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).

367 Sensitive Skin Syndrome
Table III
Reported Environmental and Lifestyle Triggers of SSS
SSS subjects Nonsensitive subjects p value Ref
Total
responding
Factor causes
irritation (%)
Total
responding
Factor causes
irritation (%)
Environmental
Humid weathera 641 48% 295 13% 0.0005 47
Dry weathera 664 78% 297 54% 0.0005
Hot weathera 659 66% 295 32% 0.0005
Cold weathera 675 87% 303 70% 0.0005
Suna 673 82% 306 66% 0.0005
Winda 654 71% 292 53% 0.0005
Air conditioningb 63 13% 22 5% 0.001 33
Temperature variationb 210 47% 104 19% 0.001
Wate b 69 15% 33 6% 0.001
Pollutionb 3,249 63% 1,823 33% 0.001 48
Dus b 2,990 58% 1,633 29% 0.001
Lifestyle and habits
Rough fabricsa 666 71% 293 43% 0.0005 47
Cosmeticsb 2,989 58% 1,250 22% 0.001 48
Sweatingb 2,814 54% 1,496 27% 0.001
Tobacco smokeb 2,055 40% 1,135 20% 0.001
Foodb 2,262 44% 950 17% 0.001
Potential triggers of SSS symptoms were included from a number of sources, as indicated. Statistical analyses
compared individuals with SSS to individuals with nonsensitive skin by methods described in the appropriate
references.
a Subjects with SSS include individuals with any degree of sensitivity (very, moderate, slight).
b Subjects with SSS include only individuals with very or moderate sensitivity.
Figure 2. BoSS. Authors used the 14-item BoSS instrument to evaluate the impact of SSS on the QoL.7,46
The instrument evaluated three dimensions (Self-Care, Daily Life, and Appearance). Subjects included a total
of 100 women, 59 with self-declared sensitive skin and 41 without sensitive skin. Adapted with permission
from reference 46. Copyright 2021 Medical Journals Sweden.