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*Address all correspondence to Miranda A. Farage, farage.m@pg.com
Adapted from Farage, M.A. Psychological Aspects of Sensitive Skin: A Vicious Cycle. Cosmetics 2022, 9, 78.
https://doi.org/10.3390/cosmetics9040078
The Vicious Cycle of Biopsychosocial Desperation for
Sensitive Skin Sufferers
MIRANDA A. FARAGE
The Procter and Gamble Company, Corporate Function R&D, Mason, Ohio, USA
Accepted for publication July 15, 2024.
Synopsis
Sensitive Skin Syndrome (SSS) has been the subject of intense research over the past decade. Recent reviews
confirm that about 40% of the population report moderate or very sensitive skin, and an additional 30%
report slightly sensitive skin. Although certain phenotypes are more susceptible, anyone can suffer from SSS,
and this condition can manifest in all anatomic sites. A wide variety of environmental and lifestyle factors
can trigger SSS symptoms, including itching, stinging, burning, pain, and tingling. To avoid such triggers,
individuals with SSS often alter their behaviors and habits such as restricting their daily and social activities
and modifying the use of everyday products that nonsensitive individuals take for granted. In addition, there
is an association between SSS and some common psychological problems. Sensitive skin symptoms such as
itching, stinging, burning, and pain can result in sleep disorders, fatigue, stress, and anxiety. Conversely, lack
of sleep and increased stress from external sources can make the SSS sufferer prone to more dermatological
outbreaks. This becomes a vicious cycle that impacts consumers’ well-being. The medical community is
beginning to understand the importance of the underlying biological causes that can impact skin conditions.
However, to holistically understand and pursue sustainable solutions for the SSS individual, it is necessary to
also be aware of the psychological factors that can trigger or worsen this condition, as well as the several social
challenges and distresses that can deeply impact the overall quality of life of the individual.
INTRODUCTION
Sensitive Skin Syndrome (SSS) has been the subject of intense research in recent years.
Anyone can suffer from SSS however, there are certain characteristics, or host factors,
which are more likely to be seen in individuals with SSS. These include female gender, fair
skin, higher susceptibility to sunburn and blushing, and skin phototypes I–IV.1 Typically,
there are no objective signs of skin irritation in subjects suffering from SSS. Rather, the
condition manifests as unpleasant sensations such as pruritus, stinging, burning, pain,
and tingling sensations, in response to a wide variety of external and internal stimuli
that normally should not provoke such sensations.2–4 Due to the absence of consistent
objective signs, such as redness or swelling, investigators have relied on a questionnaire-
based approach to evaluate this condition. Several such studies have been conducted among
J. Cosmet. Sci., 75.5, 362–377 (September/October 2024)

363 Sensitive Skin Syndrome
populations around the world to evaluate the prevalence of SSS in the general population.5
Chen et al.’s meta-analysis—representing 18 countries and a total of 51,783 individuals—
showed around 71% of people self-reported SSS.6
Sensitive skin can impact all anatomic sites, including the face, scalp, and genital area.5,7
This can have a significant impact on an individual’s everyday social routine life. Often, the
individual must cope with other dermatologic disorders in addition to the SSS symptoms. An
individual with SSS must identify and avoid a wide variety of factors that can trigger their
symptoms. In turn, the manifestation of SSS symptoms can trigger psychological effects.
BIOPHYSIOLOGICAL CONTRIBUTORS OF SSS
Several physiological differences have been identified in individuals with SSS (Table I).
The epidermal layer of the skin in individuals with SSS has reduced barrier integrity due
to differences in lipid composition, with a decrease in ceramide and sphingolipid content.8
This results in increasing the potential penetration of irritants and insufficient protection of
nerve endings.5,8–10 Increased vascular reactivity has been observed in individuals with SSS,
resulting in more intense vascular reactions to irritants.11 Roussaki–Schulze and colleagues
reported that vascular reactions to methyl nicotinate in subjects with SSS was 75 times
higher compared with nonsensitive controls.12
Neurosensory dysfunction is another physiological element that contributes to SSS. Biopsies
from subjects with SSS demonstrated a decrease of peptidergic C-fiber density.14 These fibers
are involved in pain, itching, and temperature perception. Degeneration of these fibers
can induce hyper-reactivity of the remaining nerve endings, resulting in allodynia.11 An
additional neurosensory component is an increase in TRPV1. This is a nonselective cation
channel that responds to heat and low pH, and it is related to nociception, neurogenic
inflammation, and pruritus. TRPV-1 is also classically known as the capsaicin receptor.15,16
Based on self-reported SSS skin biopsies, Ehnis-Pérez et al. found TRPV1 is dramatically
upregulated in subjects with sensitive skin.15
Another important factor for individuals with SSS is that they may also suffer from other
comorbidities and/or additional disorders (Table II). Just like SSS, rosacea is more common
in individuals who are female with fair skin and hair, blue eyes, and lighter skin—that is,
Table I
Some Physiological Elements Contributing to SSS
Epidermal
5,8–10 Reduced barrier integrity
Decrease in ceramide and sphingolipid
Increased penetration of potential irritants
Decreased protection of nerve endings
Vascular
12,13 Increase in vascular activity
Intense vascular reaction to methyl nicotinate
Greater reactions to standard allergens
Lower alkali resistance
Neurosensorial
11,14–16 Decrease of intraepidermal nerve fiber density
Reduced peptidergic C-fiber density
Increase in transient receptor potential vanilloid-1 (TRPV1)