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Borghi A, Guarneri F, Pacetti L, Donelli I, Schettini N, Ravara D, Montesi L, Corazza M. Does sensitive skin lie in epidermal barrier impairment or abnormalities? Results from an observational study assessing biophysical parameters. Ital J Dermatol Venerol 2024; 159:349-356. [PMID: 38635324 DOI: 10.23736/s2784-8671.24.07714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
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.
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Affiliation(s)
- Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lucrezia Pacetti
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Irene Donelli
- Center of Cosmetology, University of Ferrara, Ferrara, Italy
| | - Natale Schettini
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Daniela Ravara
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Leda Montesi
- Center of Cosmetology, University of Ferrara, Ferrara, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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2
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Zhu J, Hassler C, Villena FB, Papadopoulou A, Navarini AA, Mueller SM. Reverse underwear sign as an indicator of alloknesis. J Dtsch Dermatol Ges 2024; 22:574-575. [PMID: 38368270 DOI: 10.1111/ddg.15320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/03/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Jie Zhu
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Caterina Hassler
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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3
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Zhu J, Hassler C, Villena FB, Papadopoulou A, Navarini AA, Müller S. „Reverse underwear sign“ als Indikator für Alloknesis. J Dtsch Dermatol Ges 2024; 22:574-576. [PMID: 38574006 DOI: 10.1111/ddg.15320_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/03/2023] [Indexed: 04/06/2024]
Affiliation(s)
- Jie Zhu
- Abteilung für Dermatologie, Universitätsspital Basel, Basel, Schweiz
| | - Caterina Hassler
- Abteilung für Dermatologie, Universitätsspital Basel, Basel, Schweiz
| | | | | | | | - Simon Müller
- Abteilung für Dermatologie, Universitätsspital Basel, Basel, Schweiz
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Le Gall-Lanotto C, Verdin A, Cazier F, Bataille-Savattier A, Guéré C, Dorr MM, Fluhr JW, Courcot D, Vié K, Misery L. Road-traffic-related air pollution contributes to skin barrier alteration and growth defect of sensory neurons. Exp Dermatol 2024; 33:e15009. [PMID: 38284185 DOI: 10.1111/exd.15009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/12/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024]
Abstract
The effects of air pollution on health are gaining increasing research interest with limited data on skin alterations available. It was suggested that air pollution is a trigger factor for sensitive skin (SS). However, this data was based on surveys with a lack of experimental data. SS is related to altered skin nerve endings and cutaneous neurogenic inflammation. TTe present study was to assess the in vitro effect of particulate matter (PM) on epidermis and nerve ending homeostasis. PM samples were collected according to a validated protocol. Reconstructed human epidermis (RHE, Episkin®) was exposed to PM and subsequently the supernatants were transferred to a culture of PC12 cells differentiated into sensory neurons (SN). Cell viability, axonal growth and neuropeptide-release were measured. The modulation of the expression of different inflammatory, keratinocytes differentiation and neurites growth markers was assessed. PM samples contained a high proportion of particles with a size below 1 μm and a complex chemical composition. Transcriptomic and immunohistochemical analyses revealed that PM altered keratinocytes terminal differentiation and induced an inflammatory response. While viability and functionality of the SN were not modified, their outgrowth was significantly decreased after incubation with PM-exposed Episkin® supernatants. This was closely related to the modification of nerve growth factor/semaphorin 3A balance. This study showed that air pollutants have negative effects on keratinocytes and sensory nerve endings including inflammatory responses. These effects are probably involved in the SS pathophysiology and might be involved in inflammatory skin disorders.
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Affiliation(s)
| | - Anthony Verdin
- EA4492-Unit of Environmental Chemistry And Interactions With Living Organisms (UCEIV), SFR Condorcet FR CNRS 3417, Université du Littoral Côte d'Opale, Dunkerque, France
| | - Fabrice Cazier
- Common Center of Measurements (CCM), Université du Littoral Côte d'Opale, Dunkerque, France
| | | | | | | | - Joachim W Fluhr
- Univ Brest, LIEN, Brest, France
- Department of Dermatology, University Hospital, Brest, France
- Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany
- Institute of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Dominique Courcot
- EA4492-Unit of Environmental Chemistry And Interactions With Living Organisms (UCEIV), SFR Condorcet FR CNRS 3417, Université du Littoral Côte d'Opale, Dunkerque, France
| | | | - Laurent Misery
- Univ Brest, LIEN, Brest, France
- Department of Dermatology, University Hospital, Brest, France
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5
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Kim JC, Choi MG, Park JS, Lee SY, Park CW, Chung BY, Misery L, Kim HO. Sensitive skin is associated with contact sensitization and decreased nociceptive threshold. J Eur Acad Dermatol Venereol 2024; 38:e125-e127. [PMID: 37556672 DOI: 10.1111/jdv.19398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Affiliation(s)
- J C Kim
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - M G Choi
- Department of Computer Science, Kwangwoon University, Seoul, South Korea
| | - J S Park
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - S Y Lee
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - C W Park
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - B Y Chung
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - H O Kim
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Li M, Tao M, Zhang Y, Pan R, Gu D, Xu Y. Neurogenic rosacea could be a small fiber neuropathy. FRONTIERS IN PAIN RESEARCH 2023; 4:1122134. [PMID: 36890854 PMCID: PMC9986523 DOI: 10.3389/fpain.2023.1122134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
- Min Li
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Tao
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Zhang
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruoxin Pan
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Duoduo Gu
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Xu
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Manav V, Karaali MG, Erdem O, Koku Aksu AE. Association between biophysical properties and anxiety in patients with sensitive skin. Skin Res Technol 2022; 28:556-563. [PMID: 35416350 PMCID: PMC9907588 DOI: 10.1111/srt.13156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sensitive skin (SS) is a syndrome in which neurosensory disorders accompany epidermal barrier dysfunction. However, it is not yet clear how high anxiety levels affect the biophysical parameters of the skin in patients with SS. OBJECTIVES We aimed to investigate the relationship between anxiety levels and facial neurosensitivity, the erythema index, sebum content, and sensitive skin scale scores in individuals with sensitive skin. METHODS The study was carried out on 35 individuals with SS and 40 without SS over three months. In the study, a questionnaire to detect the presence of sensitive skin, the sensitive skin scale for sensitive skin severity, the lactic acid sting test (LAST) to show facial neurosensitivity, a Mexameter for erythema index measurement, and a Sebumeter for sebum content measurement were used. In addition, the anxiety levels of the patient and control groups were measured using the hospital anxiety and depression scale (HADS). RESULTS While the HADS-Anxiety scores were found to be significantly higher in patients with sensitive skin, there was no significant difference in the HADS-Depression scores. Moreover, a strong positive correlation was found between the HADS-Anxiety scores and the erythema index in patients with sensitive skin. CONCLUSIONS Sensitive skin is a disorder that can sometimes occur without any dermatological examination findings. In particular, the sensations of the patients, along with their anxiety levels, are essential parameters that should be evaluated in the approach to patients with sensitive skin.
