The research team, led by Miranda A. Farage of The Procter and Gamble Company and DermatoSciences in Cincinnati and Inna Eiberger of Procter and Gamble in Germany, mined de-identified electronic health records, claims databases, hospital data, and pharmacy records from the United States covering more than 160 million individuals. Searching for the term sensitive skin alongside relevant ICD-10 diagnosis codes returned nearly 3.65 million records, of which 59,702 were linked to the term. After filtering for complete datasets, 2,333 subjects remained for analysis, with data collected between October 2019 and September 2022. A quota-sampled subset of 240 patients underwent deeper medical chart curation to characterize symptoms, treatments, and outcomes.

The demographic profile of the cohort was striking. Sixty-eight percent were female, consistent with the established female predominance in sensitive skin, and 81 percent were White. Ages spanned all adult groups, with 15 percent aged 18 to 34, 35 percent aged 35 to 54, 22 percent aged 55 to 64, and 28 percent aged 65 or older. At the index date, the first visit that generated a diagnosis code, 48 percent had no recorded comorbidities. But cardiovascular disease, present in 26 percent, and type 2 diabetes, present in 12 percent, were the two most common conditions, and both are established drivers of peripheral neuropathy. Six months later, cardiovascular disease appeared in 50 percent of the cohort, type 2 diabetes in 22 percent, sleep disturbance in 29 percent, and depressive episodes in 24 percent, all higher than in the general electronic health record population.

The diagnostic breakdown revealed the crux of the study. Forty-four percent of subjects received a dermatitis diagnosis, 15 percent had dry skin or urticaria, and 13 percent had acne, categories that clearly reflect genuine skin conditions. But 33 percent were diagnosed with altered skin sensation, a category that maps directly onto neurological territory. Within this group, 18 percent reported paresthesia or tingling, 11 percent reported anesthesia or numbness, and 4 percent reported other sensory symptoms. These are textbook peripheral neuropathy complaints, typically described as pins-and-needles, electric shock-like sensations, or burning pain that begins in the feet and progresses to the hands in a stocking-glove distribution.

Age stratification sharpened the signal. The prevalence of every sensory subcategory rose with advancing age: among those 65 and older, paresthesia reached 21 percent, anesthesia 13 percent, and other symptoms 5 percent, compared with just 9, 7, and 1 percent respectively in the youngest group. This gradient mirrors the epidemiology of peripheral neuropathy, which affects up to 15 percent of adults over 40 worldwide and climbs steeply with age. It also contrasts with sensitive skin itself, whose self-reported prevalence tends to decline with age even as severity increases. The authors argue that this age-related pattern is more consistent with a progressive nerve disorder than with a cosmetic or dermatological phenomenon.

Body localization added further nuance. Younger subjects reported symptoms predominantly on the face, the classic territory of sensitive skin, where cosmetics and procedures are most often implicated. But older groups showed a marked shift toward the extremities: symptoms on the arms rose from 13 percent in the youngest group to 27 percent in the middle group and 25 percent in the oldest, while leg involvement climbed from 11 to 21 percent and foot involvement from 2 to 10 percent. Men reported altered skin sensation more frequently than women, 31 versus 11 percent in the curated subset, and were more likely to report symptoms on the arms, legs, hands, and feet. Male sex has been identified as a predictor of peripheral neuropathy in some studies, possibly reflecting higher rates of diabetes, obesity, and smoking.

Treatment patterns exposed a diagnostic vacuum. Among patients with altered skin sensation, 68 percent received no treatment at all. Those who did were most often prescribed antihistamines, leukotriene receptor antagonists, systemic corticosteroids, or local anesthetics, none of which address nerve pathology. Only 7 percent of the overall cohort consulted a dermatologist, while 44 percent saw family or general practice physicians and 9 percent saw internal medicine specialists, suggesting that many patients and clinicians were uncertain which specialty should own the problem. The authors note that roughly 14 to 18 percent of patients continued to report relapse or worsening of symptoms over time, and that the etiology of sensitive skin was unknown in 60 percent of curated cases.

The study is careful to frame its conclusions as hypothesis-generating rather than definitive. Because the hypothesis of a sensitive skin to neuropathy link arose from inspection of the same dataset used to explore it, no formal statistical test was possible, and all analyses were descriptive. The quota-sampled subset is not generalizable to the full cohort, retention of only complete records introduces selection bias, and the collection window overlapped the COVID-19 pandemic, which may have distorted care-seeking and coding practices. Thermal sensory data, which would be critical for identifying small-fiber neuropathy, were absent from the source records. The pooled localization pattern, with the face among the most affected sites and foot involvement low, does not fit classic length-dependent neuropathy, and the authors restrict their neuropathy interpretation to the extremity-predominant subset.

Alternative explanations remain on the table, including localized neuropathic conditions such as notalgia paresthetica and brachioradial pruritus, entrapment neuropathies, radiculopathy, medication effects, primary dermatological disease, psychosomatic contributors, and simple coding artifacts. The authors also acknowledge that a type 2 diabetes prevalence of 12 percent at the index date is not clearly above the expected background for a cohort in which roughly half are aged 55 or older, so the findings are compatible with a mixed-etiology neuropathy rather than a predominantly diabetic one. Cardiovascular disease, metabolic syndrome, smoking, and age are all recognized non-diabetic contributors to peripheral nerve damage.

Nevertheless, the convergence of evidence, sensory symptoms that overlap with neuropathy, an age gradient matching neuropathy epidemiology, extremity-predominant localization in older patients, male predominance in the altered sensation subgroup, and comorbidities that are established neuropathy risk factors, raises the possibility that a subset of patients labeled with sensitive skin are actually harboring unrecognized peripheral neuropathy, potentially small-fiber neuropathy, which some researchers have proposed as a low-noise form of the condition. Prior work has shown that patients with sensitive skin have higher neuropathic pain scores and lower heat pain thresholds than controls, implicating damaged unmyelinated C-fibers, and hyperactive transient receptor potential channels on keratinocytes have been implicated in both conditions. The authors call for prospective, objectively phenotyped studies using tools such as quantitative sensory testing, corneal confocal microscopy, and skin biopsy, alongside validated questionnaire-based screening instruments, to confirm whether the association is genuine and clinically actionable. If it is, raising clinicians’ index of suspicion for peripheral neuropathy in patients presenting with sensitive-skin complaints, particularly extremity symptoms in older patients, could prevent years of diagnostic delay, inappropriate treatment, and progressive nerve damage.

Subject of Research: neuroscience

Article Title: Beyond the skin surface: untangling sensitive skin syndrome and peripheral neuropathy through an exploratory real-world data analysis

Article References: Farage, M. A., & Eiberger, I. (2026). Beyond the skin surface: untangling sensitive skin syndrome and peripheral neuropathy through an exploratory real-world data analysis. Frontiers in Pain Research, 7, Article 1883218. https://doi.org/10.3389/fpain.2026.1883218

Image Credits: AI Generated

DOI: 10.3389/fpain.2026.1883218

Keywords: peripheral neuropathy, sensitive skin syndrome, small-fiber neuropathy, real-world evidence, misdiagnosis, paresthesia, diabetes, dermatology, Beyond, skin, surface, untangling