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

372 JOURNAL OF COSMETIC SCIENCE
countries (Brazil, China, France, Russia, and the United States).65 The study included
7,170 individuals who reported they complied with containment procedures. Among
those, 20.9% (1,500 out of 7,170) responded that their skin condition had worsened due to
containment. The three main reported changes were drier skin (44.5%), skin rash (29.3%),
and greasier skin (27%). The investigators suggested that wearing masks and stress may
have contributed to skin condition changes. Subjects were then divided into a group with
SSS including 3,410 individuals (47.6%), who reported they had sensitive or very sensitive
facial skin, along with a group including 3,760 individuals (52.4%), who had skin that was
not very sensitive or not at all sensitive. Individuals in the group with SSS were more likely
to report skin changes during containment compared with the group who had nonsensitive
skin (27.7% versus 14.8%, respectively, p 0.00001).
As mentioned previously, the authors’ laboratory developed and validated an instrument to
assess the potential impact of various consumer products on QoL (i.e., the FQoL™).50,51 We
were conducting a study among 63 healthy women aged 23–54 years old for a consumer
product using the FQoL™ when the COVID-19 pandemic hit. We took advantage of this
study to gain insights on the impact of COVID-19 on the different FQoL™ domains and
subdomains. Responses to the instrument had been collected on February 19, 2020, which
was prior to the March 15, 2020 pandemic stay-at-home orders (i.e., pre-COVID-19). A
second set of responses was collected in the early days of the stay-at-home mandate (i.e.,
early COVID-19), and a third set was collected after 24 days of at-home confinement (i.e.,
day 24 of COVID-19 on April 7, 2020). Results of the domain analyses in the previously
unpublished study are presented in Figure 5. We observed a significant decline in overall
QoL and in the Well-Being domain and the Energy and Vitality domain.
When subdomains were further evaluated (Table V), everyone exhibited a significant
worsening of scores. One very interesting finding was within the Personal Pleasure
subdomain. This subdomain includes questions about things individuals do for leisure and
recreation. A large percentage of respondents (71.4%) checked the “not applicable” option,
which is a true reflection of an absence of activities during the stay-at-home orders.
CONCLUSION
Many dermatological diseases are associated with psychological problems such as depression,
anxiety, stress, and sleep disorders. The same can be said for SSS. Although SSS does not
present with objectively treatable signs and symptoms, individuals with SSS can suffer
from the same psychological problems. In addition, individuals with SSS are more likely to
suffer from comorbidities and other skin disorders such as acne, atopic dermatitis, psoriasis,
rosacea, vitiligo, or contact dermatitis. This can lead to feelings of helplessness and worry
that can further exacerbate symptoms of SSS such as itching and irritation and can result in
sleep disorders, fatigue, stress, and anxiety. Conversely, lack of sleep and stress from these
sources can make the SSS sufferer more prone to the symptoms. This can therefore lead to
a vicious psychological cycle that can deeply impact consumers’ well-being.
Individuals with SSS have also identified a wide array of external factors that can trigger
their physiological symptoms, including weather and environmental conditions, along with
exposure to a multitude of household and personal products. Attempts to avoid such factors
to circumvent the onset of SSS symptoms can impact their social freedom, with results
such as restriction of outdoor and/or indoor activities important for emotional interactions,