Journal of Cosmetics, Dermatological Sciences and Applications, 2012, 2, 184-195
http://dx.doi.org/10.4236/jcdsa.2012.23035 Published Online September 2012 (http://www.SciRP.org/journal/jcdsa)
Sensitive Skin in China
Miranda A. Farage1*, Christian P. Mandl2, Enzo Berardesca3, Howard I. Maibach4
1The Procter & Gamble Company, Winton Hill Business Center, Cincinnati, USA; 2The Procter & Gamble Company, Schwalbach,
Germany; 3San Gallicano Dermatological Institute, Rome, Italy; 4Department of Dermatology University of San Francisco, Medical
School, San Francisco, USA.
Received May 10th, 2012; revised June 15th, 2012; accepted June 29th, 2012
ABSTRACT
Background: Many consumers in the USA and Europe define themselves as having sensitive skin, a phenomenon
whose etiology appears to include both physiological and psychosocial factors. Objectives: Sensitive skin data from the
developing world is sparse. This study evaluates the prevalence and characteristics of sensitive skin in China and com-
pares data collected to existing data from the western world. Patients/Materials/Methods: A total of 408 Chinese wo-
men voluntarily completed a survey on sensitive skin. Results: Some degree of skin sensitivity was claimed by 94 (23%)
of respondents; most (90.4%) said their skin was only slightly or moderately sensitive. Facial sensitivity was claimed by
21% of Chinese women, sensitivity of the body surface by 9% and genital sensitivity by only 6%. Small numbers of
respondents reported a history of skin allergy (3%) or a familial history of sensitive skin (2%). Many reported making
buying decisions based on product claims. Conclusions: Only 23% of Chinese women claimed any degree of sensitive
skin, a prevalence substantially lower than that observed in most Western countries. Sensitivity of the genital skin, in
particular, was dramatically lower, suggesting at least some cultural component to perceptions of sensitive skin.
Keywords: Sensitive Skin; Genital Skin; Irritation; Skin Sensitivity; Stinging; Erythema; Feminine Hygiene; Fabrics;
Sensory
1. Introduction
Many consumers in industrialized countries today define
themselves as having “sensitive skin”, reporting unplea-
sant dermatological sensations to common exposures like
weather conditions or health and beauty products, the lat-
ter despite extensive premarket testing which had seem-
ingly confirmed a lack of irritant potential. The condition
is typically self-diagnosed, with sensory manifestations
which include burning, stinging, and itching with visual
manifestations such rashes, erythema, and papules. Many
patients, however, report sensory hyperstimulation with-
out any measurable cutaneous manifestation.
An authoritative definition of sensitive skin is elusive.
Numerous testing methodologies have attempted to de-
fine the physiological basis for these complaints, include-
ing visual inspection, transepidermal water loss (TEWL),
hydration of the stratum corneum, erythema, blood flow,
and surface pH. Subjective effects are more difficult to
study; and no consistent correlation between the degree
of perceived sensitivity and any measurable physiologi-
cal parameters has been established.
The diversity of both the causes of sensitive skin and
its manifestations implies a multifactorial syndrome in
which numerous components, both intrinsic and extrinsic,
may play significant roles. Gender is an obvious contri-
butor; women report sensitive skin significantly more of-
ten than men [1-6]. Age may also be a factor, as well as
skin type, concurrent dermatological diseases, or a his-
tory of allergy or atopy. Ethnicity also may influence
skin sensitivity, as ethnicity and skin type strongly influ-
ence both skin structure and function [7].
The anatomic location in question may also be influ-
ential. Skin structure differs at different anatomic sites
[7]. Green found differences in sensory responses to cap-
saicin between the face and the forearm [8]; Britz and
Maibach [9] and Elsner [10] observed that vulvar skin
exhibits chemical-specific differences from forearm skin
with regards to reactivity to a variety of known chemical
irritants.
Genital skin, particularly, differs structurally and his-
tologically from skin in other anatomical areas and those
differences affect skin sensitivity. While no association
between sensitive skin and ethnic background was found
at the face or body, sensitive skin of the genital region
was significantly higher in African Americans than in
Caucasians, Asians, or Hispanics [1]. Similarly, while
skin on the face and body showed no gender-specific dif-
*Corresponding author.

Sensitive Skin in China 185
ferences in sensitivity, the genital area did: 58.1% of wo-
men report skin sensitivity in the genital area as com-
pared to 44.2% of men [1]. Older people are more likely
to claim sensitivity of genital skin than younger [1].
Geographical differences have also been observed in
the prevalence of skin sensitivity. Geographical disparity
may stem from natural factors like weather patterns, but
some scientists have proposed that the geographic dif-
ferences may represent a cultural phenomenon related to
media and advertising wherein it has become culturally
fashionable to claim sensitive skin.
Cultural factors do seem to play a role in the pheno-
menon of skin sensitivity. The percentage of people who
perceive themselves to have sensitive skin appear to be
on the increase, particularly among men [11], probably
related to an increase in marketing of sensitive-skin pro-
ducts to men which may make it more culturally accept-
able for men to claim sensitive skin [12]. The fact that
the majority are women in the industrialized world defies
the perception as a minority complaint and tends to sup-
port at least some psychosocial component.
