The burden of sensitive skin questionnaire: from assessment to identifying country-specific differences

Sensitive skin (SS) is estimated to affect 70% of the population, with prevalence appearing to rise over time. This syndrome is not necessarily associated with objective clinical signs. However, affected individuals report unpleasant sensations - burning, pain, pruritus, and/or tingling - triggered by lifestyle and environmental factors that should not normally elicit a reaction. Those affected tend to modify their behaviour, limit activities, and often suffer from sleep disturbance, stress, and psychological distress, all of which further impair their well-being and quality of life.

As SS relates to sensations, objective evaluation may be unsuccessful, and subjective assessment remains a method of choice. Consequently, numerous questionnaires have been developed to assess SS, but few have undergone validation. We contributed to the development of the Burden of Sensitive Skin (BoSS) questionnaire.
After the phases of conception, development and validation, the 14-question BoSS questionnaire was structured around self-care (seven questions), daily life (four questions), and appearance (three questions), generating a score ranging from 0 (no impact) to 56 (maximal impact)

(Misery et al., JEADV, 2018).

Beyond measuring the burden of SS, the BoSS questionnaire can also serve diagnostic purposes. Since the initial study conducted in France in 2018, the BoSS questionnaire has been translated and adapted into 7 languages, undergoing cultural and linguistic validation. It has become a reference mentioned in review articles and has been employed in 16 studies, encompassing a total of 5,179 subjects worldwide.

Recently, a comparative evaluation of SS in Thai and Polish subjects (40 and 50 subjects, respectively) revealed notable differences between these two populations. While all subjects had a BoSS score > 20, Polish participants exhibited higher levels of redness and dryness and reported a greater burden due to facial redness. Conversely, Thai subjects consistently rated clinical (dryness, roughness, and scaling) and functional signs (tingling, pain, and itching) more severely. In line with these observations, BoSS questions related to appearance were significantly higher in Polish subjects (p < 0.05), where BoSS scores related to sensations were higher in Thai subjects (***, p < 0.001). In both cases, the daily use of a specific cream led to improvement in the BoSS score, showing the benefit of dermo-cosmetics in supporting SS (data not shown).