Proposal of a self-assessment questionnaire for the diagnosis of sensitive skin

Development and validation of a prospective questionnaire for assessing oily sensitive skin

BACKGROUND

Skin type has a strong influence on how sensitive skin develops, with oily skin accounting for a larger proportion of sensitive skin. However, there has not been a scientifically sound questionnaire for determining oily sensitive (OS)-type skin in prior studies.

OBJECTIVES

In order to identify OS-type skin in the general population, we therefore intend to create an OS-type skin evaluation questionnaire, develop various thresholds through data analysis and classify skin based on two dimensions of sensitivity and oiliness.

METHODS

A questionnaire with questions regarding subjects' basic information, skin oiliness and skin sensitivity was given to each individual who participated in the study (n = 1297). To define the thresholds for OS-type skin, receiver-operating characteristic (ROC) curves were generated. The results of the lactic acid stinging test (LAST) and noninvasive instrument information obtained were compared with the thresholds mentioned above to verify the effectiveness of this tool.

RESULTS

According to the ROC curves, questionnaire cut-off values of 11.5, 20.5 and 29.5 can be used to detect mildly, moderately and severely sensitive skin, respectively. In addition, the questionnaire cut-off values of 22.5 and 31.5 can be used to detect moderately and severely oily skin, respectively. According to our study, the four sensitive-skin groups' LAST scores differed significantly from one another, while the skin sebum levels differed significantly between the three oily groups. Additionally, the EI and LAST scores were significantly correlated with skin sensitivity levels, whereas sebum, moisture and EI were positively correlated with skin oiliness levels.

CONCLUSIONS

We developed an OS-type skin evaluation questionnaire that has been tested and shown scientifically to be a promising method for evaluating OS-type skin and to completely examine the traits of sensitive and oily skin.

ABCD Classification of Skin Types

The classification of an individual's skin type is important because it helps dermatologists and aesthetic clinicians select the most effective methods for treating the skin. To select suitable cosmetic products and procedures that help ensure healthy and beautiful skin, clinicians must consider the patient's skin type. An individualized classification of skin types allows the clinician to develop personalized skin care recommendations that consider an individual's genetic and physiological characteristics. In the fields of dermatology and aesthetics, the classification of skin types is the basis for scientific research. Skin type classification systems are additionally important for both dermatologists and aesthetic practitioners because they influence the selection of cosmetic products, procedures, and treatments. The purpose of this paper was to provide a detailed review and evaluation of the relevance, suitability, and benefits of the new ABCD Classification of Skin Types, to compare it with other systems for classifying skin types, and to identify parameters for its improvement.

Does sensitive skin lie in epidermal barrier impairment or abnormalities? Results from an observational study assessing biophysical parameters

BACKGROUND

The pathophysiology of sensitive skin is largely unknown and no univocal data on the role of the epidermal barrier impairment have been identified. The aim of this study was to assess whether subjects with or without sensitive skin differ for some biophysical skin parameters, which reflect skin barrier integrity or skin hyperactivity.

METHODS

This observational, cross-sectional study included adult volunteers not affected with chronic inflammatory skin diseases who attended the Unit of Dermatology and the Center of Cosmetology of the University of Ferrara, Ferrara, Italy, between March 2021 and November 2022. All subjects, subdivided into those with or without sensitive skin, based on either Lactic Acid Stinging Test (LAST) result or a questionnaire-based skin sensitivity score ≥4, were tested for transepidermal water loss (TEWL), skin elasticity and hydrations and dermographism.

RESULTS

One hundred and eighty-seven subjects were included. No significant differences in terms of TEWL, elasticity and hydration levels were recorded between subjects with sensitive skin and those without, subdivided according to both the LAST result and the questionnaire score. Dermographism was elicited more in subjects with sensitive skin than in the others, although without statistical significance.

CONCLUSIONS

The study failed to find significant biophysical differences between sensitive and non-sensitive skin. Therefore, the role of skin barrier impairment does not appear to be a necessary condition in determining an abnormal skin sensitivity to potentially unpleasant and irritating stimuli. These findings indirectly support the relevance of a peripheral sensory neural hyperactivity in the pathophysiology of sensitive skin.

From consistent subjective assessment of skin sensitivity severity to its accurate objective scoring

BACKGROUND

Sensitive skin (SenS) is a syndrome leading to unpleasant sensations with little visible signs. Grading its severity generally relies on questionnaires or subjective ratings.

MATERIALS AND METHODS

The SenS status of 183 subjects was determined by trained assessors. Answers from a four-item questionnaire were converted into numerical scores, leading to a 0-15 SenS index that was asked twice or thrice. Parameters from hyperspectral images were used as input for a multi-layer perceptron (MLP) neural network to predict the four-item questionnaire score of subjects. The resulting model was used to evaluate the soothing effect of a cosmetic cream applied to one hemiface, comparing it to that of a placebo applied to the other hemiface.

RESULTS

The four-item questionnaire score accurately predicts SenS assessors' classification (92.7%) while providing insight into SenS severity. Most subjects providing repeatable replies are non-SenS, but accepting some variability in answers enables identifying subjects with consistent replies encompassing a majority of SenS subjects. The MLP neural network model predicts the SenS score of subjects with consistent replies from full-face hyperspectral images (R2 Validation set  = 0.969). A similar quality is obtained with hemiface images. Comparing the effect of applying a soothing cosmetic to that of a placebo revealed that subjects with the highest instrumental index (> 5) show significant SenS improvement.

CONCLUSION

A four-item questionnaire enables calculating a SenS index grading its severity. Objective evaluation using hyperspectral images with an MLP neural network accurately predicts SenS severity and its favourable evolution upon the application of a soothing cream.