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Affiliation(s)
- Vildan Manav
- Department of Dermatology, University of Health Sciences, İstanbul Training and Research Hospital, Istanbul, Turkey.,Master of Cosmetology, İstanbul University Graduate School of Medicine, İstanbul, Turkey
| | - Müge Göre Karaali
- Department of Dermatology, Erzincan Binali Yildirim University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Ozan Erdem
- Deparment of Dermatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Ayşe Esra Koku Aksu
- Department of Dermatology, University of Health Sciences, İstanbul Training and Research Hospital, Istanbul, Turkey
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8
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Misery L, Bataille A, Talagas M, Le Gall-Ianotto C, Fouchard M, Huet F, Ficheux AS, Roudot AC, Fluhr JW, Brenaut E. Sensitive Skin Syndrome: A Low-Noise Small-Fiber Neuropathy Related to Environmental Factors? FRONTIERS IN PAIN RESEARCH 2022; 3:853491. [PMID: 35399156 PMCID: PMC8990967 DOI: 10.3389/fpain.2022.853491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Laurent Misery
- Univ Brest, LIEN, Brest, France
- *Correspondence: Laurent Misery
| | | | | | | | | | | | | | | | - Joachim W. Fluhr
- Univ Brest, LIEN, Brest, France
- Department of Dermatology, Venereologie and Allergology, Charité Universitaetsmedizin, Berlin, Germany
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Wollenberg A, Giménez-Arnau A. Sensitive skin: A relevant syndrome, be aware. J Eur Acad Dermatol Venereol 2022; 36 Suppl 5:3-5. [PMID: 35315153 DOI: 10.1111/jdv.17903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/05/2021] [Indexed: 10/18/2022]
Abstract
Sensitive skin is clinically defined by characteristic sensory perceptions including tightness, abnormal stinging, burning, tingling, pain and pruritus. Facial erythema may occur, and other body areas can be involved. Sensitive skin affects extremely the quality of life. According with the International Forum for the Study of Itch (IFSI), sensitive skin is defined as a syndrome. The unpleasant sensations described are in response to stimuli that normally should not provoke such sensations. Moreover, these unpleasant sensations cannot be explained by any skin disease. Sensitive skin is always considered when any new consumer health, cosmetic or household product is introduced in the market. Once sensitive skin is recognized, it is mandatory to identify specific triggers that commonly induce symptoms and even cutaneous visible signs. Sensitive skin syndrome can be exacerbated by an allergic setting and environmental factors (cold, hot, dryness, pollution, wind, chemicals ...), a source of intolerance and unpleasant sensations. Cosmetics are the main triggering factors of sensitive skin according to patient's reports. The presence of potentially irritant substances in their composition increases the clinical expression of symptoms. As sensitive skin is frequent, and it is increasing based on the current development of cosmetic use worldwide, there is a need to develop better skin care products. The continuous research of active and safe skin care products to prevent and treat sensitive skin is extremely welcome.
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Affiliation(s)
- A Wollenberg
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - A Giménez-Arnau
- Department of Dermatology, Inmunodermatology Section at Hospital del Mar, Institut Mar d´Investigacions Mèdiques, Autonomous University of Barcelona, Barcelona, Spain
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10
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Viodé C, Rouquier A, Mias C, Questel E, Bessou-Touya S, Duplan H. Specific protection of sensitive skin against environmental stress by maintenance and improvement of barrier function. J Eur Acad Dermatol Venereol 2022; 36 Suppl 5:13-20. [PMID: 35315151 DOI: 10.1111/jdv.17910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sensitive skin is a common condition that can severely impact quality of life. Several mechanisms are thought to be involved, including those affecting the skin barrier function, hydration and skin innervation. OBJECTIVES To investigate the benefit of cream and balm formulations dedicated to sensitive skin and containing Aquaphilus dolomiae extract-G3 (ADE-G3) on skin barrier functions (lipid composition, pH, TEWL), as well as protective responses to dry and pollution stresses. METHODS In vitro sensitized (using histamine) reconstructed human epidermis (RHE) were subjected to dehydration and pollution stress in the absence and presence of the formulations. Endpoint measurements included transepithelial electric resistance (TEER), stratum corneum protein expression and lipid contents. Clinical measurements included transepithelial water loss (TEWL), skin pH and the lipid index. RESULTS When applied in cream and balm formulations, ADE-G3, increased the TEER in sensitized RHEs. In non-sensitized dehydrated RHEs, both formulations increased recovery of skin barrier integrity after dehydration, evident as a return of the ratios of filaggrin/profilaggrin and caspase-14/procaspase-14 to values measured in control non-stressed RHEs, as well as reducing the 'natural moisturizing factor' to control levels. In clinical studies performed on dry human skin, the formulations helped to maintain and improve the skin barrier function. This was evident as an intense and sustained moisturization (total lipids and lipid esters were increased), an increase in pH and a decrease in the TEWL by both formulations. When exposed to pollution stress by treating the models with benzo[a]pyrene and airborne particulate matter (PM10), application of both formulations prior to exposure attenuated the induction of CYP1A1, CYP1B1 and UGT1A7 expression, indicating a protective effect. CONCLUSIONS ADE-G3 cream and balm formulations increased the hydration of the skin but also protected and improved the skin barrier integrity of sensitive skin exposed to dry and cold and airborne pollutant-induced stress environments.