Surveys have been a popular method for collecting epi-
demiological data on sensitive skin, a largely self-iden-
tified condition, in various populations. Although sur-
veys across Europe, Asia, and North and South America
have consistently shown that the majority of the popula-
tions of industrialized societies (and more women than
men) believe themselves to have sensitive skin (Table 1),
Table 1. Percentage of overall skin sensitivity across the world.
Reported sensitivity (%)
Country Year Population
Overall
sensitivity**
Very
sensitive
Moderately
sensitive
Slightly
sensitive Reference
China 2009 F
18 - 65
N = 408
23 2 5 16 Present study
Global 2010
F
N = 191
84 10 38 36
Asia 2010
M and F
18 - 65 years
N = 72
90 NA NA NA
Europe 2010 M and F
18-65 years
N = 94
88 NA NA NA
Latin America 2010 M and F
18 - 65 years
N = 78
85 NA NA NA
North America, OH 2010 M and F
18-65 years
N = 122
78 NA NA NA
North America, all other 2010 M and F
18-65 years
N = 71
77 NA NA NA
Farage, data
yet unpublished
USA (MS) 2010 F
18 - 68 years
N = 57
87.5 NA NA NA Farage, data
yet unpublished
Europe (total) 2007 M and F
≥15 years
N = 4506
74.7 13 25.1 36.6 [3]
Greece 2007
M and F
≥15 years
N = 500
70 8.6 22.4* 29* [3]
Germany 2007 M and F
≥15 years
N = 500
59 15.8* 20* 23.2 [3]
Belgium 2007
M and F
≥ 15 years
N = 500
60 10* 16* 4
* [3]
Switzerland 2007 M and F
≥15 years
N = 500
59 13* 18* 28* [3]
Spain 2007
M and F
≥15 years
N = 500
88 13* 20* 55* [3]

Sensitive Skin in China 186
Continued
Italy 2007
M and F
≥15 years
N = 500
90.6 17.4* 37.2* 36* [3]
Portugal 2007
M and F
≥15 yrs
N = 500
86 16.2* 13.4* 56.4* [3]
France 2007
M and F
≥15 yrs
N = 1006
82 12.1%* 39.9%* 30%* [3]
USA (OH) 2006 M 16%
F 84%
Mean Age 39 yrs
N = 1039
68.4 4.9 23 40.5 [1]
F only 69.0 NA NA NA
Japan 2006 F
Adults
N = NA
~50 NA NA NA [16]
Greece 2005 F
Age 18 - 45 yrs
N = 25
64 0 16 48 [17]
France 2004-2005
F
18 - 85 yrs
N = 400
85.4 30.5 NA NA [18]
Italy 2004 M 11.5%
F 88.5%
18 - 80 yrs
N = 2101
59.9 F NA NA NA [19]
France March, 2004 M 41%
F 59%
≥15 yrs
N = 1006
80.3 11.9 39.8 28.5 [2,5]
March 2004
F
≥15 yrs
N = 594
85.46 14.91 44.36 26.2 [2,5]
France July, 2004 M 48%
F 52%
≥15 yrs
N = 1001
86.3 20.7 38.2 27.5 [5]
France July, 2004 F
≥ 15 yrs
N = 521
91.17 28.21 41.07 21.88 [5]
Germany 2001 M 39%
F 61%
Mean age 46 yrs
N = 420
75. 17.6 29.5 28.1 [6]
F only
N = 258
82.6 19.0 29.5 28.1 [6]
UK 2001 M and F 49.56 8.12 NA NA [4]
F only
≥18 yrs
N = 2046
51% 10 NA NA [4]
France 2000
F
Adult
N = 310
90 ~25 NA NA [20]
France 2006 F
Adult
N = 5074
61 NA NA NA [21]
USA (CA) 1998 F
18 - 54 yrs
N = 811
52 NA NA NA [22]
*Percentages not reported but interpreted from bar graphs; **Overall sensitivity percentages totals all respondents who reported any degree of sensitivity; F =
female, M = male.

Sensitive Skin in China 187
no data has previously been collected with regard to the
experience of sensitive skin in the rapidly developing
nation of China.
2. Methods
The Chinese data presented here were obtained in the
context of a study that evaluated the needs of sensitive-
skin consumers in China. The survey assessed multiple
parameters of perception of sensitive skin in Chinese
women. Subjects were aged 18 - 65. Of subjects who
completed surveys, 84.3% were between 25 and 54 years
of age, 9.1% were 24 or younger, and 6.6% were 55 and
older. Specific questions addressed the relationship of
skin sensitivity to intrinsic factors like age and anatomic
site as well as to environmental exposures, product use,
and product buying decisions.
3. Results
3.1. Overall Skin Sensitivity
A total of 408 surveys were collected. Of those respon-
dents, 314 (77%) denied sensitive skin, while 65 respon-
dents (16%) claimed they had slightly sensitive skin, 20
respondents (5%) claimed they had moderately sensitive
skin, and 9 respondents (2%) claimed they had very sen-
sitive skin. Only 3% of respondents stated that they have
skin allergies confirmed by a doctor, and only 2% of re-
spondents claimed a family member also had sensitive
skin. Eleven percent of the respondents claimed not to
buy products with specific ingredients because of poten-
tial irritation.
