365 Sensitive Skin Syndrome
individuals is no different or less than in younger individuals.19,23,33,34 A 2010 study with
1,039 individuals evaluated SSS at several body sites in the United States.29 No consistent
pattern with age was seen when subjects were asked about sensitive skin in general (of the
face or body, specifically). However, genital area skin sensitivity demonstrated an increase
from 53% in subjects ≤30 years old to 66% in subjects ≥50 years old (Figure 1). This
difference was mainly due to the females in the study.
Another critical factor is the impact of hormonal fluctuations during the different consumer
life stages on skin sensitivity. In both the dermis and epidermis, the skin has highly sensitive
estrogen receptors, and variation of female hormones can have an impact on the skin.38
Decreased estrogen levels can adversely affect barrier function, elasticity, blood circulation,
and vasomotor function. Farage’s study, which included 1,039 individuals, demonstrated that
the menstrual cycle was contributing to unpleasant genital skin in 61% of women with SSS
and 40% of women with nonsensitive skin (p 0.00001).37 Falcone and colleagues reported
that women with more intense perimenstrual symptoms perceived their skin as more sensitive
during some phases of the menstrual cycle compared with women who had lower intensity
symptoms (p =0.002).39 Furthermore, 70% of postmenopausal women claimed they perceived
that SSS caused their skin sensitivity to increase after menopause.39 In general, among women
with SSS, products used for menstrual protection and hygiene have been shown to trigger
significantly greater symptoms than among women in the nonsensitive group.37
PSYCHOLOGICAL EFFECTS OF SKIN DISEASE
As mentioned previously, individuals with SSS are more likely to also suffer from other skin
disorders and comorbidities. While most skin diseases are not associated with substantial
functional impairment, they can have significant adverse effects on the psychological health
of sufferers and the overall quality of life (QoL).40 Furthermore, the presence of certain other
psychological conditions—such as depression, anxiety, stress, and sleep disorders—can lead
Figure 1. Age and gender effect on prevalence of sensitive genital skin. Responders were asked if they had
sensitive skin (“slight,” “moderate,” or “very”).35,36 MH chi-square was used to test for correlations between
perceptions of sensitive skin and age for responders overall and for each gender. Adapted with permission from
reference 37. Copyright 2019 Frontiers Media.

366 JOURNAL OF COSMETIC SCIENCE
to increased dermatologic symptoms.40 Hong and colleagues proposed that the psychosocial
and occupational impact of cutaneous illnesses can be comparable to other chronic medical
conditions.41
Yew and colleagues conducted an evaluation of an adult population in Singapore.42 These
investigators found that individuals who had a history of skin diseases scored significantly
higher on the indices of depression (1.3 in patients versus 0.6 in controls, p 0.001) and
loneliness (3.5 versus 3.3, p =0.002). In addition, the group with skin disease scored
significantly lower on the social network index (15.9 versus 16.6, p =0.043) and the
health-related QoL index (0.89 versus 0.95, p 0.001). Demographic measures revealed
that participants with skin diseases were less likely to be employed and more likely to have
financial constraints and alcohol misuse when compared with their healthy counterparts.42
Individuals with skin disease reported higher prevalence of chronic conditions such
as diabetes, hypertension, pulmonary disease, and arthritis.42 Dalgard and colleagues
conducted a study among 4,994 participants (3,635 patients and 1,359 controls) to
evaluate the psychological impact of dermatologic diseases.43 Using the Hospital Anxiety
and Depression Scale, these investigators reported that compared with control subjects,
dermatologic patients had a higher incidence of depression (10.1% in patients versus 4.3% in
controls), anxiety (17.2% versus 11.1%), and suicidal ideation (12.7% versus 8.3%). Costeris
and colleagues investigated the influence of dermatological disorders on self-esteem and
perceived social support in three groups of subjects: patients with severe visible facial acne,
patients with nonvisible psoriasis/eczema, and control groups composed of participants
without a dermatologic disorder.44 Both patient groups showed lower self-esteem and lower
perceived social support compared with the control group.
Misery and colleagues evaluated approximately 2,000 subjects (1,003 women and 935 men)
using Short-Form 12 to evaluate the overall QoL.45 Calculations were made for a Physical
Component Summary (PCS-12) and a Mental Component Summary (MCS-12). These
investigators found that the MCS-12 score was impaired in individuals with SSS, and the
impairment increased in parallel with the severity of the SSS. In a later study, these authors
showed a similar result with a larger sample of 5,000 individuals (2,557 women and 2,443
men).23
In 2018, Misery and colleagues developed a 14-item instrument, the Burden of Sensitive
Skin (BoSS) questionnaire, designed specifically to determine the impact of SSS on QoL.7,46
The BoSS questionnaire is composed of items grouped into three dimensions: Self-Care,
Daily Life, and Appearance. The BoSS mean total score for subjects without sensitive skin
was 14.05. For subjects with sensitive facial skin, the BoSS score was significantly worse at
25.61 (p 0.001). Furthermore, the subjects with sensitive skin had worse scores for each
of the 3 BoSS dimensions: Self-Care (14.93 for subjects with sensitive skin versus 8.20 for
subjects with nonsensitive skin), Daily Life (4.64 versus 2.10), and Appearance (6.03 versus
3.76), all p 0.001 (Figure 2).46
PSYCHOSOCIAL IMPACT OF SSS
CONSUMERS’ SOCIAL BEHAVIOR, LIFESTYLE, AND DAILY ACTIVITIES: AVOIDANCE AND
RESTRICTIONS
Individuals with SSS have identified a wide variety of environmental factors that can trigger
their symptoms.1 These include extremes of humidity (dry or wet weather), extremes
of temperature (cold or hot), wind, sun, air conditioning, dust and pollution (Table III).