Multiple chemical sensitivity (MCS) – a guide for dermatologists on how to manage affected individuals

Abstract

Summary Multiple chemical sensitivity (MCS) is a condition characterized by a subjectively perceived increase in sensitivity to environmental chemicals. Individuals affected report a wide variety of nonspecific complaints, and frequently attribute cutaneous and mucosal symptoms to chemical exposures. Dermatologists should therefore be familiar with this condition. MCS is a diagnosis of exclusion. Other causes for the patients’ symptoms should be ruled out by routine laboratory tests, allergy tests and, if indicated, monitoring for toxic (environmental) substances. The primary job of dermatologists is to rule out skin diseases or hypersensitivities as possible causes of the complaints. Interdisciplinary patient management is essential, especially in severe cases in which those affected have problems coping with everyday life. Relevant specialties in this context include environmental medicine, psychosomatic medicine as well as occupational and social medicine. Cutaneous symptoms are usually addressed with symptomatic treatment using basic skin care products. There are currently no evidence‐based treatment recommendations for MCS. It is crucial that MCS patients be protected from unnecessary treatments and thus from mental, social and financial strain. In addition to medical skills, managing MCS patients requires communicative and psychosocial competence in particular. Physicians involved in the treatment will benefit from training in psychotherapy. Irrespective of the mechanisms that lead to MCS, diagnosis and treatment of this condition require an actively supportive attitude towards these patients, a good doctor‐patient relationship and interdisciplinary cooperation.

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

“…The skin can appear normal or be accompanied by erythema. Sensitive skin can affect all body locations, especially the face.” 1 This condition may be very distressing and have a significant impact on the quality of life 2,3 …”

“…1 This condition may be very distressing and have a significant impact on the quality of life. 2,3 Sensitive skin is very common: it affects about half of the European population, to different degrees, and is more frequent among young people and women. [4][5][6][7][8][9] Its pathophysiology is not well known; it appears to be caused by hyper-reactivity of the cutaneous nervous system and is associated in particular with the activation of sensorial proteins present on keratinocytes and nerve endings.…”

Living with multiple chemical sensitivity during the COVID ‐19 pandemic: a patient's perspective

“…2 The prevalence of physician-diagnosed MCS has been found to be 0.5%. 3 No objective proof of a causal relationship between chemical exposure and symptoms has been shown, and the pathophysiology remains unclear, 4 although there appears to be overlap with other somatoform syndromes, such as fibromyalgia. Many different chemicals are implicated, including insecticides, disinfectants, perfumes, weed-killers, bleach, exhaust fumes and paints.…”

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

“…These unpleasant sensations can affect all body locations, especially the face, and cannot be explained by concurrent skin diseases. Sensitive skin is very common and may be distressing and affect the quality of life [3][4][5][6].…”