Association between two painful and poorly understood conditions: Irritable bowel and sensitive skin syndromes

Psychological Aspects of Sensitive Skin: A Vicious Cycle

Sensitive Skin Syndrome (SSS) has been the subject of intense research in the past several years. Recent reviews confirm that about 40% of the population report moderate or very sensitive skin, and an additional 30% report slightly sensitive skin. Although certain phenotypes are more susceptible, anyone can suffer from SSS and this condition can manifest in all anatomic sites. A wide variety of environmental and lifestyle factors can trigger SSS symptoms of itching, stinging, burning, pain, and tingling. In order to avoid such triggers, the SSS individuals often alter their behaviors and habits such as restricting their daily activities, and modifying the use of everyday products that non-sensitive individuals take for granted. In addition, there is an association between SSS and some common psychological problems. Sensitive skin symptoms such as itching, stinging, burning and pain can result in sleep disorders, fatigue, stress and anxiety. Conversely, lack of sleep and stress from external sources can make the SSS sufferer more prone to the symptoms. This becomes a vicious cycle that impacts consumers’ quality of life and well-being. We are beginning to understand the importance of the underlying causes that can impact skin conditions. However, in order to better understand the SSS individual, we need to also be aware of the psychological factors that can trigger and/or worsen this skin condition, as well as the psychological stresses the condition places on the individual.

Sensitive Skin Syndrome: A Low-Noise Small-Fiber Neuropathy Related to Environmental Factors?

Background and Objectives

Patients frequently complain of mild, transient, unpleasant skin sensations that cannot be diagnosed as common neuropathies. Dermatologists have termed these symptoms “sensitive skin syndrome.” This narrative review was performed for a better knowledge by other specialists.

Databases and Data Treatment

Publications on pain in sensitive skin syndrome were obtained from PubMed.

Results

There is a growing body of data supporting the concept that sensitive skin is a type of small-fiber neuropathy. The arguments are based on clinical data, a decrease in intra-epidermal nerve fiber density, quantitative sensory testing abnormalities and an association with irritable bowel syndrome and sensitive eyes. Sensitive skin is triggered by environmental factors. Sensitive skin is a frequent condition, with a lifetime prevalence of ~50% according to self-reports.

Conclusions

Mild levels of skin pain or itch are frequently experienced by patients, who rarely report them. There is a need for a better knowledge of sensitive skin because it can be the first level of small-fiber neuropathies.

Association of sensitive eyes with sensitive skin: A worldwide study of 10,743 subjects

INTRODUCTION

Sensitive eyes are commonly reported by patients but there are very few epidemiological studies on this disorder. The aim of this study was the evaluation of the self-reported frequency of sensitive eyes and the association with sensitive skin.

METHODS

A survey was performed on a representative sample of the population aged more than 18 years in five different countries (Brazil, China, France, Russia, and the United States). All participants answered a questionnaire on sociodemographic characteristics; skin phototype; eye color; tobacco consumption; exposure to sunlight, air pollution or having pets; and sleep disorders. The presence of sensitive eyes, eyelids or skin and their triggering factors were assessed with specific questions.

RESULTS

A total of 10,743 individuals (5285 men and 5458 women) were included in the study. Among them, 48.2% reported having sensitive skin and 46.0% reported having "sensitive eyes". "Sensitive eyes" were more frequently reported by women (46.5%) than men (39.4%) in all countries, with the exception of China. The presence of "sensitive eyes" was more frequent if skin was very sensitive. More than half of subjects with "sensitive eyes" declared that their triggering factors were exposure to sunlight, dust, touch pad screens or computer screens or dry air. They were more exposed to pollution and tobacco. Their phototype (including eye color) was lighter.

DISCUSSION/CONCLUSION

This large study shows that self-declared "sensitive eyes" are very frequent and commonly associated with sensitive skin. Triggering factors of sensitive eyes are more specific.

Understanding the Sensitive Skin Subject to Achieve a More Holistic Diagnosis

Sensitive skin Syndrome (SSS) is a complex global clinical phenomenon that is defined by the self-reported presence of different sensory perceptions, including tightness, stinging, burning, tingling, pain and pruritus and often without objective signs. Due to the subjective nature of this clinical condition, the diagnosis is complex and there is often a disconnect between what subjects feel and what medical professionals can observe. This chapter reviews the known underlying physiology, some of the triggering factors associated with SSS, co-morbidities as well as the psychological impact on individuals suffering from this condition. The goal is to bridge the gap between the physicians’ understanding and the subjects’ perceptions of this real-life condition that affects so many.

Association between chronic idiopathic cough and sensitive skin syndromes is a new argument in favor of common neuropathic pathways: results from a survey on 4050 subjects

Sensitive skin syndrome has a neuropathic origin, which is why it is frequently associated with irritable bowel syndrome. We have looked for a possible association with chronic cough, which is commonly maintained by neurogenic mechanisms, whatever the initial cause(s). A survey was carried out on a representative sample of the population over 15 years of age using the quota method. The questionnaire included sociodemographic data and questions about sensitive skin, the presence of chronic cough, smoking and possible causes of chronic cough. Chronic cough was assessed by the Leicester Cough Questionnaire, and 4050 subjects responded (mean age: 45 years). Overall, 12.2% of subjects with a chronic cough were compared to the 87.8% without any cough. Among them, 72.5% had sensitive skin (vs. 47.8%, p < 0.001); additionally, 17.4% of the subjects with sensitive skin had a chronic cough (vs. 6.9% if no sensitive skin). These proportions were higher if very sensitive skin was reported. The risk of having chronic cough was twice as high if sensitive skin was reported [OR = 1.9 (1.5-2.4), p < 0.001]. The risk of having sensitive skin was also twice as high for chronic cough. Thus, chronic cough and sensitive skin are frequently associated. This association represents a new argument in favor of a neuropathic nature of sensitive skin. Sensitive skin and chronic cough are both modes of overreaction to environmental factors, which tend to be autonomized by neurogenic mechanisms. Dermatologists should ask their patients if they have a chronic cough, and pneumologists should ask about the presence of sensitive skin.

