneous disorders, such as atopic dermatitis(AD), psoriasis, acne, rosacea, and seborrheic dermatitis.2, 3 For example, subjects who claimed sensitive skin were 5 times likely to report skin allergies,4 while prevalence of sensitive skin in patients with rosacea can be as high as 100%.5 Likewise, over 40% of psoriatic patients experience symptoms and signs of sensitive skin, such as itchy, hot/burning, tender, and cramping.6 The odds of having sensitive skin is 3.7 times greater in psoriatic patients than in the controls.2 Similarly, odds of having sensitive skin are 2.5 times greater in patients with acne.2 To distinguish sensitive skin from them is sometimes difficult. When a patient complains of sensitive skin presented with skin lesion or symptom, a diagnosis of dermatosis should be considered at first. If the complaint of unpleasant sensation cannot be explained by lesions attributable to any dermatosis, a diagnosis of sensitive skin or sensitive skin syndrome could be made.

In addition to dermatoses, medications, such as topical or systemic retinoid and glucocorticoids can also induce symptoms and signs of sensitive skin. Additionally, sensitive skin can result from adverse reactions to skin care products.7, 8 Taken together, evidence indicates that sensitive skin could represent manifestations of cutaneous disorders and of treatment to skin disease. Skin disorders associated with sensitive skin are summarized in Table 1.

Table 1.

Association of sensitive skin symptoms with cutaneous and extracutaneous disorders

Disorders Epidemiology/Symptom References
Atopic dermatitis a history of childhood AD was more frequent in sensitive skin patient (OR: 1.6) Misery et al, 20092
56% of sensitive skin subjects reports a concomitant atopic condition Richters RJ et al, 20173
more self‐reported skin allergies in AD patients(OR: 5.0) Farage MA,20084
Itching after exposure to heat, wind, and low humidity Bonchak JG et al, 201827
Psoriasis 1.5% of sensitive skin patient have psoriasis, greater sensitive skin in psoriasis people (OR: 3.7) Misery et al, 20092
skin pain, itchy, unpleasant, aching, sensitive, hot/burning, tender and cramping in psoriasis patient Patruno C et al, 20156
Rosacea 1.5% of sensitive skin patient have rosacea Misery et al, 20092
100% French rosacea patients complained having very sensitive skin Misery L et al, 20055
78.2% Germany and Russian rosacea patients presented with sensitive skin Tan J et al, 201628
flushing, erythema, intolerance to stimuli Misery L et al, 201129
sensitive to burning and stinging van Zuuren EJ, 201730
Acne

2.5% of sensitive skin patient have acne;

Odds of sensitive skin in acne patients is 2.5 times greater

 Misery et al, 20092
itching, dryness, and desquamation related to treatment Yee KC et al, 199431
Adverse reactions to skin care products branded skin care products can cause severe adverse cutaneous reactions Li Z et al, 20187
Hyperglycemia and insulin resistance sensitive skin syndrome Sulk M et al, 201223
reduced permeability barrier function of the skin

Aoki M et al, 20199;

Han SH et la, 201710

Obesity surface roughness was higher by 70% Mori S et al, 201714
redness accompanied by a 34% increase in face skin blood flow
diminished skin barrier function and overheated in obese children Nino M et al, 201213
dry skin and itching Brown J et al, 200432
Neuropathy decreased heat pain threshold and the presence of hyperalgesia Huet F et al, 201811

dry skin

 Tominaga M et al, 200733
Sjogren's syndrome dryness and skin inflammation Katayama I et al, 201826
Itching in 59% of patients Yahya A et al, 201916
Systemic lupus erythematosus Itching in 61% of patients Yahya A et al, 201916
Dermatomyositis Itching in 83% of patients Yahya A et al, 201916
Systemic sclerosis Itching in 22% of patients Yahya A et al, 201916
Mixed connective tissue disease Itching in 60% of patients Yahya A et al, 201916
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Abbreviation: OR, odds ratio.