An additional 128 surveys were collected exclusively
from subjects who perceived themselves to have sensi-
tive skin, yielding a total of 222 sensitive-skin subjects.
There were no directional differences between the
three body areas in perceived duration of skin sensitivity.
Overall there was a slight correlation between the degree
of sensitive skin and its duration, particularly with regard
to genital skin. When the duration of skin sensitivity was
evaluated only in those who claimed sensitivity, no dif-
ference was observed between body areas and just over a
third of the respondents claimed to have sensitive skin
for less than 6 months. Although not significant, severity
of sensitive skin tended to decrease over time in all three
body areas evaluated. Only skin sensitivity in the facial
area increased.
The majority of the 408 respondents from the general
population, 79%, stated that their menstrual cycle was
regular, 3% stated their cycle was not regular and they
were not close to menopause, 2% stated their cycle was
not regular but that they were close to menopause, 2%
stated they were experiencing menopausal symptoms,
14% stated they no longer have menstrual cycles, and
none of the respondents stated they were pregnant. None
of the respondents were taking hormone replacement the-
rapy (HRT), while 97.9% stated they were not experi-
encing menopausal symptoms and the remaining 2.1%
stated they had symptoms but were not on HRT.
3.1.1. Facial Skin
Of the 408 respondents 324 (79%) claimed to be not sen-
sitive in the facial area, while 50 respondents (12%)
claimed to be slightly sensitive, 22 respondents (5%)
claimed to be moderately sensitive, and 12 respondents
(3%) claimed to be very sensitive.
Respondents were asked “Why you think you have
sensitive facial skin?” The most common answer among
those that claimed to have sensitive skin was due to topi-
cal products causing visual side effects (35.1%). Another
29.3% stated it was due to sensory side effects by topical
products, 29.8% stated it was due to the weather, 2.0%
stated rough fabrics to be the cause and 3.9% stated other
reasons.
Of the respondents who claimed to have sensitive skin,
39.5% said they have had sensitive skin for less than 6
months, 7.3% said 6 to 11 months, 27.8% said 1 to 5
years, 7.3% said 6 to 10 years, and 18% said 10 years or
more. Respondents were also asked if their sensitive skin
has changed over time and 43.4% stated they were either
much less or a little less sensitive now, 46.8% stated
there was no change and 9.8% stated they were either
much more or a little more sensitive now. Answers were
scored as +2 for much more sensitive over time, +1 for a
little more, 0 for no change, –1 for a little less sensitive
over time, and –2 for much less sensitive. The average
change in severity of sensitive facial skin was –0.49
(±0.90), a value that indicates slight improvement of over-
all facial skin sensitivity over time.
3.1.2. Body
Of the 408 respondents, 370 (91%) denied sensitivity of
the body area, while 26 respondents (6.0%) claimed to be
slightly sensitive, 9 respondents (2%) claimed to be mo-
derately sensitive, and 3 respondents (1%) claimed to be
very sensitive.
When sensitive skin respondents were asked why they
have sensitive skin of the body, the most common an-
swer was weather (44.3%). Another 21.6% claimed to be
due to rough fabrics, 9.1% was due to visual effects,
19.3% due to sensory effects, and 5.7% by other causes.
Of the respondents claiming sensitive skin of the body,
34.1% stated they have had it for less than 6 months,
6.8% stated 6 to 11 months, 27.3% stated 1 to 5 years,
6.8% stated 6 to 10 years, and 25% stated 10 years or
more. Twenty-five percent of respondents stated their
skin of the body was either much less or little less sensi-
tive now, 61.4% stated there was no change, and 13.6%

Sensitive Skin in China 188
stated it was either much more or little more sensitive
now. The average change in severity of sensitive skin of
the body was –0.22 (±0.81), a value that indicates a slight
decrease in skin sensitivity on the body, although not as
much of a decrease as was observed with regards to fa-
cial skin.
3.1.3. Genital Area
Of the 408 respondents, 383 (94%) denied sensitivity in
the genital area, while 18 respondents (4%) claimed to be
slightly sensitive, 4 respondents (1%) claimed to be mo-
derately sensitive, and 3 respondents (1%) claimed to be
very sensitive.
Among those who claimed sensitivity of genital skin,
the most common cause was reported to be rough fabrics
(42.5%). Weather was blamed by 22.5%, 12.5% claimed
topical products were to blame (causing visual effects),
and 20% named topical products (causing sensory ef-
fects). Some 2.5% claimed other causes.
Of the respondents who claimed to have sensitive ge-
nital skin, 37.5% stated they have had it for less than 6
months, 15% stated 7 to 11 months, 22.5% stated 1 to 5
years, 5% stated 6 to 10 years, and 20% stated 10 years
or more. When asked about change in skin sensitivity,
47.5% of respondents said their skin is much less or a
little less sensitive now, 47.5% stated no change, and 5%
reported that their skin was much more or a little more
sensitive now. The average change in severity of sensi-
tive genital skin was –0.68 (±0.92), indicating improve-
ment of skin sensitivity in the genital area that exceeds
that of both the facial skin and the body.