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Affiliation(s)
- C Viodé
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - A Rouquier
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - C Mias
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - E Questel
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - S Bessou-Touya
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
| | - H Duplan
- R&D Pierre Fabre Dermo-Cosmétique Toulouse, Toulouse, France
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Abstract
People with self-reported sensitive skin may reluctantly use performing anti-ageing skin care products as it could elicit skin discomfort. We thus aimed to design and test an anti-ageing skin care routine that is suitable for people reporting sensitive skin. Key principles for developing products for sensitive skin were applied and formulas were screened for their mildness in vitro using the Reconstructed Human Epidermis ET50 method. Anti-ageing efficacy and mildness was evaluated during a clinical study in China, with 33 female volunteers aged 40–65 years, with sensitive skin. The anti-ageing benefits were measured using Primos 3D, the cutometer and clinical evaluation. Hallmarks for sensitive skin such as skin hydration, skin barrier, skin redness and response to lactic acid were also measured. The ET50 method yielded values suggesting moderate to mild expected irritancy effect in vivo for most of them, and non-irritating effect for the serum. During the clinical study, no physical or functional signs of discomfort were reported with twice-daily usage of the routine. Instrumental evaluation of Wrinkle depth, skin elasticity/firmness, skin hydration, skin barrier and skin redness revealed improvement at 4 and 8 weeks. Clinical evaluation evidenced skin smoothness, skin suppleness and radiance improvements. The skin was less reactive to lactic acid stimuli, while the sensitive skin burden was lowered according to the dermatological quality of life index. Lastly, a separate investigation suggested the potential relief aspect of such routines to alleviate discomforts from mask wearing. With the right formulation design, the benefits of layering products from a routine can be made accessible to people with sensitive skin while simultaneously alleviating the burden of sensitive skin.
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12
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Le Gall-Ianotto C, Verdet R, Nowak E, Le Roux L, Gasse A, Fiedler A, Carlhant-Kowalski D, Marcorelles P, Misery L, Ianotto JC. Rationale and design of the multicentric, double-blind, double-placebo, randomized trial APrepitant versus HYdroxyzine in association with cytoreductive treatments for patients with myeloproliferative neoplasia suffering from Persistent Aquagenic Pruritus. Trial acronym: APHYPAP. Trials 2021; 22:938. [PMID: 34923994 PMCID: PMC8686668 DOI: 10.1186/s13063-021-05864-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Aquagenic pruritus (AP), an intense sensation of scratching induced after water contact, is the most troublesome aspect of BCR-ABL1-negative myeloproliferative neoplasms (MPNs). Mostly described in polycythemia vera (PV, ~ 40%), it is also present in essential thrombocythemia (ET) and primary myelofibrosis (PMF) (10%). Even if this symptom can decrease or disappear under cytoreductive treatments, 30% of treated MPN patients still persist with a real impact on the quality of life (QoL). Because its pathophysiology is poorly understood, efficient symptomatic treatments of AP are missing. The neuropeptide substance P (SP) plays a crucial role in the induction of pruritus. Several studies showed the efficacy of aprepitant, an antagonist of SP receptor (NK-1R), in the treatment of chronic pruritus but never evaluated in AP. The objectives of APHYPAP are twofold: a clinical aim with the evaluation of the efficacy of two drugs in the treatment of a persistent AP for MPN patients and a biological aim to find clues to elucidate AP pathophysiology. Methods/design A multicentric, double-blind, double-placebo, randomized study will include 80 patients with MPN (PV or ET or PMF) treated since at least 6 months for their hemopathy but suffering from a persistent AP (VAS intensity ≥6/10). Patients will be randomized between aprepitant (80 mg daily) + placebo to match to hydroxyzine OR hydroxyzine (25 mg daily) + placebo to match to aprepitant for 14 days. At D0, baseline information will be collected and drugs dispense. Outcome measures will be assessed at D15, D30, D45, and D60. The primary study endpoint will be the reduction of pruritus intensity below (or equal) at 3/10 on VAS at D15. Secondary outcome measures will include the number of patients with a reduction or cessation of AP at D15 or D60; evaluation of QoL and AP characteristics at D0, D15, D30, D45, and D60 with MPN-SAF and AP questionnaires, respectively; modification of plasmatic concentrations of cytokines and neuropeptides at D0, D15, D30, and D60; and modification of epidermal innervation density and pruriceptor expression at D0 and D15. Discussion The APHYPAP trial will examine the efficacy of aprepitant vs hydroxyzine (reference treatment for AP) to treat persistent AP in MPN patients. The primary objective is to demonstrate the superiority of aprepitant vs hydroxyzine to treat persistent AP of MPN patients. The treatment received will be considered efficient if the AP intensity will be reduced at 3/10 or below on VAS after 14 days of treatment. The results of this study may provide a new treatment option for this troublesome symptom and also give us more insights in the pathophysiology understanding of AP. Trial registration APHYPAP. NCT03808805, first posted: January 18, 2019; last update posted: June 10, 2021. EudraCT 2018-090426-66
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13
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Polena H, Chavagnac-Bonneville M, Misery L, Sayag M. Burden of Sensitive Skin (BoSS) Questionnaire and Current Perception Threshold: Use as Diagnostic Tools for Sensitive Skin Syndrome. Acta Derm Venereol 2021; 101:adv00606. [PMID: 34648037 PMCID: PMC9455310 DOI: 10.2340/actadv.v101.365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The assessment of sensitive skin syndrome, characterized by subjective unpleasant sensations, remains a challenge, since there is no international consensus on the best diagnostic tools. This study evaluated the combination of the Burden of Sensitive Skin (BoSS) questionnaire and the current perception threshold as diagnostic tools for sensitive skin syndrome, and the relationship between BoSS and the subjects’ smoking status, phototype and skin type. A total of 100 women completed the BoSS questionnaire, and current perception threshold was measured on the face. The BoSS score was significantly higher in the self-reported sensitive skin group compared with the non-sensitive skin group (25.61 vs 14.05; p < 0.001), and in non-smokers vs smokers (23.00 vs 18.37; p < 0.05). In addition, the current perception threshold values were similar between the sensitive and non-sensitive groups. These results suggest that BoSS is a better diagnostic tool for sensitive skin syndrome than the current perception threshold, and that smokers less frequently have sensitive skin than do non-smokers.
