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

Abstract

Background and ObjectivesPatients 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 TreatmentPublications on pain in sensitive skin syndrome were obtained from PubMed.ResultsThere 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.ConclusionsMild 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.

Classification of psychodermatological disorders: Proposal of a new international classification

“…Burning mouth syndrome, vulvodynia and peno‐scrotodynia would be examples of functional skin disorders without secondary lesions, along with some cases of chronic pruritus (both idiopathic and in systemic disorders) and other skin sensory disorders (e.g. sensitive skin syndrome and other skin pain syndromes) 2,38,39 …”

Multiple topical product dermatitis: Paradigms in understanding and future perspectives

“…63 The underlying mechanisms are not fully known, however recent work suggests it may be a type of small fibre neuropathy due to interplay of extrinsic (environment such as UV, pollutants, cosmetics) and intrinsic factors (hormones, epidermal dysfunction and immune changes). 64 Triggers can be environmental (UV and weather), lifestyle-related (smoking, alcohol and certain topical products) or endogenous (psychological factors). 62,64 For a comprehensive discussion of prevalence and pathophysiologic mechanisms underlying disease see Honari et al 65 and Misery et al 64…”

“…64 Triggers can be environmental (UV and weather), lifestyle-related (smoking, alcohol and certain topical products) or endogenous (psychological factors). 62,64 For a comprehensive discussion of prevalence and pathophysiologic mechanisms underlying disease see Honari et al 65 and Misery et al 64…”

“…Three subtypes have been defined: Type I (low barrier function), Type II (normal barrier function with inflammatory changes) and type III (normal barrier function without inflammation but with reactivity problems) 63 . The underlying mechanisms are not fully known, however recent work suggests it may be a type of small fibre neuropathy due to interplay of extrinsic (environment such as UV, pollutants, cosmetics) and intrinsic factors (hormones, epidermal dysfunction and immune changes) 64 . Triggers can be environmental (UV and weather), lifestyle‐related (smoking, alcohol and certain topical products) or endogenous (psychological factors) 62,64 .…”

Epidermal barrier function in dry, flaky and sensitive skin: A narrative review

“…Approximately 50%–70% of adults report some degree of sensitive skin, 18 which can affect all body areas, particularly the face 10 . Although the underlying pathophysiology of sensitive skin has not been definitively determined, its origin appears multifactorial, with neurosensory dysfunction (possibly a subtype of small‐fibre neuropathy) considered a key mechanism 10,19 …”