3.2. Age Distribution
Individuals between the ages of 18 - 65 were chosen and
the average age of respondents in each perceived sensi-
tivity degree were similar average ages. Respondents who
claimed to not have sensitive skin in general were an
average age of 39 years old, those who claimed to be
slightly sensitive were 38 years old, those who claimed
moderate sensitivity were 40 years old, and those who
claimed to be very sensitive were 38 years old. The dis-
tribution of sensitive skin with respect to age was similar
between all age groups and no difference was observed
between any age group with the perceived degree of sen-
sitive skin at any body site. Women in the 55 - 65 age
group had the highest percentage of respondents who
claimed they did not have sensitive skin in all three body
areas.
3.3. Factors Attributed to Skin Irritation
3.3.1. Environmental Factors
The sun and hot weather caused skin irritation (34.5%,
31.2% respectively) and breakouts (21.6%, 22.6% re-
spectively) more often any other weather condition. Fab-
rics were the least likely cause of irritation with only
11.6% of the population claiming it. Most other envi-
ronmental factors caused irritation in 15% to 20% of the
population. Only 16.6% of women claimed their men-
strual cycle ever caused them to have skin irritation. For
most the environmental factors, greater than 80% of re-
spondents who claimed to have irritation caused by that
factor had irritation only sometimes.
3.3.2. Household, Health, and Beauty Products
Seven products that were perceived as irritating by less
than 5% of the respondents as follows: shampoo/condi-
tioner, deodorants, antiperspirants, household cleaners,
dishwashing liquid, laundry detergent, and fabric soften-
ers. Eight products perceived to cause irritation by greater
than 10% of the respondents as follows: hair colorants,
facial cosmetics, facial moisturizers, facial astringents,
facial cleanser, body moisturizers, sunscreen, and pow-
der/talc (Figure 1). All the products used directly on the
face were perceived as irritating in greater than 10% of
the population. Powder/talc maybe more likely to be
perceived to cause irritation than deodorant because in
the eastern hemisphere powder is used as a deodorant
more than other products. Household products were not
frequently perceived as a source of irritation. Laundry
detergent was the most likely household product to be
perceived as a source of irritation (4.9%); the least likely
was dishwashing liquid (1.8%).
3.3.3. Personal-Hygiene Products
Respondents were asked whether certain feminine prod-
ucts used on the genitalia caused irritation (redness,
burning or itching). The products most likely to be per-
ceived as a source of irritation were clothing, toilet paper,
and feminine wipes. The two products with the most re-
spondents claiming perceived irritation, feminine wipes
and incontinence pads, however were most often defined
as only sometimes causing irritation (Figure 2). Men-
strual pads, pantiliners, tampons, deodorants/antiperspi-
rants and douching products were used by less than 40%
of the respondents. Menstrual pads and pantiliners were
the least likely products to be perceived to cause irrita-
tion on a regular basis. No respondent perceived men-
strual pads or pantiliners to always or frequently be a
source of irritation, though respondents did claim that
menstrual pads (3.7%) and pantiliners (1.3%) did some-
times seem to cause irritation.
4. Discussion
The study population was relatively large with 536 re-
spondents and composed entirely of adults Chinese wo-
men. Although comparison ata cannot be collected for d

Sensitive Skin in China 189
Figure 1. Percent of females reporting irritation caused by products.
gender or ethnicity, since the questionnaire employed
was similar to our previous study conducted in Cincin-
nati, Ohio, the results can still be effectively compared to
the US data.
The majority of the studies conducted globally have
shown that greater than 50% of individuals have sensi-
tive skin (Table 1), with percentages of women who
claim sensitive skin across the globe varying from about
60% to 90%. The present study found that only 23% of
Chinese women claim to have sensitive skin, demonstra-
bly lower than lower than that found thus far in other
countries.
When the Chinese data is compared to our prior US
data there is a clear difference in the perceived skin sen-
sitivity. In the study conducted in Cincinnati, Ohio, in
2009, 68.4% of 1039 people surveyed claimed to have
some degree of sensitivity, compared to 23% in China
[1]. Facial skin sensitivity also showed different findings:

Sensitive Skin in China 190
21% claimed to have some degree of sensitivity of facial
skin in China respectively, compared to 77.3% in our
prior study [1] and as much as 85% of women in France
(Table 2). A prior study in San Francisco evaluated com-
parative skin sensitivity in specific ethnic groups, includ-
ing 200 Asians and found that 52% claimed to have sen-
sitive facial skin. This finding is closer to the overall rate
for Chinese women of 23% than the overall US average
obtained in our prior study of 77.3% [1]. However, the
San Francisco study found similar prevalence with a 52%
prevalence of sensitive skin overall, a difference which
could result from the different wording of the questions
asking women to define their skin as sensitive. In addi-
tion, the San Francisco study was one of the earliest epi-
demiological studies performed (2001) and self-reported
sensitive skin in industrialized countries has steadily ri-
sen (Table 1).