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14
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Akabane AL, Smith GP. Cutaneous manifestations of small fibre polyneuropathy. J Eur Acad Dermatol Venereol 2021; 36:100-107. [PMID: 34592031 DOI: 10.1111/jdv.17714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Because typical and atypical features of small fibre polyneuropathy (SFN) in the skin have not been fully elucidated, the diagnosis is often made by the exclusion of alternative conditions rather than by its identification as a primary syndrome. OBJECTIVE The objective of this study was to characterize dermatologic manifestations in patients with SFN. METHODS Large retrospective series of biopsy-proven SFN cases seen at the Massachusetts General Hospital and Brigham and Women's Hospital (January 2000 to December 2019). RESULTS The majority of the 301 participants included presented with at least one cutaneous manifestation [292/301 (97%)]. Pain was most common with 254/301 (84.4%) perceiving this as occurring in the skin. It was frequently described as 'burning' [95/254 (37.4%)] and affected distal [174/254 (68.5%)] slightly more than proximal [111/254 (43.7%)] limbs. Numbness [182/301 (60.5%)], edema [61/301 (20.3%)] and skin colour changes [53/301 (17.6%)], which include redness [23/53 (43%)], also had predominant distal distribution. Characteristic loss of distal hair occurred among 17/29 (59%) those reporting hair loss. Other findings with classic limb involvement, Raynaud's phenomenon [33/301 (11%)] and erythromelalgia [26/301 (8.6%)] were seen. Itch [45/301 (15%)], mostly localized [22/45 (49%)] and localized eczematous dermatitis were also found. CONCLUSION SFN has a wide range of clinical features in which the skin is affected, with characteristic findings affecting the extremities.
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Affiliation(s)
- A L Akabane
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - G P Smith
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
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15
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Peres M, Huet F, Le Bonniec M, Guéhenneux S, Vié K, Misery L. Evaluation of the effects on cutaneous sensitivity of a face emulsion containing sclareolide in women presenting with sensitive skin through quantitative sensory testing. J Eur Acad Dermatol Venereol 2021; 36:e74-e75. [PMID: 34487370 DOI: 10.1111/jdv.17638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- M Peres
- Department of Dermatology, University Hospital of Brest, Brest, France.,LIEN, University of Brest, Brest, France
| | - F Huet
- Department of Dermatology, University Hospital of Brest, Brest, France.,LIEN, University of Brest, Brest, France
| | | | | | - K Vié
- Clarins Laboratories, Pontoise, France
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France.,LIEN, University of Brest, Brest, France
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16
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Misery L, Shourick J, Reychler G, Taieb C. Association between chronic idiopathic cough and sensitive skin syndromes is a new argument in favor of common neuropathic pathways: results from a survey on 4050 subjects. Sci Rep 2021; 11:16976. [PMID: 34417530 PMCID: PMC8379212 DOI: 10.1038/s41598-021-96608-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Sensitive skin syndrome has a neuropathic origin, which is why it is frequently associated with irritable bowel syndrome. We have looked for a possible association with chronic cough, which is commonly maintained by neurogenic mechanisms, whatever the initial cause(s). A survey was carried out on a representative sample of the population over 15 years of age using the quota method. The questionnaire included sociodemographic data and questions about sensitive skin, the presence of chronic cough, smoking and possible causes of chronic cough. Chronic cough was assessed by the Leicester Cough Questionnaire, and 4050 subjects responded (mean age: 45 years). Overall, 12.2% of subjects with a chronic cough were compared to the 87.8% without any cough. Among them, 72.5% had sensitive skin (vs. 47.8%, p < 0.001); additionally, 17.4% of the subjects with sensitive skin had a chronic cough (vs. 6.9% if no sensitive skin). These proportions were higher if very sensitive skin was reported. The risk of having chronic cough was twice as high if sensitive skin was reported [OR = 1.9 (1.5-2.4), p < 0.001]. The risk of having sensitive skin was also twice as high for chronic cough. Thus, chronic cough and sensitive skin are frequently associated. This association represents a new argument in favor of a neuropathic nature of sensitive skin. Sensitive skin and chronic cough are both modes of overreaction to environmental factors, which tend to be autonomized by neurogenic mechanisms. Dermatologists should ask their patients if they have a chronic cough, and pneumologists should ask about the presence of sensitive skin.
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Affiliation(s)
- Laurent Misery
- Laboratory of Neurosciences, University of Western Brittany, Brest, France.
