Laurent Misery


Expert Rev Dermatol. 2013;8(6):631-637. 

In This Article


To assess the prevalence of and to quantify sensitive skin, reproducible tests are necessary. Unfortunately, no simple robust testing regime exists.[9] Due to the tremendous variability in the manifestations of sensitive skin, investigations of this issue are very complicated. Moreover, it is currently unclear whether an individual with a low threshold for one irritant stimulus is also susceptible to all other types of irritant stimuli.

Marriott et al. performed analysis of different test methods.[32] The stinging test of Frosch and Kligman consists in application of lactic acid to the nasolabial fold, followed by evaluation of the intensity of the subjective symptoms. It was suggested to be the most suitable method in previous articles.[8] However, Marriott et al. showed that nasolabial stinging is a poor predictor of general skin sensitivity.[32] They tested four chemicals that have been reported to induce different sensory effects (lactic acid, stinging; capsaicin, burning; menthol, cooling; and ethanol, a mixture of burning and stinging) on 58 individuals. There were a high number of variations in reactivity to the tested chemicals. An increased reactivity to one material was not predictive of an increased response to another. Moreover, Marriott et al. used potent skin irritants (anionic surfactants and cationics) and virtual non-irritants, such as amphoterics.[32] Although, it would be expected that volunteers who are exhibiting an irritant response to amphoterics would present a strong response to potent skin irritants, which may represent sensitive skin, only some individuals had a strong response to all irritants. Most results were not indicative of a response to another chemical, even the one that had a similar mode of action. Green and Schaffer demonstrated that individuals highly differed in their response to only two chemicals.[33] The topical application of capsaicin was proposed as a test of skin neurosensitivity and a tool for the diagnosis of sensitive skin.[33] In a recent study on women, two subgroups were identified with different reactions toward the topical application of capsaicin: individuals with a low capsaicin detection threshold and individuals with a high threshold.[34] These two subpopulations strongly differed in their respective self-perception of sensitive skin. The higher the self-declared sensitive skin incidence was, the lower the detection threshold was.

Overviews of possible options for the diagnostic testing of sensitive skin were presented in three review articles.[6,35,36] The authors proposed the thermal sensation test, the stinging test,[8] an occlusive application of sodium lauryl sulfate, an evaluation of the itch response, the washing and exaggerated immersion test, TEWL assessment, corneometry, laser Doppler velocimetry, colorimetry, squamometry, corneosurfametry and quantitative sensory testing (QST) to diagnose or quantify sensitive skin.[4,8,37] However, the latter method is especially very time consuming and most likely limited to clinical trials.

In summary, it is obvious that only a very small subset of individuals will react to any stimulus applied under any test conditions. The response to only one test does not mean that these individuals suffer from sensitive skin and could react to other stimuli.

Not all tests are tools for diagnosis, and certain tests can only be used to follow-up patients. Because sensitive skin is defined by abnormal sensations and/or erythema in response to a variety of factors, the best method to diagnose sensitive skin is the use of scales. Unfortunately, we lack validated questionnaires. To our knowledge, only one questionnaire was proposed until now: the Score d'Irritabilité Global Local (SIGL).[38] Another questionnaire was assessed for sensitive scalps.[17]