The most dramatic differences could be seen in the
body and genital areas, where the US population shows
that 60.7% and 56.3% have some degree of sensitivity in
those areas respectively compared to 9% and 6% respec-
tively for the Chinese population [1] (Table 3). Genital
skin differs from exposed skin in other body areas, in
eing dramatically thinner [13] and to varying degrees b
Figure 2. Frequency (%) of irritation (redness, burning, itching) in the genital area following the use of different products
(China).
Table 2. Percent of women with self-declared sensitive skin at the face.
Reported Sensitivity (%)
Country Year Population Overall sensitivityVery sensitiveModerately sensitiveSlightly sensitive Reference
China 2009
F
18 - 65 yrs
N = 408
21.0 3.0 5.0 12.0 Present data
USA (Ohio) 2006 F
Adults
N = 1039
77.3 4.9 23.0 40.5 [1]
France 2004-2005 F
18 - 85 yrs
N = 400
85.4 30.5 NA NA [18]
UK 2001
F
≥18 yrs
N = 2036
34.6 NA NA NA [4]
USA (California) 1998 F
18 - 54 yrs
N = 811
52 NA NA NA [22]
F = Female, NA = Data not available.

Sensitive Skin in China 191
Table 3. Percent of individuals with self-declared sensitive skin at specific anatomic locations.
Anatomic Location (%)
Country Year Population Face Body Genitals Reference
China 2009 F
18 - 65 yrs
N = 408
21 9 6 Current study
USA 2009 M (16%)
F (84%)
Mean age 35.1 yrs
N = 1039
77.3 60.7 56.3 [1]
France 2008 M and F
≥ 15 yrs
N = 1011
NA Scalp
47.4 F
40.8 M
NA [23]
France 2004-2005 F
18 - 85 yrs
N = 400
85 58 Hands
36 Scalp
34 Feet
27 Neck
23 Torso
21 Back
NA [18]
F = Female, M = Male, NA = Data not available.
non-keratinized and occluded. These differences may
make the genital area in women more permeable than ex-
posed keratinized skin [14].
Our finding that skin sensitivity between the US and
Chinese population of women to have the most dramatic
difference observed is consistent with prior observation
that findings related to genital skin tend to differ from
those at other body sites. Perception of overall skin sen-
sitivity was well correlated to perceptions of sensitivity
of face or body skin in a prior study (weighted kappa
value for agreement for general and facial skin or body
skin 0.51 and 0.57, respectively), while agreement be-
tween the perception of sensitive skin overall and that of
genital skin sensitivity was not (weighted kappa value
0.28%) [1]. An association between incontinence and
genital sensitivity was also observed), between ethnicity
(African American) and genital sensitivity, and between
gender (higher number of women) and genital sensitivity,
while no association were observed between any of these
parameters and sensitivity at the face or other non-genital
sites [1].
The questionnaire presented to respondents in both US
and China was identical. It is therefore likely that the
differences observed from the two studies can be attrib-
uted to regional or cultural differences, most likely the
fact that individuals in China and eastern hemisphere
countries are in general much more reserved when talk-
ing about their genitalia as compared to the US or Europe.
Talking about the genital area may be taboo in China
compared to the US and European nations where it can
be talked about freely. Also in the US, countless products
targeted for sensitive skin has created the perception that
sensitive skin is fashionable [1].
4.1. Age Distribution
In our previous study conducted in Cincinnati, we no-
ticed a distinct correlation between age and genital sensi-
tivity. As respondents age, their skin sensitivity increases.
Fifty-three percent of respondents younger than 30 years
old claimed to have sensitive genital skin, compared to
55% of respondent between 31 - 39 years old, 58% of
respondents between 40 - 49 years old, and 66% of re-
spondents older than 50 years old [1]. The Chinese popu-
lation may have shown a slight increase in genital skin
sensitivity but because the percentage of respondents
claiming genital sensitivity was so low that it is not pos-
sible to conclude that there is a statistically significant
correlation between age and genital sensitivity.
The age distribution did not show any differences in
degree of sensitive skin, but it may have been difficult to
judge the distribution of those that were sensitive for
body and genital skin due to the high percentage of re-
spondents who claimed to be not sensitive. The data
though, for respondents not sensitive of the body and
genitals was very similar in all age groups.
4.2. Factors Affecting Skin Sensitivity
Subjects with sensitive skin consistently report skin sen-
sitivity to a variety of factors, including topical products,
weather conditions, exposure to rough fabrics or paper
products, stress, and the hormones that regulate the men-
strual cycle (Figure 3). Weather is an important trigger
for sensitive skin, a finding borne out in numerous stud-
ies on different continents (Table 4).
Our previous US study had similar findings. Adverse
reaction to products accounted 50% of the causes of sen-

Sensitive Skin in China 192
Figure 3. Sensitive skin triggers (%).
Table 4. Percentages of people who report skin sensitivity to specific weather conditions.
