370 JOURNAL OF COSMETIC SCIENCE
disorders compared with control subjects without cutaneous disorders (4.1 ± 2.51 versus
3.5 ± 2.3, respectively, p =0.0019).57 These authors found that pain and pruritus were
good predictors of sleep disturbance (OR 1.7, 95% CI 1.4–2.0, p 0.0001, and 1.6, 95%
CI 1.3–2.0, p 0.0001, respectively).
Misery and colleagues conducted a survey among five different countries.48 Participants were
asked to rate the severity of sleep disorders and unpleasant skin sensations on numerical
scales, with 0 being no disturbance and 10 being the maximum. A score of 3 was considered
mild, between 3 and ≤7 was considered moderate, and ≥7 was considered severe. Among
the 10,743 participants 8,296 subjects reported sleep disorders. Approximately half of these
(4,295 or 51.77%) also reported SSS. Subjects with SSS had significantly worse (higher) scores
for sleep disorders (3.6 out of 10) compared with subjects without sensitive skin (1.6 out of
10) (p 0.001).48 Xiao and colleagues found similar results in a China study, which included
22,085 women.34 These authors reported that SSS was more likely in individuals who slept
Figure 3. Some product categories reported to trigger SSS symptoms. Responders in the Cincinnati study
were asked if a variety of categories of cosmetics, personal care products, and household products had ever
caused adverse reactions to their skin.35,36 For all product categories, the proportion of individuals with SSS
who responded positively was significantly higher than the number of individuals without SSS who responded
positively. (*=p 0.00001).
Figure 4. Consumer and shopping practices for individuals with SSS. In the Cincinnati study, responders
were asked about specific shopping practices. Compared to the group who did not have SSS, the subjects with
SSS were far more likely to: (A) look for skin related claims on products (such as, “safe for sensitive skin” and
“hypoallergenic”) (OR =5.3) and (B) avoid specific ingredients when shopping (OR =5.2).

371 Sensitive Skin Syndrome
for 6 hours compared with 8 hours (OR 1.36, p =0.001) and in individuals retiring at or
later than 2 am compared with 10 pm (OR 1.81, p =0.007).
STRESS, ANXIETY, AND DEPRESSION
Depression, anxiety, and emotional distress can have a deleterious effect on many conditions,
including dermatological diseases, and may initiate the itch–scratch cycle.58 Stressors such
as helplessness and worrying may have a role in worsening the itching sensation in patients
with skin diseases.59 Dalgard and colleagues reported a study conducted with 3,635
dermatology outpatients with common skin diseases and 1,359 controls.43 Subjects were
administered the Hospital Anxiety and Depression Scale questionnaire. Among the patient
group, 35.6% reported stress compared with 30.6% of the controls (p 0.001). In addition,
the patient groups demonstrated a significantly higher prevalence of clinical depression
(10.1% in patient group versus 4.3% in the control group, p 0.001), anxiety (17.2% versus
11.1%, p 0.001), and suicidal ideation (12.7% versus 8.3%).43
Stress has been known to trigger dermatological conditions such as psoriasis, rosacea,
and atopic dermatitis.60–62 In the study conducted by Farage, stress was identified as a
contributing factor to skin irritation by 51% of the total subjects’ responders (485 out of
954).47 Stress was perceived as a contributor by 63% (415 out of 654) of subjects with SSS,
compared with 24% (70 out of 290) of the subjects without SSS (p 0.0005).1,47 Saint-
Martory and colleagues reported a similar result among 400 women in France, where
about 61% of the participants who perceived sensitive skin of the face identified stress as a
contributing factor.63
In a study conducted by Misery and colleagues among 1,000 subjects in the United States,
skin reactivity to emotion was significantly higher among individuals who identified as
having “sensitive” or “very sensitive” skin, compared with individuals who identified as
“slightly sensitive” or “nonsensitive” skin. (53% versus 47% p 0.001).33
Individuals with SSS are more likely to feel stress. Misery and colleagues evaluated QoL
using the Short-Form 12 questionnaire.45 Individuals with sensitive or very sensitive skin
had a worse QoL than individuals without it. In addition, the QoL deteriorated as the
severity of sensitive skin increased. More recent studies have also shown similar results.23,64
Stress was reported as a trigger of unpleasant skin symptoms by 63% of the SSS subjects in
a study involving 1,039 subjects.47 In that same study, responders in different age groups
were asked if they had some degree of genital sensitivity and whether specific environmental
factors triggered the unpleasant sensations of SSS in the genital area.29 Overall, 58%
of individuals with irritation in the genital area claimed stress was a trigger. Xiao and
colleagues reported that the likelihood of SSS increased with the amount of stress in the
lifestyle.34 Compared with individuals who had no stress in their lives, SSS was more likely
in individuals who experienced mild stress (OR 1.31, p =0.001) or heavy stress (OR 1.57,
p =0.001).
THE IMPACT OF FORCED SOCIAL CONTAINMENT
Kluger and colleagues evaluated the potential effects of containment during the COVID-
19 pandemic from 2020 to 2021 and its effects on skin condition among subjects in five