Lifestyle-Driven Phenotypes in Sensitive Skin: A Cross-Sectional, Multicenter Study Across Urbanization Tiers

Sensitive skin is shaped by intrinsic physiology and environmental exposures, yet how concurrent lifestyle factors modulate its expression remains poorly characterized. This study examined how differing environmental and lifestyle conditions influence sensitive skin phenotypes through clinical evaluation, biophysical measurements, and biomarker profiling.

A cross-sectional, multicenter study enrolled 151 women (aged 35-50 years) into three groups based on environmental and lifestyle factors: non-sensitive highly urbanized lifestyle (NS-1), sensitive skin highly urbanized lifestyle (SSS-1), and sensitive skin moderately urbanized lifestyle (SSS-2). Lifestyle classification was defined using three concomitantly considered indicators: pollution exposure, sleep quality, and psychological stress. Tier 1 PM_2.5 (21.3-28.9 μg/m³) exceeded tier 2 levels (17.2-23.8 μg/m³), both surpassing World Health Organization (WHO) guidelines. 100% of SSS-1 individuals slept < 7 h/night with stress scores ≥ 18; 100% of SSS-2 individuals slept > 7 h/night with stress scores ≤ 14. Assessments included clinical grading, VISIA-CR imaging, bioinstrumentation, and biomarker analysis.

In the intrinsic-biology comparison (SSS-1 vs. NS-1), sensitive skin was associated with significantly elevated prostaglandin E₂ (PGE₂) (23.5% higher) and protein carbonylation (17.9% higher), along with 7.9% greater skin tone heterogeneity and 38.0% higher dark spot density. In the lifestyle comparison (SSS-1 vs. SSS-2), highly urbanized living was associated with 185.0% higher PGE₂, 22.5% increased sebum, and 7.5% greater pore visibility, while moderately urbanized high-ultraviolet (UV) conditions were linked to 27.8% higher pigmentation and 27.3% elevated oxidative stress.

In this cross-sectional cohort, sensitive skin was associated with elevated protein carbonylation and greater pigmentary reactivity relative to non-sensitive skin under matched highly urbanized conditions. PGE₂, by contrast, tracked with highly urbanized living rather than with skin sensitivity: highest in the urban groups and lowest in the moderately urbanized cohort. Highly urbanized living was associated with greater inflammatory activity and sebum production, whereas the moderately urbanized, high-UV setting was associated with greater oxidative stress and hyperpigmentation. Because the design is cross-sectional and the two cities differ in multiple environmental factors, these findings are associative and hypothesis-generating and support further study of personalized, context-specific management.