- Department of Dermatology, University Hospital of Brest, Brest, France.
| | | | - Grégory Reychler
- Department of Pneumology, University Clinics Saint-Luc, Brussels, Belgium
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17
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Misery L, Morisset S, Séité S, Brenaut E, Ficheux AS, Fluhr JW, Delvigne V, Taieb C. Relationship between sensitive skin and sleep disorders, fatigue, dust, sweating, food, tobacco consumption or female hormonal changes: Results from a worldwide survey of 10 743 individuals. J Eur Acad Dermatol Venereol 2021; 35:1371-1376. [PMID: 33561893 DOI: 10.1111/jdv.17162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sensitive skin is related to environmental factors. OBJECTIVES We aimed to investigate the roles of poorly known associated and triggering factors on sensitive skin in a large global population. METHODS A survey was administrated to a representative sample of the adult population aged 18-75 years in five different countries (Brazil, China, France Russia, and the United States). All participants answered a web-based questionnaire on sociodemographic characteristics, sensitive skin and environmental factors. RESULTS Among the 10 743 included individuals (5285 men and 5458 women), 48.2% declared that they had sensitive skin. The group with sensitive skin reported significant increases in fatigue, dust or sweating and to a lesser extent food or tobacco consumption. The members of this group also declared that they experienced more sleep disorders than individuals without sensitive skin. Sensitive skin was very frequent in pregnant women, women with painful menstruations or women using contraceptive pills. CONCLUSIONS This large cohort study identified new factors, including female hormonal status, fatigue, sleep disorders and food, associated with sensitive skin. These associations suggest that sensitive skin is not restricted to an epidermal disorder but may be included in a larger context. The identified factors are potential upstream drivers of neurogenic inflammation in sensitive skin.
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Affiliation(s)
- L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France.,Univ. Brest, LIEN, Brest, France
| | - S Morisset
- Biostatistics Consultant, Pérouges, France
| | - S Séité
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France.,Univ. Brest, LIEN, Brest, France
| | | | - J W Fluhr
- Department of Dermatology, University Hospital of Brest, Brest, France.,Univ. Brest, LIEN, Brest, France.,Department of Dermatology, Charité Universitaetsmedizin, Berlin, Germany
| | - V Delvigne
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
| | - C Taieb
- EMMA, Fontenay-sous-Bois, France.,Hôpital Necker Enfants Malades, Santé Publique, Paris, France
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18
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Abstract
Sensitive skin can be considered a neuropathic disorder. Sensory disorders and the decrease in intra-epidermal nerve ending density are strong arguments for small-fiber neuropathies. Sensitive skin is frequently associated with irritable bowel syndrome or sensitive eyes, which are also considered neuropathic disorders. Consequently, in vitro co-cultures of skin and neurons are adequate models for sensitive skin.
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19
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Yuan C, Wang X, Shang Y, Chen X, Xu H, Zhang Z. Will Repeated Low-Energy 1064-nm Q-Switched Nd:YAG Laser Treatment Sessions Affect Facial Skin Sensitivity? Results of a 12-Month, Prospective, Randomized Split-Face Study. Lasers Surg Med 2021; 53:1050-1058. [PMID: 33508159 DOI: 10.1002/lsm.23380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/25/2020] [Accepted: 01/10/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare changes in skin sensitivity before and after treatment with a 1064-nm Q-switched Nd:YAG laser in healthy individuals, and to provide a reference for clinicians to use this laser reasonably. STUDY DESIGN/MATERIALS AND METHODS Nineteen healthy female volunteers underwent 10 random unilateral 1064-nm Q-switched Nd:YAG laser treatments. The skin transepidermal water loss rate (TEWL), skin glossiness, epidermal and dermal thickness and density, current perception threshold (CPT) value, facial blood perfusion were determined before and after treatment at different time points. Moreover, the changes in skin barrier function, blood vessels, and sensory nerve reaction in the treated and untreated sides of the face were recorded before and after treatment. RESULTS Seventeen volunteers completed the 12-month follow-up study after 1064-nm Q-switched Nd:YAG laser treatment. At D3, M3, and M6, skin TEWL was decreased on the treated side of the face. Skin glossiness was significantly improved in the early post-treatment period (D1-D7) and M3, M6, and M12 compared with the untreated side of the face. There was no significant change in dermal and epidermal thickness or density at all time points before and after treatment. There were no significant differences in sensory nerve CPT values and local blood flow volume or velocity between the treated side of the face and the untreated side before and after treatment. CONCLUSION Multiple low-energy 1064-nm Q-switched Nd:YAG laser treatments will not affect the barrier function of facial skin, skin nerve sensitivity, or local microcirculation of healthy skin over the long term. Therefore, 1064-nm Q-switched Nd:YAG laser treatment is safe, and does not alter skin sensitivity. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Chao Yuan
- Department of Skin & Cosmetic Research, Shanghai Skin Disease Hospital, Shanghai, 200050, China
| | - Xue Wang
- Department of Dermatology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Ying Shang
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Xiangdong Chen
- Department of Dermatology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Hui Xu
- Department of Dermatology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Zhen Zhang
- Department of Dermatology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
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20
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Chen L, Zheng J. Does sensitive skin represent a skin condition or manifestations of other disorders? J Cosmet Dermatol 2020; 20:2058-2061. [PMID: 33159415 PMCID: PMC8359429 DOI: 10.1111/jocd.13829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022]
Abstract
Sensitive skin or cutaneous sensory syndrome is defined as a skin condition that is hypersensitive to stimuli, presented with itching, irritant, erythema, and dryness. However, is it associated with more than impairment of epidermal functions, psychological stress and topical medication or products? We think that it can be a skin condition or manifestation of other cutaneous or extracutaneous disorders. In this paper, we brief relation of sensitive skin syndrome with cutaneous and extracutaneous disorders, clinically, and pathophysiologically.
