LAUSR

‘Sensitive skin’ was probably first mentioned in a scientific publication in 1947. A definition of the concept of sensitive skin, by means of a Delphi procedure among experts, a special interest group of the International Forum for the Study of Itch, has been recently provided in a position paper. Sensitive skin is defined there as a syndrome where unpleasant sensations, such as itching, stinging, tingling, prickling, heat, burning or pain sensations and others are elicited – mostly on the face – by stimuli that are normally not expected to produce such sensations. The syndrome shows a variable, but altogether high prevalence (possibly a worldwide prevalence around 40%), and is likely to be more frequent among women; however, a recent increase of men reporting sensitive facial skin has been observed. The existence of a ‘general sensitive skin’ has been hypothesized, without the stringent need of the presence of concomitant skin diseases. Nonetheless, a plethora of various conditions, such as atopic dermatitis, atopic predisposition, life style habits, neurogenic inflammation, changes of the microbiome and even irritable bowel syndrome may be associated with sensitive skin. Various classifications of sensitive skin have been proposed: for instance, by Muizzudin, by Pons-Guiraud and by Mis ery; Muizzudin according to the type of perception/skin reaction, Pons-Guiraud according to the possible triggers perceptions of the unpleasant sensations, Mis ery according to severity. The pathophysiology of sensitive skin has still to be deeper investigated; however, beyond the usual ‘dos and don’t’, therapeutic approaches targeting the TRPV1 receptor, a component of the transient receptor potential (TRP) family, have already recently been presented. The high prevalence, the common involvement of the face and the intrusive nature of symptoms of sensitive skin make the syndrome likely to put a significant burden on patients. The burden of most diseases generally encompasses more (bot not only) the physical comorbidity, as well as often a higher risk of mortality, the one put on patients by skin conditions may often; albeit clearly not always, concern more the psychosocial dimensions. Diagnostic criteria, tests and even first treatment approaches have been developed, definitions and classifications have been proposed, first insights into pathophysiology have been gained, but the assessment of the burden posed by sensitive skin had so far inexplicably been neglected. Misery et al. have now provided with the BoSS a useful tool to assess the burden of sensitive skin. The validated 14-item questionnaire addresses elementary but vital issues, such as choices of dresses and cosmetics, of place of residency, of holiday destination and social interaction, all of which may be heavily influenced by having sensitive skin. BoSS is a welcome tool: it will not only allow better assessment of efficacy of treatments, since assessment of the psychosocial dimension is now routinely integrated in every outcome measure of any type of therapy, but it will also be conducive to a better understanding of the disorder itself, since it will, for instance, allow to establish whether various types of sensitive skin put a lesser or greater burden on the patient. Instruments like BoSS reflect therefore the acknowledgement that sensitive skin deserves full recognition as an important skin condition which needs to be further explored in all its biological, psychological and social aspects.