2. IN ADDITION TO CUTANEOUS DISORDERS, CERTAIN EXTRACUTANEOUS DISORDERS ARE ALSO ASSOCIATED WITH SENSITIVE SKIN

For instance, subjects with insulin resistance and hyperglycemia can suffer from sensitive skin syndrome, likely due to a defective epidermal permeability barrier9 and impaired peripheral sympathetic nervous system.10 Likewise, diabetic patients can experience skin sensory symptoms, such as itching, stinging, and flushing, possibly due to peripheral neuropathy and angiopathy.11 Obesity is another exemplar of an association between sensitive skin and systemic condition. The common comorbidities of obesity include itching and burning,12 which are linked to the fragile skin structure and epidermal dysfunction.13 In obesity, face roughness was higher than nonobesity, the water content was lower, and significant facial redness accompanied by increased skin blood flow was also observed, all of them were correlated to systemic inflammation, serum insulin, and leptin.14

Some disorders, such as hyperalgesia, with damage of cutaneous C‐fibers, can increase sensitivity to stimuli because of a reduction in pain threshold.15 Symptoms of sensitive skin, especially itching, are also common in some autoimmune connective tissue diseases, including dermatomyositis, systemic lupus erythematosus, Sjogren syndrome, systemic sclerosis, as well as mixed connective tissue disease.16 Collectively, sensitive skin can also be a phenomenon of extracutaneous disorders.

REGARDING THE MECHANISMS BY WHICH SENSITIVE SKIN DEVELOPS IN SOME CUTANEOUS AND EXTRA CUTANEOUS DISORDERS, IT IS NOT CLEAR YET. HOWEVER, EVIDENCE SUGGEST SEVERAL POSSIBLE MECHANISMS.

Firstly, the development of sensitive skin is associated with epidermal dysfunction, which commonly exists in inflammatory dermatoses, diabetes, obesity, and autoimmune connective tissue disease.10, 14, 17, 18 Secondly, some symptoms of sensitive skin syndrome, including itching, stinging, and flushing, could be due to the damage of C‐fibers in some disorders, such as diabetic peripheral neuropathy.11 There are also numerous neuromediators involved in the pathogenesis of itch in dry skin, like nerve growth factor (NGF), muscarinic acetylcholine receptors, opiates, serine proteases such as tryptase and their respective proteinase‐activating receptor 2 (PAR2).19 Non‐neuronal transient receptor potential (TRP) channels also play a central role in the perception and pathophysiology of sensitive skin because they can be activated by heterogeneous physical, chemical, or thermal stimuli, which in parallel act as triggers of sensitive skin.20 On the other hand, transient receptor potential vanilloid 1 (TPRV1) is involved in inflammatory dermatoses like psoriasiform inflammation,,21 and some autoimmune diseases.22 Moreover, dysfunction of cutaneous TRPV 2, 3, and 4 expression was observed in rosacea.23 Thirdly, in addition to pro‐inflammatory cytokines, TRPV,24 hyperglycemia,25 and hypoidrotic in AD and Sjogren syndrome26 can also contribute to skin inflammatory reaction. Finally, increased skin blood flow, redness, and flushing resulting from small vessel dysfunction of sensitive skin are also observed in obesity14 and diabetic patients.10

In conclusion, above evidence strongly suggests that sensitive skin could represent cutaneous manifestations of various cutaneous and extracutaneous disorders. Therefore, caution should be taken when subjects display sensitive skin because a variety of cutaneous and extracutaneous disorders can accompanied with sensitive skin. For example, screening for insulin resistance and serum glucose is recommend to obese sensitive skin subjects, autoimmune antibody test is recommend to female subjects.

CONFLICT OF INTEREST

Authors declare no conflict of interests for this article.

Chen L, Zheng J. Does sensitive skin represent a skin condition or manifestations of other disorders?. J Cosmet Dermatol.2021;20:2058–2061. 10.1111/jocd.13829

Funding informationThis work was supported by grants from the National Natural Science Foundation of China (81803134).

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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