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Affiliation(s)
- Lihong Chen
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Zheng
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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21
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Abstract
Sensitive skin syndrome is a widely reported complaint but a diagnostic challenge because of its subjective symptoms and lack of clearly visible manifestations. Epidemiological studies have shown the prevalence of sensitive skin to be as high as 60-70% among women and 50-60% among men. Patients with this syndrome usually have unpleasant sensations when exposed to physical, thermal, or chemical stimuli that normally cause no provocation on healthy skin. Recent studies and newly accepted position papers have provided a more in-depth understanding and consensus of its underlying pathophysiology, associations, diagnosis, and treatment. Since no clinical studies have been conducted about specific treatment protocols, patients with this condition should be provided with personalized skin management. Given this updated knowledge, our review offers an approach to sensitive skin syndrome, with differential diagnoses, and interventions targeting its pathophysiology.
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22
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Wang X, Lai Q, Zheng B, Ye L, Wen S, Yan Y, Yang B, Man MQ. Prevalence and Severity of Dermatological Condition-Associated Skin Pain in the Chinese. J Pain Res 2020; 13:1201-1207. [PMID: 32581569 PMCID: PMC7266942 DOI: 10.2147/jpr.s245514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIM Although the characteristics of cutaneous sensory symptoms in the general population have been documented, dermatological condition-associated skin pain has not been characterized yet. In the present study, we aimed to characterize dermatological condition-associated skin pain in the Chinese. SUBJECTS AND METHODS A questionnaire was given to outpatients to identify self-proclaimed skin pain at our dermatology clinic. The severity of skin pain was assessed using pain scale 0-10. Prevalence and pain severity were compared between males and females. RESULTS A total of 2144 patients, including 1254 females and 890 males aged 13-94 years, were included in this study. The overall prevalence of skin pain was 9.93% in this cohort. The prevalence of skin pain varied greatly with dermatological conditions (p<0.0001). Moreover, a higher prevalence of skin pain was observed in males than in females (p<0.05). Among the dermatological conditions reported, higher skin pain scales were found in subjects with either glucocorticoid-induced dermatitis (4.20 ± 0.73) or herpes zoster (4.00 ± 0.29). While the overall pain scales were comparable between males and females (2.38 ± 0.13 versus 2.68 ± 0.13), pain scales in patients with eczematous dermatitis were higher in females than in males (p<0.05). Furthermore, pain scales correlated positively with age. However, pain scales did not differ between subjects with versus without a family history of cutaneous sensory symptoms. These results demonstrate that the prevalence and severity of dermatological condition-associated skin pain vary with dermatological conditions and gender in the Chinese. CONCLUSION Patients with some dermatological conditions may experience skin pain. Although the pain is moderate, it can negatively impact the quality of patients' lives. Alleviation of skin pain should be considered when treating patients with certain dermatological conditions.
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Affiliation(s)
- Xiaohua Wang
- Dermatology Hospital, Southern Medical University, Guangdong510095, People’s Republic of China
| | - Qingsong Lai
- Puning City Chronic Disease Prevention and Control Center, Guangdong515300, People’s Republic of China
| | - Baoqing Zheng
- Dermatology Hospital, Southern Medical University, Guangdong510095, People’s Republic of China
| | - Li Ye
- Dermatology Hospital, Southern Medical University, Guangdong510095, People’s Republic of China
| | - Si Wen
- Dermatology Hospital, Southern Medical University, Guangdong510095, People’s Republic of China
| | - Yunling Yan
- Dermatology Hospital, Southern Medical University, Guangdong510095, People’s Republic of China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangdong510095, People’s Republic of China
| | - Mao-Qiang Man
- Dermatology Hospital, Southern Medical University, Guangdong510095, People’s Republic of China
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23
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Sonbol H, Brenaut E, Nowak E, Misery L. Efficacy and Tolerability of Phototherapy With Light-Emitting Diodes for Sensitive Skin: A Pilot Study. Front Med (Lausanne) 2020; 7:35. [PMID: 32118019 PMCID: PMC7020244 DOI: 10.3389/fmed.2020.00035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 01/23/2020] [Indexed: 01/25/2023] Open
Abstract
Sensitive skin (SS) syndrome is defined by the occurrence of unpleasant sensations in response to stimuli that should normally not induce such sensations. It affects ~50% of women and 40% of men and can impact the quality of life. There is no consensus on therapeutic management. Phototherapy by light-emitting diodes (LEDs) is increasingly being used in dermatology for various inflammatory skin disorders with significant reduction in SS-10 and good tolerability. A Korean study suggested its efficacy in alleviating SS symptoms associated with other facial diseases. Our objective is to obtain preliminary data on the efficacy of phototherapy with LEDs for alleviating SS symptoms and increasing tolerance in subjects with SS that is not associated with other facial skin disorders. This monocentric pilot study included 30 subjects with SS who had a Sensitive Scale-10 score ≥40. The treatment consisted of red LED light exposure twice a week until significant reduction in SS-10 with a maximal treatment length of 8 weeks. The primary outcome was defined by a 60% decrease in the SS-10 score compared to the baseline. Results: Thirty subjects were included; 83% were women, and the mean age was 28.9 years. Two participants were considered lost to follow-up. The cheeks (90%) and the nose (70%) were the most frequently involved parts of the face. Cold, heat, temperature variation, water and sun were the most frequent triggering factors. Twenty-eight subjects (93.3%, 95% CI 77.9 to 99.2%) achieved the primary outcome. Significant reduction in SS-10 was achieved in 77% of subjects in six sessions or fewer. The mean (SD) SS-10 scores were 54.7 (12.1) at inclusion, 14.4 (6.0) at the last session and 13.9 (7.5) 2 months after the last session, suggesting that the benefits persist for a few weeks. Two side effects were reported: both were allergic reactions to the nickel contained in the protective goggles. This pilot study had a small sample size and no control group. LEDs were effective in treating SS in all 28 subjects who completed the study in accordance with the protocol, and the benefits persisted for 2 months after the last LED therapy session.