Weather condition (%)
Country Year* Population Sun Heat Cold Dry Wind Humidity Reference
China 2009 F
18 - 65 years
N = 408
34.5 31.2 19.2 20.5 21.1 14.7 Farage current study
USA 2009 F
Mean age 35.1 yrs
N = 869
78.4 58.7 83.9 72.9 65.0 39.9 [11]
Greece 2008 F
18 - 45 yrs
N = 25
NA 20.0 33.0 38.0 25.0 16.0 [17]
USA 2006 M and F
Mean age
39 (M) and 35.1 (F) yrs
N = 1032
(163M, 869F)
77.0 55.0 81.0 71.0 65.0 37.0 [12]
France 2004-2005
F
18 - 85 yrs
N = 400
50.8 27.9 65.6 NA 41.8 NA [18]
France March
2004
M and F
≥15 yrs
N = 1006
54.6 NA 60.2 41.1 48.9 NA [2]
France July
2004
M and F
≥15 yrs
N = 1001
47.6 NA 57.8 35.0 42.3 NA [5]
Italy 2004 F
18 - 80 yrs
N = 1850
NA 49.4 54.4 NA 54.4 NA [19]
USA 2002 F
18 - 54 yrs
N = 811
68.3 NA 60.2 NA 61.7 NA [22]
F
= Female, M = Male, NA = Data not available; *Year of publication.

Sensitive Skin in China 193
sitive skin in the US, while in China it was 51% when the
three body sites were combined. Weather conditions ac-
counted for 35% in US [12]. In China, when the three
body sites were combined, weather accounted for 33%.
These figures were adjusted to only include respondents
who claimed to have sensitive skin. Interviewees were
asked about effects environmental factors on skin sensi-
tivity. The results are dramatically different from the US
study, as can be expected since individuals in China have
a smaller overall perception of sensitive skin. One find-
ing that was particularly interesting was that in the US
cold and hot weather caused skin irritation in 83.9% and
58.7% of sensitive skin sufferers, respectively, while in
China the sensitivities were reversed. In China hot weather
caused more irritation than cold weather, 31.2% and
19.2% respectively. Studies in the largely Caucasian popu-
lation of France, interestingly, conducted 4 months apart
(March and July) similarly found higher percentages of
sensitive skin in winter months than in the summer [2].
Skin sensitivity related to topical products confirmed
the general findings of lower prevalence of skin sensitiv-
ity in China, despite the fact that topical products osten-
sibly carry a high risk of causing irritation. Soap in China
does not seem to cause much irritation, while in the US,
Greece and France they are some of the worst offenders
(Figure 1).
Allergies and hereditary causes could not be assessed
due to the low number positive responses 6% and 4%
respectively.
4.3. Duration of Skin Sensitivity
Respondents were also asked how long they have had
sensitive skin; most answers were less than 6 months, 1
to 5 years, and 10 years or more. In the US survey 42%
of the individuals responded that they had it for greater
than 10 years, while only 1% claimed to have had the
sensitive skin for less than 6 months. After adjusting for
the individuals who were not sensitive, we have 62% of
respondents in the US with sensitive skin having had it
for more than 10 years compared to only 20% for the
Chinese population [12]. When comparing the less than 6
months group, we have 1.5% of Americans compared to
38% of Chinese [12]. Also when asked about changes in
severity of sensitive skin, the findings between the US
and China were dramatically different [12]. The degree
of severity of sensitive skin is decreasing in China where
the US survey shows that individuals feel that the sever-
ity is increasing. Thirty one percent of the responders in
the US survey claimed that they are either a little or
much more sensitive now [12]. In China 3% stated that
they are either a little or much more sensitive facial skin
now, 2% for sensitive body skin, and less than 1% for
sensitive genital skin. Even though there were many re-
spondents who claimed to have sensitive skin for less
than 6 months. between 1 and 5 years, or 10 years or
more, but there were very few who claimed to have sen-
sitive skin between 6 - 11 months or 6 - 10 years. Data
for China came by combining data from the three body
sites.
The meaning of sensitive skin in the East differs from
that of the West, which may contribute to the higher
prevalence observed in the West as compared to China.
In China sensitive skin is considered an acute and transi-
tory condition while in the US it is viewed as more of a
permanent condition causing chronic irritation. Therefore
there may have been respondents in China who claimed
not to have sensitive skin who may have had it in the past.
The number of individuals who had sensitive skin in the
past were not accounted for because we understood the
cultural differences in sensitive skin perception only after
the completion of the study. Sensitive skin in the past,
therefore, was not included in the questionnaire. In gen-
eral, since sensitive skin is not as well defined as other
disease states, different cultures interpret or understand
sensitive skin differently.
5. Conclusions
When we compared this study to the one conducted in
the US we were surprised to find much lower percent-
ages of individuals claiming to have overall sensitive
skin, but especially sensitive skin of the body and geni-
tals. The percent of respondents who claimed to have sen-
sitive skin was 41.4%, while 38% claimed to have sensi-
tive facial skin, 16% claimed to have sensitive skin of the
body, and only 7% claimed to have sensitive genital skin.
