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.

368 JOURNAL OF COSMETIC SCIENCE
Lifestyle and personal habits can also trigger symptoms, such as wearing rough fabrics,
the use of cosmetics, and exposure to tobacco smoke. A wide array of triggering conditions
must be avoided in order to circumvent the onset of SSS symptoms.
Such avoidance may lead to a restriction of outdoor or indoor activities important for social
interactions, leisure, recreation, and fitness. Thus, it may impact overall QoL.35
Factors that contribute to the symptoms of SSS may differ depending on age group. Among
those who claimed to have sensitive skin, hot weather and rough fabrics were the factors
most strongly associated with skin sensitivity among the oldest adults (aged 50 and older)
and were specifically associated with genital skin sensitivity in this group (Table IV).1 Cold
weather was most strongly associated with skin sensitivity in midlife (40–49 age group),
and stress was the most important factor cited by younger adults (i.e., individuals younger
than 40).1 The menstrual cycle was perceived to contribute to skin sensitivity by women of
all age groups except those aged ≥50.
Many everyday products were identified by individuals with SSS as potential triggers to
SSS symptoms. These included facial products and cosmetics, personal care products, and
common household products (Figure 3). A Cincinnati study reported by Farage with 1,039
individuals reported that 68.4% of the study population claimed their skin was sensitive to
some degree (very, moderately, or slightly).49 SSS seems to also influence shopping behavior
and practices. Subjects claiming SSS were 5 times more likely to look for skin-related
claims on products (such as “safe for sensitive skin” and “hypoallergenic”) compared with
subjects who had nonsensitive skin (OR =5.3) (Figure 4A). Meanwhile, they were 5 times
more likely to avoid specific ingredients, because the individual perceived they caused skin
irritation (OR =5.2) (Figure 4B).
Consumer product manufacturers are now fully aware of the need to develop products
specifically for individuals with SSS. The authors’ laboratory developed and validated a self-
administered scientific tool, Farage QoL (FQoL™, P&G), to assess the potential impact of
a variety of consumer products on health-related QoL.50,51 The tool consists of 27 general
items scored on a Likert scale and covering overall QoL (1 item), Well-Being (12 items),
and Energy and Vitality (14 items). The Well-Being domain has 3 subdomains: Emotion,
Self-Image, and Self-Competence the Energy and Vitality domain also has 3 subdomains:
Personal Pleasure, Physical State, and Routine Activity. The resulting FQoL™ instrument
has been used several times to evaluate the impact of various consumer products on the
consumers’ QoL.52
FATIGUE AND SLEEP DISORDERS
Fatigue has a high prevalence among patients with skin diseases.53 In a study conducted
in France by Misery and colleagues among 2,502 individuals, these authors found the
risk of fatigue was over four times greater for individuals with skin diseases compared
to those with no skin diseases.54 Sleep disorders and fatigue are common in patients with
inflammatory skin disorders, such as psoriasis and chronic eczema,55 and they have been
reported as upstream drivers of other sensory disorders.48
Itching and pain are major symptoms of sensitive skin and can contribute to sleep disorders.11
In a 2019 publication, Schmelz reported that individuals classified as having sensitive skin
experienced itching and pain sensations upon weak external stimuli that were not typically
painful or itchy in individuals without sensitive skin.56 Halioua and colleagues found that
subjects suffering from cutaneous disorders had a significantly higher severity of sleep