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Affiliation(s)
- Haitham Sonbol
- Department of Dermatology, University Hospital, Brest, France
| | - Emilie Brenaut
- Department of Dermatology, University Hospital, Brest, France.,Univ Brest, LIEN, Brest, France
| | | | - Laurent Misery
- Department of Dermatology, University Hospital, Brest, France.,Univ Brest, LIEN, Brest, France
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24
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Misery L, Weisshaar E, Brenaut E, Evers A, Huet F, Ständer S, Reich A, Berardesca E, Serra‐Baldrich E, Wallengren J, Linder D, Fluhr J, Szepietowski J, Maibach H, Honari G, Le Gall‐Ianotto C, Takamori K, Richters R. 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). J Eur Acad Dermatol Venereol 2019; 34:222-229. [DOI: 10.1111/jdv.16000] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022]
Affiliation(s)
- L. Misery
- Department of Dermatology University Hospital of Brest Brest France
| | - E. Weisshaar
- Department of Dermatology, Occupational Dermatology Ruprecht‐Karls University Heidelberg Heidelberg Germany
| | - E. Brenaut
- Department of Dermatology University Hospital of Brest Brest France
| | - A.W.M. Evers
- Department of Health, Medical and Neuropsychology Faculty of Social and Behavioral Science Leiden The Netherlands
| | - F. Huet
- Department of Dermatology University Hospital of Brest Brest France
| | - S. Ständer
- Department of Dermatology Center for Chronic Pruritus University Hospital Münster Münster Germany
| | - A. Reich
- Department of Dermatology University of Rzeszow Rzeszów Poland
| | | | - E. Serra‐Baldrich
- Department of Dermatology Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - J. Wallengren
- Department of Dermatology and Venereology Skåne University Hospital Lund Sweden
| | - D. Linder
- Section of Biostatistics University of Oslo Oslo Norway
| | - J.W. Fluhr
- Department of Dermatology and Allergy Charité‐Universitätsmedizin Berlin Berlin Germany
| | - J.C. Szepietowski
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - H. Maibach
- Department of Dermatology School of Medicine University of California, San Francisco San Francisco CA USA
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25
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Brenaut E, Barnetche T, Le Gall‐Ianotto C, Roudot A, Misery L, Ficheux A. Triggering factors in sensitive skin from the worldwide patients’ point of view: a systematic literature review and meta‐analysis. J Eur Acad Dermatol Venereol 2019; 34:230-238. [DOI: 10.1111/jdv.15985] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Affiliation(s)
- E. Brenaut
- LIEN Univ Brest Brest France
- Department of Dermatology University Hospital Brest France
| | - T. Barnetche
- Department of Rheumatology Bordeaux University Hospital Bordeaux France
- FHU ACRONIM Bordeaux University Hospital Bordeaux France
| | | | | | - L. Misery
- LIEN Univ Brest Brest France
- Department of Dermatology University Hospital Brest France
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26
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Huet F, Misery L. Sensitive skin is a neuropathic disorder. Exp Dermatol 2019; 28:1470-1473. [DOI: 10.1111/exd.13991] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Flavien Huet
- University of Brest LIEN Brest France
- Department of Dermatology University Hospital of Brest Brest France
| | - Laurent Misery
- University of Brest LIEN Brest France
- Department of Dermatology University Hospital of Brest Brest France
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27
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Abstract
Itching can result from activity of specialized primary afferent neurons (“pruriceptors”) that have been shown to express certain molecular markers such as B-type natriuretic peptide and several members of the Mrgpr-family in rodents. On the other hand, neurons involved in pain processing (“nociceptors”) can also provoke itching when the activation site is restricted to an isolated tiny spot within the epidermis. Individuals classified as having sensitive skin report increased itching and pain sensations upon weak external stimuli that are not painful or itchy in the control group. Numerous possible factors could contribute to sensitive skin along the pathway of transduction of the external stimuli into peripheral neuronal signals, followed by neuronal processing, finally resulting in the perception: (a) reduced local protective factors leading to impaired skin barrier function, (b) increased production of excitatory skin mediators, (c) sensitized peripheral neurons, (d) facilitated spinal and central processing, and (e) reduced descending inhibition from the central nervous system. For all of those pathophysiological mechanisms there are clinical examples such as atopic dermatitis (a,b,c), neuropathic itching (c,e), and restless leg syndrome (d,e). However, none of these factors have been directly linked to the occurrence of sensitive skin. Moreover, individuals reporting sensitive skin are heterogeneous and a subpopulation with defined pathophysiology has not yet been identified. Given that the condition is reported in about 50% of women, and thereby includes many healthy individuals, it appears problematic to assign a definitive pathophysiological mechanism to it.
