Sensitive skin syndrome biologically distinct from rosacea

New evidence suggests that sensitive skin syndrome (SSS) is biologically distinct from rosacea, according to a pilot study titled “Pathophysiologic Distinctions Between Sensitive Skin Syndrome and Rosacea: Evidence from a Sensitive vs. Non-Sensitive Skin Pilot Study.” It was recently published in the Journal of the American Academy of Dermatology. The two conditions share symptoms and triggers, complicating diagnoses. Overlapping symptoms include redness, burning and itching. Triggers include environmental, psychological and hormonal factors.

Rosacea affects approximately 16 million people in the United States. While it can affect anyone, it most commonly affects women and those with fairer skin.

Millions of people have sensitive skin as well, with one report saying it impacts 60%–70% of women and 50%–60% of men. The results from this study add to the growing body of evidence that SSS is its own condition, potentially caused by impaired neurosensory and epidermal barrier function.

“These findings further support our ongoing work that sensitive skin syndrome is a unique skin condition, not simply a milder form of rosacea, a condition well known for imparting skin sensitivity,” senior author Adam Friedman, M.D., professor and chair of dermatology at the George Washington School of Medicine and Health Sciences, said in a news release. “This distinction matters because it can help clinicians avoid treatments that may not benefit sensitive skin patients and instead focus on over the counter and prescription therapies better aligned with the biology of the condition.”

For this study, Friedman and his team studied 30 women between the ages of 30 and 50, recruited using the Eurofins database. Half of the women had sensitive skin syndrome and half of the women did not (NSS).

The team aimed to identify measurable biologic differences between the conditions rather than relying solely on visible symptoms reported by patients. Using advanced skin imaging techniques, Friedman and his team checked the patients’ cheeks for the presence of Demodex folliculorum mites and analyzed skin protein samples of antimicrobial peptides linked to inflammation in rosacea. Demodex are microscopic mites that live naturally in the infundibulum, which is the uppermost part of the hair follicle that serves as a passage for sebum and cellular debris. The mites are beneficial because they feed on dead skin cells and extra oil. However, when the mites multiply too quickly due to immune system issues or skin conditions, symptoms include rashes, eczema and itching and burning.

In this study, Demodex mites were present on 20% of SSS and NSS patients, but researchers did notice a difference in peptide levels — the peptides cathelicidin and dermcidin were reduced in SSS patients but not NSS patients, suggesting that SSS is a separate skin condition from rosacea. Cathelicidin in particular drives rosacea inflammation.

“These results help provide biologic evidence that sensitive skin syndrome has its own unique mechanisms,” first author Nikita Menta, who is part of the George Washington School of Medicine and Health Sciences Sensitive Skin Translational Research Fellowship Program and Galderma Sensitive Skin Research Fellow, also said in the news release. “Understanding those differences is important for developing more precise diagnostic and treatment strategies.”