Sensitive Skin-Syndrome T78.4

Sensitive skin syndrome", SSS also called "sensitive skin syndrome", is clinically defined by characteristic, subjective sensory perceptions such as a feeling of tightness, abnormal stinging, burning, tingling, pain and itching, which significantly reduces the quality of life of those affected (International Forum for the Study of Itch). Causative skin diseases are not present or can be excluded. Inconstantly associated is redness. Because SSS is a self-diagnosed condition with no objectifiable organic findings, quantification is difficult by definition. Acceptable and objective screening tests are lacking so far (Lev-Tov H et al. 2012).

To formulate a systematic clinical approach, attempts have been made in the past to better characterize the condition. In a large epidemiological English study (n = 2316), 51.4% of women and 38.2% of men reported having sensitive skin (Willis CM et al 2001). Interestingly, atopy did not appear to affect self-perceived hypersensitivity in the participating women. However, measurements of transepidermal water loss and measurements of dielectric water content revealed no differences in reactivity between men and women (Lammintausta K et al. 1987; Björnberg A et al. 1975). Apparently, self-perception of skin sensitivity is increased in women compared with that in men. However, this cannot be objectified by test procedures. Ethnic differences in skin reactivity led to the clinical hypothesis that the skin of darkly pigmented people is less reactive than the skin of light-skinned Caucasians, and this in turn is less reactive than the skin of Asians (Modjtahedi SP et al. 2002).

Cosmetics are the main triggers for sensitive skin. The presence of potentially irritating substances in cosmetics may increase the clinical expression of symptoms. Furthermore, symptoms may be aggravated by an irritative environment with cold, heat, dryness, pollution, wind, chemicals (Wollenberg A et al. 2022).

Sensitive skin syndrome is a common and challenging condition, but little is known about its underlying pathophysiology. Patients with SSS often complain of subjective complaints such as severe facial irritation, burning and/or stinging after the application of cosmetic products. However, the complained complaints are out of proportion to the objective clinical findings. Basically, sesnsitive skin syndrome could be defined as a condition of "hyperreactivity to environmental stimuli." Basically, SSS seems to be an orthergic (toxic) phenomenon rather than an immunologic reaction. Impairment of the skin barrier has been discussed (di Nardo A et al 1996).

Young patients seem to be affected more frequently than old patients (Wöhrl S et al. 2003, Robinson MK 2002).

Symptoms mainly affect the face, less frequently other parts of the body ((Misery L et al. 2020).

Patients with sensitive skin syndrome often present with subjective complaints that are out of proportion to the objective clinical findings. They complain of severe irritation, burning and/or stinging of the face after the application of cosmetic products and hygiene items such as sunscreens and soaps, but do not show the clinical phenomena expected for a dermatitic reaction such as: erythema formation, infiltration or scaling (Maibach HI 1987; Pons-Guiraud A 2004). Not infrequently, the condition is aggravated by certain climatic conditions (Berardesca E et al 2006; Saint-Martory C et al 2008). Maibach paraphrased the syndrome with the term "cosmetic intolerance" for which Fisher coined the term "status cosmeticus". He defined an "extreme state" of SSS in which the patient gradually becomes completely intolerant of the use of any cosmetic product (Fisher AA 1990).

Some dermatoses that are easy for most clinicians to diagnose may have an atypical appearance and therefore not have the "expected" morphology: contact allergic eczema, atopic dermatitis, rosacea, seborrheic dermatitis are probably the four most common differential diagnoses. Contact urticaria should also be excluded.

The physician consulted should always consider body dysmorphic disorder (BDD) when evaluating skin complaints without objective findings. Involvement of a psychiatrist is indicated because these patients may well be suicidal (36. Singh S et al 1996).

Multiple chemical sensitivity (MCS), a "hypersensitivity" caused by chemical exposure and characterized by recurrent symptoms in different organs (see also eco-syndrome).

Special algorithms have been developed for the treatment of SSS, which are based on accumulated clinical experience but for which no experimental evidence is available. These algorithms include four basic steps: discontinuation, assessment, testing, and slow reintroduction. Discontinuation of all topical medications and/or products and avoidance of activities and clothing that cause skin irritation should be initiated and may take up to 12 months. The patient should then be evaluated for the appearance of visible dermatoses. If underlying dermatoses have been ruled out, patch and photopatch testing should be performed with routine allergens as well as with all of the patient's skin care items. If all testing is negative, psychiatric evaluation is indicated.

The next step in the treatment sequence is the slow reintroduction of "minimally necessary" skin care products. In women, it is recommended to introduce cosmetic products with low allergenic potential one by one in the following order: lipstick, face powder and blush. It is recommended to test all newly introduced products. Practical procedure: application of the product for five consecutive nights on a 2 cm area on the side of the eye; the positive and/or negative result must be documented.

As sensitive skin is common and becoming more prevalent given the current trend in the use of cosmetics worldwide, better skin care products need to be developed. Continued research into active and safe skin care products to prevent and treat sensitive skin is most welcome (Wollenberg A et al. 2022).

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