Pathophysiology and Management of Sensitive Skin: Lack of Study Data Limits Consensus

Dermatologist examining a patient's arm.
Dermatologist examining a patient’s arm.
Patients with sensitive skin require a personalized approach that takes into account the various possible biomedical, neural, and psychosocial factors that may be responsible.

According to the results of a position paper published in the Journal of the American Academy of Dermatology and Venereology, clinical trial data on the pathophysiology and management of sensitive skin are limited. As such, experts endorse a holistic management approach.

Investigators employed the Delphi method to build consensus on the characteristics and treatment of sensitive skin. Consensus building was performed over the course of 2 years through e-mail discussions and in-person meetings with researchers from the International Forum for the Study of Itch. Specifically, consensus data were obtained through communications with the forum’s special interest group on sensitive skin. In the first step of the Delphi approach, in-person interviews were conducted to generate items of interest for the pathophysiology and management of sensitive skin. Candidate items were subjected to several rounds of the Delphi process, with an aim of 75% consensus. Of 37 initial items, a final list of 14 were approved by all polled researchers. A subset of researchers composed and synthesized a series of recommendations for sensitive skin management. The resulting 7 recommendations were again approved by 17 of 17 members after a 2-round Delphi process.

The final 14-item list comprised 9 items on pathophysiology: skin barrier function, stratum corneum, atopic dermatitis and disposition, environmental factors, sensory proteins, epidermal nerve endings, vasculature, stress, and nocebo effect. Although skin barrier function is a hypothesized causal factor in sensitive skin, few studies exist to describe the relationship. Sensitive skin may be associated with atopic dermatitis, although the exact nature of the association is unclear. Existing studies have indicated that patients with sensitive skin may have a thinner stratum corneum and may be susceptible to certain environmental factors and stress. Other studies suggest that sensitive skin may be associated with overexpression of certain sensory proteins and increased vasodilation. Sensitive skin was hypothesized to be a result of “alterations [in] the skin nervous system,” rather than immunologic dysfunction. Finally, panelists agreed that the “nocebo” effect may play a role in studies of sensitive skin, with patients’ negative expectations influencing treatment outcomes.

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In addition to the pathophysiology list, 6 management items were also identified: avoidance of triggers, use of emollients/moisturizers, consistent protection from ultraviolet radiation, inhibition of neurogenic inflammation, the placebo effect, and a holistic approach. Inhibition of neurogenic inflammation may be achieved by targeting pruritogens such as transient receptor potential cation channel subfamily V member 1. To date, however, no clinical trials have been performed to identify the efficacy of topical or systemic drugs for sensitive skin. Panelists also suggested that the placebo effect may be a useful means of improving patient outcomes. Published data suggest that instructions or verbal suggestions about possible treatment outcomes may induce more positive response in patients.

Results from this consensus study underline the lack of published research on sensitive skin. Given the array of possible causes and treatment outcomes, investigators suggested a multimodal management approach. Further study is needed to better characterize sensitive skin and identify the best mode of treatment.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures

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Misery L, Weisshaar E, Brenaut E, et al. Pathophysiology and management of sensitive skin: position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI) [published online October 28, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16000