Even though the sensitive skin figures were lower than
in the US population we still noticed relatively similar
results when we looked at what causes and exacerbates
sensitive skin. Weather conditions were stated as the
most likely cause of sensitive skin (32.7%), then sensory
irritation (25.5%), visual irritation (25.5%), and rough
fabrics (12.0%). If sensory and visual irritation were
combined, the primary cause of sensitive skin would be
adverse reactions to products. Of the weather conditions,
the sun and hot weather were considered to be the worst
offenders.
There were a larger percentage of respondents who
claimed to have sensitive skin for less than 6 months as
compared to approximately half that claiming to have
had it for greater than 10 years. Most respondents also
claimed that their severity of sensitive skin was also get-
ting better over time, especially those that claimed to
have slightly sensitive skin. Only two respondents claim-
ed to have much more sensitive skin now.
As discussed, numerous interpersonal variables can af-
fect evaluations of skin sensitivity such as lifestyle pa-

Sensitive Skin in China 194
rameters including time spent outdoors, forms of indoor
climate control, and occupational or leisure activities. In
addition, slight variations in the wording of surveys can
cause substantial differences in the survey results ob-
tained, i.e. asking subjects whether they experience red-
ness or sensory effects rather than asking if skin is “eas-
ily irritated”.
One debated factor in skin sensitivity is that the influ-
ence that cultural components, including advertising, can
play. Manufacturers of skin products, over the time pe-
riod that the rise in skin sensitivity in western cultures
has risen, have increasingly marketed products targeted
for sensitive skin. An increase in perceived skin sensitiv-
ity in men, particularly (although one recent study found
the perception of sensitive skin in men and women to be
virtually equal) [1].
A recent epidemiological study in Europe would seem
to confirm a cultural component. A comparison of self-
reported skin sensitivity in eight European countries
found dramatic differences between national populations
that are genetically very similar (Portugal, Italy, and
Spain, for example, reporting 80% to 90% of their popu-
lation as experiencing at least some sensitivity; while
Germany, Belgium, and Switzerland reported just a little
more than half), an unexpected finding that the authors
attributed primarily to substantially more fashion and
beauty-related advertising in specific European countries
[3].
The finding that substantially fewer Chinese women
(residents of a developing country with putatively less
aggressive advertising of products targeted for sensitive
skin), claim skin sensitivity than their counterparts in the
west would seem to bolster the supposition that sensitive
skin has at least some cultural component.
However, this study relied solely on consumer claims
of skin sensitivity without independent physiological
verification; much progress has been made over the last
decade in unraveling a genuine physiological basis for
skin sensitivity as well [15]. Much work remains to be
done in order to achieve a satisfactory understanding of
both dermatological and psychosocial aspects of sensi-
tive skin in the global context.
6. Acknowledgements
The authors would like to thank for Dr. Kenneth W.
Miller and Mr. Ron Visscher for the review and input on
this manuscript; Mr. Sugar Shukla for his critical work
on the technical draft revisions and Ms. Wendy Wippel
and Ms. Zeinab Schwen (Strategic Regulatory Consult-
ing) for technical writing assistance.
REFERENCES
[1] M. A. Farage, “How Do Perceptions of Sensitive Skin
Differ at Different Anatomical Sites? An Epidemiological
Study,” Clinical and Experimental Dermatology, Vol. 38,
No. 8, 2009, pp. e521-e530.
doi:10.1111/j.1365-2230.2 009. 03487.x
[2] L. Misery, E. Myon, N. Martin, S. Consoli, T. Nocera and
C. Taieb, “Sensitive Skin: Epidemiological Approach and
Impact on Quality of Life in France,” In: E. Berardesca, J.
W. Fluhr and H. I. Maibach, Eds., Sensitive Skin Syn-
drome, Taylor & Francis, New York, 2006, pp. 181-191.
[3] L. Misery, S. Boussetta, T. Nocera, N. Perez-Cullell and
C. Taieb, “Sensitive Skin in Europe,” Journal of the Euro-
pean Academy of Dermatology and Venereology, Vol. 23,
No. 4, 2009, pp. 376-381.
doi:10.1111/j.1468-3083.2 008. 03037.x
[4] C. M. Willis, S. Shaw, O. De Lacharrière, M. Baverel, L.
Reiche, R. Jourdain, P. Bastien and J. D. Wilkinson, “Sen-
sitive Skin: An Epidemiological Study,” The British Jour-
nal of Dermatology, Vol. 145, No. 2, 2001, pp. 258-263.
doi:10.1046/j.1365-2133.2 001. 04343.x
[5] L. Misery, E. Myon, N. Martin, S. Consoli, S. Boussetta,
T. Nocera and C. Taieb, “Sensitive Skin: Psychological
Effects and Seasonal Changes,” Journal of the European
Academy of Dermatology and Venereology, Vol. 21, No.
5, 2007, pp. 620-628.
[6] H. Löffler, “Contact Allergy and Sensitive Skin,” In: E.
Berardesca, J. Fluhr and H. Maibach, Eds., Sensitive Skin
Syndrome, Taylor and Francis, New York, 2006, pp. 225-
235.