Rosacea and seborrheic dermatitis differentially respond to lactic acid sting and capsaicin tests in Chinese women

BACKGROUND

Although rosacea and seborrheic dermatitis share some symptoms of sensitive skin, whether they respond differently to lactic acid sting and capsaicin tests, common tests for diagnosis of sensitive skin, is unknown.

OBJECTIVES

To reveal the cutaneous responses to lactic acid sting (LAST) and capsaicin test (CAT) in females with either rosacea vs. seborrheic dermatitis.

METHODS

A total of 60 patients with rosacea, 20 patients with seborrheic dermatitis and 40 normal controls were enrolled in the study. Their skin sensitivity to stimuli were evaluated following topical application of either 10% lactic acid solution or 0.001% capsaicin solution. Transepidermal water loss (TEWL) rates and erythema indexes were also measured on the face.

RESULTS

In comparison to normal controls, the positive rate to either LAST or CAT was significantly higher in subjects with rosacea (p < 0.001), but not in that with seborrheic dermatitis. Similarly, individuals with rosacea displayed a higher positive rate to both LAST and CAT than those with seborrheic dermatitis and normal controls (p < 0.001). In parallel, the LAST scores and CAT scores in individuals with rosacea were significantly higher than in that with either seborrheic dermatitis or normal controls (p < 0.001). The baseline TEWL rates and erythema indexes were higher in individual with rosacea than in normal controls (p < 0.001). But the baseline TEWL rates and erythema indexes did not differ significantly between subjects with rosacea and that with seborrheic dermatitis. Moreover, LAST scores and CAT scores correlated positively with TEWL (p < 0.0001). TEWL rates were higher in CAT positive than in CAT negative subjects (p < 0.0001). Finally, erythema index correlated positively with CAT scores (p < 0.0001), but not with LAST scores (p = 0.0842).

CONCLUSIONS

Skin responses to LAST and CAT differ between individuals with rosacea and those with seborrheic dermatitis, possibly due to the differences in epidermal permeability barrier and the neurovascular hyperreactivity. The higher LAST and CAT scores, as well as positive rates of both LAST and CAT can be attributable to inferior permeability barrier and the neurovascular hyperreactivity in subjects with rosacea.

Explore highly relevant questions in the Baumann skin type questionnaire through the digital skin analyzer: A retrospective single-center study in South Korea

BACKGROUND

Baumann skin type questionnaire (BSTQ) has been widely used for evaluating skin types in dermatology. However, it requires excessive assessment time and lacks sufficient clinical validation for the Asian population.

AIMS

We aimed to establish optimized BSTQ based on dermatological assessment of the Asian population.

METHODS

This was a single-center retrospective study, where the patient completed a modified BSTQ and a digital photography examination. The answers to four question groups for evaluating skin properties, including oily versus dry (O-D), sensitive versus resistant (S-R), pigmented versus non-pigmented (P-N), and wrinkled versus tight (W-T) were compared with the measurements. Highly relevant questions are selected using two different strategies and used to determine the threshold level, which was compared with skin-type measurement.

RESULTS

In O-D, S-R, P-N, and W-T, 3-5 out of 6, 2-6 out of 9, 3-6 out of 7, and 4-9 out of 11 questions were selected, respectively. As a result, skin type scores from two strategies and measurements showed similar Pearson correlation coefficient values compared to modified BSTQ (for O-D and sebum, 0.236/0.266 vs. 0.232; for O-D and porphyrin, 0.230/0.267 vs. 0.230; for S-R and redness, 0.157/0.175 vs. 0.095; for S-R and porphyrin, 0.061 vs. 0.051; for P-N and melanin pigmentation, 0.156/0.208 vs. 0.150; for W-T and wrinkle, 0.265/0.269 vs. 0.217).

CONCLUSION

Two strategies for optimizing BSTQ are proposed and validated for Asian patients. Compared to the BSTQ, our methods show comparable performance with a significantly reduced number of questions.

Results from an extended study on the reliability of a questionnaire for the diagnosis of sensitive skin: Confirmations and improvements

OBJECTIVE

A recently proposed self-assessment questionnaire aimed at diagnosing sensitive skin provided promising results in a relatively small population. The main objectives were: (i) to assess the reliability of the aforementioned questionnaire in a larger population and verify the cut-off score previously found to predict skin sensitivity (defined as positivity to LAST, lactic acid stinging test) and (ii) to define a formula that yields the probability of a positive LAST result.

METHODS

Adult volunteers were included in this observational, cross-sectional, extended study. Both LAST-positive subjects, who were considered as having sensitive skin ('patients') and negative ones ('controls') completed the questionnaire, which concerned sensitivity to possible triggers of unpleasant skin sensations in real life. A cumulative score (questionnaire-based skin sensitivity score, 0-10) was calculated from the sum of all items.

RESULTS

Three hundred and sixty-four subjects were enrolled, 214 patients and 150 controls. The mean questionnaire-based skin sensitivity score was significantly higher among patients than controls. Using two different methods, cut-off values of 4 and 5 were defined for the identification of LAST-positive subjects, with 76.6% and 72.8% accuracy, respectively. Scores below 4 or above 5 showed a high (80% or better) negative or positive predictive value, respectively. The coefficients found that in multivariate analysis for each questionnaire item, gender and age allowed us to calculate the probability of LAST positivity with higher precision taking into account the 'relative weight' of each factor.

CONCLUSION

With small variations in the results, the self-assessment questionnaire confirmed its reliability for diagnosing sensitive skin in clinical practice.