Relationship between sensitive skin and sleep disorders, fatigue, dust, sweating, food, tobacco consumption or female hormonal changes: Results from a worldwide survey of 10 743 individuals

BACKGROUND

Sensitive skin is related to environmental factors.

OBJECTIVES

We aimed to investigate the roles of poorly known associated and triggering factors on sensitive skin in a large global population.

METHODS

A survey was administrated to a representative sample of the adult population aged 18-75 years in five different countries (Brazil, China, France Russia, and the United States). All participants answered a web-based questionnaire on sociodemographic characteristics, sensitive skin and environmental factors.

RESULTS

Among the 10 743 included individuals (5285 men and 5458 women), 48.2% declared that they had sensitive skin. The group with sensitive skin reported significant increases in fatigue, dust or sweating and to a lesser extent food or tobacco consumption. The members of this group also declared that they experienced more sleep disorders than individuals without sensitive skin. Sensitive skin was very frequent in pregnant women, women with painful menstruations or women using contraceptive pills.

CONCLUSIONS

This large cohort study identified new factors, including female hormonal status, fatigue, sleep disorders and food, associated with sensitive skin. These associations suggest that sensitive skin is not restricted to an epidermal disorder but may be included in a larger context. The identified factors are potential upstream drivers of neurogenic inflammation in sensitive skin.

Sensitive Skins May Be Neuropathic Disorders: Lessons from Studies on Skin and Other Organs

Sensitive skin can be considered a neuropathic disorder. Sensory disorders and the decrease in intra-epidermal nerve ending density are strong arguments for small-fiber neuropathies. Sensitive skin is frequently associated with irritable bowel syndrome or sensitive eyes, which are also considered neuropathic disorders. Consequently, in vitro co-cultures of skin and neurons are adequate models for sensitive skin.

Sensitive Skin Syndrome: An Update

Sensitive skin syndrome is a widely reported complaint but a diagnostic challenge because of its subjective symptoms and lack of clearly visible manifestations. Epidemiological studies have shown the prevalence of sensitive skin to be as high as 60-70% among women and 50-60% among men. Patients with this syndrome usually have unpleasant sensations when exposed to physical, thermal, or chemical stimuli that normally cause no provocation on healthy skin. Recent studies and newly accepted position papers have provided a more in-depth understanding and consensus of its underlying pathophysiology, associations, diagnosis, and treatment. Since no clinical studies have been conducted about specific treatment protocols, patients with this condition should be provided with personalized skin management. Given this updated knowledge, our review offers an approach to sensitive skin syndrome, with differential diagnoses, and interventions targeting its pathophysiology.

Itch Processing in the Skin

Itching can result from activity of specialized primary afferent neurons (“pruriceptors”) that have been shown to express certain molecular markers such as B-type natriuretic peptide and several members of the Mrgpr-family in rodents. On the other hand, neurons involved in pain processing (“nociceptors”) can also provoke itching when the activation site is restricted to an isolated tiny spot within the epidermis. Individuals classified as having sensitive skin report increased itching and pain sensations upon weak external stimuli that are not painful or itchy in the control group. Numerous possible factors could contribute to sensitive skin along the pathway of transduction of the external stimuli into peripheral neuronal signals, followed by neuronal processing, finally resulting in the perception: (a) reduced local protective factors leading to impaired skin barrier function, (b) increased production of excitatory skin mediators, (c) sensitized peripheral neurons, (d) facilitated spinal and central processing, and (e) reduced descending inhibition from the central nervous system. For all of those pathophysiological mechanisms there are clinical examples such as atopic dermatitis (a,b,c), neuropathic itching (c,e), and restless leg syndrome (d,e). However, none of these factors have been directly linked to the occurrence of sensitive skin. Moreover, individuals reporting sensitive skin are heterogeneous and a subpopulation with defined pathophysiology has not yet been identified. Given that the condition is reported in about 50% of women, and thereby includes many healthy individuals, it appears problematic to assign a definitive pathophysiological mechanism to it.

Association of sensitive skin with sensitive corneas and sensitive eyelids

BACKGROUND

Sensitive scalp or irritable bowel syndrome has been previously shown to be associated with sensitive skin. We wondered whether sensitive eyelids and sensitive eyes could also be associated with sensitive skin.

METHODS

A cross-sectional epidemiological study was carried out on a representative sample of French people, according to the quota method, using a questionnaire.

RESULTS

A total of 2048 subjects were included in the present study. Notably, 52.2% declared sensitive eyes, which was more frequent in women than in men. The subjects who reported sensitive eyes were more numerous according to the severity of skin sensitivity, the severity of sleep disorders and the presence of bright eyes. More than half of the subjects with sensitive eyes thought that they were sensitive to sun exposure, dust, computer or touch pads or dry air. The presence of sensitive eyelids was reported by 18.65% (more frequent in women) and was associated with sensitive skin and sensitive eyes, sun exposure and exposure to dust.

CONCLUSION

This study is the first to investigate sensitive eyelids or sensitive eyes. Sensitive eyelids can be considered a localization of sensitive skin. The concept of sensitive eyes is not commonly used by ophthalmologists and remains to be more precisely defined.