[7] M. A. Farage, K. W. Miller, P. Elsner and H. I. Maibach,
“Intrinsic and Extrinsic Factors in Skin Ageing: A Re-
view,” International Journal of Cosmetic Science, Vol.
30, No. 2, 2008, pp. 87-95.
doi:10.1111/j.1468-2494.2 007. 00415.x
[8] B. G. Green, “Measurement of Sensory Irritation of the
Skin,” American Journal of Contact Dermatitis, Vol. 11,
No. 3, 2000, pp. 170-180. doi:10.1053/ajcd.2000.7185
[9] M. B. Britz and H. I. Maibach, “Human Cutaneous Vul-
var Reactivity to Irritants,” Contact Dermatitis, Vol. 5, No.
6, 1979, pp. 375-377.
doi:10.1111/j.1600-0536.1 979.t b04908.x
[10] P. Elsner, D. Wilhelm and H. I. Maibach, “Sodium Lauryl
Sulfate-Induced Irritant Contact Dermatitis in Vulvar and
Forearm Skin of Premenopausal and Postmenopausal Wo-
men,” Journal of the American Academy of Dermatology,
Vol. 23, No. 4, 1990, pp. 648-652.
[11] M. A. Farage, “Does Sensitive Skin Differ between Men
and Women?” Cutaneous and Ocular Toxicology, Vol. 29,
No. 3, 2010, pp. 153-163.
doi:10.3109/1556952100 377499 0
[12] M. A. Farage, “Perceptions of Sensitive Skin: Changes in
Perceived Severity and Associations with Environmental
Causes,” Contact Dermatitis, Vol. 59, No. 4, 2008, pp.
226-232. doi:10.1111/j.1600-0536.2008.013 98.x
[13] M. A. Farage and H. I. Maibach, “Sensitive Skin: Closing
in on a Physiological Cause,” Contact Dermatitis, Vol. 62,
No. 3, 2010, pp. 137-149.
doi:10.1111/j.1600-0536.2 009. 01697.x
[14] M. A. Farage, A. Katsarou and H. I. Maibach, “Sensory,

Sensitive Skin in China 195
Clinical and Physiological Factors in Sensitive Skin: A Re-
view,” Contact Dermatitis, Vol. 55, No. 1, 2006, pp. 1-14.
doi:10.1111/j.0105-1873.2 006. 00886.x
[15] E. Berardesca, J. Fluhr and H. Maibach, “Sensitive Skin
Syndrome,” Taylor and Francis, New York, 2006.
[16] A. Johnson and D. Page, “Making Sense of Sensitive Skin,”
Congress of the International Federation of Society of
Cosmetic Chemists, Yokohama, 13-16 October 1992.
[17] M. A. Farage, P. Bowtell and A. Katsarou, “Self-Diag-
nosed Sensitive Skin in Women with Clinically Diagnosed
Atopic Dermatitis,” Clinical Medicine: Dermatology, Vol.
2, 2008, pp. 21-28.
[18] C. Saint-Martory, A. M. Roguedas-Contios, V. Sibaud, A.
Degouy, A. M. Schmitt and L. Misery, “Sensitive Skin Is
Not Limited to the Face,” The British Journal of Derma-
tology, Vol. 158, No. 1, 2008, pp. 130-133.
[19] A. Sparavigna, A. Di Pietro and M. Setaro, “Healthy Skin:
Significance and Results of an Italian Study on Healthy
Population with Particular Regard to ‘Sensitive’ Skin,”
International Journal of Cosmetic Science, Vol. 27, No. 6,
2005, pp. 327-331. doi:10.1111/j.1467-2494.2005 .00287.x
[20] F. Morizot, C. Guinot, S. Lopez, I. Le Fur, E. Tschachler
and C. Wood, “Sensitive Skin: Analysis of Symptoms, Per-
ceived Causes and Possible Mechanisms,” Cosmetics &
Toiletries, Vol. 115, 2000, pp. 83-89.
[21] C. Guinot, D. Malvy, E. Mauger, K. Ezzedine, J. Latreille,
L. Ambroisine, M. Tenenhaus, P. Préziosi, F. Morizot, P.
Galan, S. Hercberg and E. Tschachler, “Self-Reported Skin
Sensitivity in a General Adult Population in France: Data
of the SU.VI.MAX Cohort,” Journal of the European
Academy of Dermatology and Venereology, Vol. 20, No.
4, 2006, pp. 380-390.
doi:10.1111/j.1468-3083.2 006. 01455.x
[22] R. Jourdain, O. de Lacharrière, P. Bastien and H. I. Mai-
bach, “Ethnic Variations in Self-Perceived Sensitive Skin:
Epidemiological Survey,” Contact Dermatitis, Vol. 46, No.
3, 2002, pp. 162-169.
doi:10.1034/j.1600-0536.2 002. 460307.x
[23] L. Misery, V. Sibaud, M. Ambronati, G. Macy, S. Bous-
setta and C. Taieb, “Sensitive Scalp: Does This Condition
Exist? An Epidemiological Study,” Contact Dermatitis,
Vol. 58, No. 4, 2008, pp. 234-238.
doi:10.1111/j.1600-0536.2 007. 01288.x