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Affiliation(s)
- Martin Schmelz
- Department Experimental Pain Research, CBTM, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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28
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Bataille A, Le Gall-Ianotto C, Genin E, Misery L. Sensitive Skin: Lessons From Transcriptomic Studies. Front Med (Lausanne) 2019; 6:115. [PMID: 31192213 PMCID: PMC6546803 DOI: 10.3389/fmed.2019.00115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/09/2019] [Indexed: 12/22/2022] Open
Abstract
In 2016, a special interest group from the International Forum for the Study of Itch defined sensitive skin (SS) as a syndrome that manifests with the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) after stimuli that should not cause a reaction, such as water, cold, heat, or other physical and/or chemical factors. The pathophysiology of sensitive skin is still poorly understood, but the symptoms described suggest inflammation and peripheral innervation. Only two publications have focused on sensitive skin transcriptomics. In the first study, the authors performed a microarray comparison of SS and non-sensitive skin (NSS) samples and showed differences in the expression of numerous genes in SS and NSS samples. Moreover, in the SS samples, two clusters of genes were identified, including upregulated and downregulated genes, compared to NSS samples. These results provide some interesting clues for the understanding of the pathophysiology of SS. The second study compared SS and NSS samples using RNA-seq assays. This method allowed the identification of long non-coding RNAs (lncRNAs) and differentially expressed mRNAs and provided a comprehensive profile in subjects with SS. The results showed that a wide range of genes may be involved in the pathogenesis of SS and suggested pathways that could be associated with them. In this paper, we discuss these two studies in detail and show how transcriptomic studies can help understand the pathophysiology of sensitive skin. We call for new transcriptomic studies on larger populations to be conducted before putative pathogenic mechanisms can be detected and analyzed to achieve a better understanding of this complex condition.
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Affiliation(s)
- Adeline Bataille
- LIEN, F-29200, Univ Brest, Brest, France.,Department of Dermatology, University Hospital, Brest, France
| | | | - Emmanuelle Genin
- UMR1078 "Génétique, Génomique Fonctionnelle et Biotechnologies", INSERM, Univ Brest, Brest, France
| | - Laurent Misery
- LIEN, F-29200, Univ Brest, Brest, France.,Department of Dermatology, University Hospital, Brest, France
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29
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Talagas M, Misery L. Role of Keratinocytes in Sensitive Skin. Front Med (Lausanne) 2019; 6:108. [PMID: 31165070 PMCID: PMC6536610 DOI: 10.3389/fmed.2019.00108] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/02/2019] [Indexed: 01/05/2023] Open
Abstract
Sensitive skin is a clinical syndrome defined by the occurrence of unpleasant sensations such as burning, stinging, tingling, pricking, or itching in response to various normally innocuous physical, chemical, and thermal stimuli. These particular symptoms have led the consideration of a potential dysfunction of the intra-epidermal nerve fibers (IENF) that are responsible for pain, temperature, and itch perception. This neuronal hypothesis has just been reinforced by recent studies suggesting that sensitive skin could become assimilated to small fiber neuropathy. Meanwhile, the involvement of keratinocytes, the pre-dominant epidermal cell type, has so far mainly been considered because of their role in the epidermal barrier. However, keratinocytes also express diverse sensory receptors present on sensory neurons, such as receptors of the transient receptor potential (TRP) family, including Transient Receptor Potential Vallinoid 1 (TRPV1), one of the main transducers of painful heat which is also involved in itch transduction, and Transient Receptor Potential Vallinoid 4 (TRPV4) which is depicted as a heat sensor. While TRPV1 and TRPV4 are expressed both by sensory neurons and keratinocytes, it has recently been demonstrated that the specific and selective activation of TRPV1 on keratinocytes is sufficient to induce pain. Similarly, the targeted activation of keratinocyte-expressed TRPV4 elicits itch and the resulting scratching behavior. So, contrary to classical conception, the IENF are not the exclusive transducers of pain and itch. In light of these recent advances, this review proposes to consider the putative role of epidermal keratinocytes in the generation of the unpleasant sensations characteristic of sensitive skin syndrome.
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Affiliation(s)
- Matthieu Talagas
- Laboratory on Interactions Neurons Keratinocytes (EA4685), Faculty of Medicine and Health Sciences, University of Western Brittany, Brest, France.,Department of Pathology, Brest University Hospital, Brest, France
| | - Laurent Misery
- Laboratory on Interactions Neurons Keratinocytes (EA4685), Faculty of Medicine and Health Sciences, University of Western Brittany, Brest, France.,Department of Dermatology, Brest University Hospital, Brest, France
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30
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Misery L, Cochener B, Brenaut E, Séité S, Taieb C. Association of sensitive skin with sensitive corneas and sensitive eyelids. J Eur Acad Dermatol Venereol 2019; 33:1358-1362. [PMID: 30903713 DOI: 10.1111/jdv.15595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sensitive scalp or irritable bowel syndrome has been previously shown to be associated with sensitive skin. We wondered whether sensitive eyelids and sensitive eyes could also be associated with sensitive skin. METHODS A cross-sectional epidemiological study was carried out on a representative sample of French people, according to the quota method, using a questionnaire. RESULTS A total of 2048 subjects were included in the present study. Notably, 52.2% declared sensitive eyes, which was more frequent in women than in men. The subjects who reported sensitive eyes were more numerous according to the severity of skin sensitivity, the severity of sleep disorders and the presence of bright eyes. More than half of the subjects with sensitive eyes thought that they were sensitive to sun exposure, dust, computer or touch pads or dry air. The presence of sensitive eyelids was reported by 18.65% (more frequent in women) and was associated with sensitive skin and sensitive eyes, sun exposure and exposure to dust. CONCLUSION This study is the first to investigate sensitive eyelids or sensitive eyes. Sensitive eyelids can be considered a localization of sensitive skin. The concept of sensitive eyes is not commonly used by ophthalmologists and remains to be more precisely defined.
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Affiliation(s)
- L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France.,University Brest, LIEN, Brest, France
| | - B Cochener
- Department of Ophtalmology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France.,University Brest, LIEN, Brest, France
| | - S Séité
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
| | - C Taieb
- EMMA, Fontenay-sous-Bois, France.,Santé Publique, Hôpital Necker Enfants Malades, Paris, France
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Affiliation(s)
- L Misery
- Service de dermatologie, CHU de Brest, 2, avenue Foch, 29200 Brest, France; Laboratoire sur les interactions épithéliums-neurones (LIEN-EA4685), université de Bretagne Occidentale, 29200 Brest, France.
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