Characterization of Cowhage-induced Pruritus in Sensitive Skin: An Observational Laboratory Study


  • Ying Zuo
  • Ping Jiang
  • Ruoyu Wan
  • Li Li
  • Qiyong Gong
  • Wei Hua Department of Dermatology, West China Hospital, Sichuan University, 610041 Chengdu, China



sensitive skin, pruritus, cowhage


Sensitive skin is a prevalent syndrome, characterized by discomfort in response to mild stimuli, which impacts on quality of life. Pruritus is one of the major symptoms of sensitive skin. However, the pathomechanism of sensitive skin is insufficiently understood. As an experimental model for pruritus, the cowhage skin prick test might provide insight into the understanding of sensitive skin. This study aimed to specify the characteristics of cowhage-induced pruritus in sensitive skin. Female volunteers, 20 with sensitive skin and 20 controls, were recruited. Self-report questionnaires were distributed and the responses evaluated; moreover, alongside assessments by dermatologists, skin physiology assessments, lactic acid sting test, capsaicin test and cowhage skin challenge were performed. Pruritus in sensitive skin was perceived as more intense and longer-lasting than in normal skin, with different qualities of accompanying sensations. Cowhage skin challenge results showed moderate consistency with clinical assessments. The results suggest that cowhage skin challenge could be a new tool for the assessment of sensitive skin.


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Misery L, Ständer S, Szepietowski JC, Reich A, Wallengren J, Evers AWM, et al. Definition of sensitive skin: an expert position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch. Acta Derm Venereol 2017; 97: 4-6. DOI:

Farage MA. How do perceptions of sensitive skin differ at different anatomical sites? An epidemiological study. Clin Exp Dermatol 2009; 34: e521-e530. DOI:

Saint-Martory C, Roguedas-Contios AM, Sibaud V, Degouy A, Schmitt AM, Misery L. Sensitive skin is not limited to the face. Br J Dermatol 2008; 158: 130-133. DOI:

Farage MA. The prevalence of sensitive skin. Front Med (Lausanne) 2019; 6: 98. DOI:

Guinot C, Malvy D, Mauger E, Ezzedine K, Latreille J, Ambroisine L, et al. Self-reported skin sensitivity in a general adult population in France: data of the SU.VI.MAX cohort. J Eur Acad Dermatol Venereol 2006; 20: 380-390. DOI:

Misery L, Myon E, Martin N, Verrière F, Nocera T, Taieb C, et al. Sensitive skin in France: an epidemiological approach. Ann Dermatol Venereol 2005; 132: 425-429. DOI:

Willis CM, Shaw S, De Lacharrière O, Baverel M, Reiche L, Jourdain R, et al. Sensitive skin: an epidemiological study. Br J Dermatol 2001; 145: 258-263. DOI:

Sparavigna A, Di Pietro A, Setaro M. 'Healthy skin': significance and results of an Italian study on healthy population with particular regard to 'sensitive' skin. Int J Cosmetic Sci 2005; 27: 327-331. DOI:

Do LHD, Azizi N, Maibach H. Sensitive skin syndrome: an update. Am J Clin Dermatol 2020; 21: 401-409. DOI:

Kim EJ, Lee DH, Kim YK, Kim M, Kim JY, Lee MJ, et al. Decreased ATP synthesis and lower pH may lead to abnormal muscle contraction and skin sensitivity in human skin. J Dermatol Sci 2014; 76: 214-221. DOI:

Yang L, Lyu L, Wu W, Lei D, Tu Y, Xu D, et al. Genome-wide identification of long non-coding RNA and mRNA profiling using RNA sequencing in subjects with sensitive skin. Oncotarget 2017; 8: 114894-114910. DOI:

Berardesca E, Farage M, Maibach H. Sensitive skin: an overview. Int J Cosmetic Sci 2013; 35: 2-8. DOI:

Kueper T, Krohn M, Haustedt LO, Hatt H, Schmaus G, Vielhaber G. Inhibition of TRPV1 for the treatment of sensitive skin. Exp Dermatol 2010; 19: 980-986. DOI:

Shelley WB, Arthur RP. Mucunain, the active pruritogenic proteinase of cowhage. Science 1955; 122: 469-470. DOI:

LaMotte RH, Shimada SG, Green BG, Zelterman D. Pruritic and nociceptive sensations and dysesthesias from a spicule of cowhage. J Neurophysiol 2009; 101: 1430-1443. DOI:

Baumann L. The skin type solution: a revolutionary guide to your best skin ever. New York: Bantam Books 2006.

Luan M, Dai R, Fan L, Hua W, Xie H, Li L. Developing a new sensitive skin questionnaire and compare reliability, validity of new Questionnaire and Baumann Sensitive Skin Questionnaire. Ch J Dermatol 2018; 32: 80-83.

Fullerton A, Fischer T, Lahti A, Wilhelm KP, Takiwaki H, Serup J. Guidelines for measurement of skin colour and erythema. A report from the Standardization Group of the European Society of Contact Dermatitis 1996; 35: 1-10. DOI:

Berardesca E, Loden M, Serup J, Masson P, Rodrigues LM. The revised EEMCO guidance for the in vivo measurement of water in the skin. Skin Res Technol 2018; 24: 351-358. DOI:

Rogiers V. EEMCO guidance for the assessment of transepidermal water loss in cosmetic sciences. Skin Pharmacol Appl Skin Physiol 2001; 14: 117-128. DOI:

Papoiu ADP, Tey HL, Coghill RC, Wang H, Yosipovitch G. Cowhage-induced itch as an experimental model for pruritus. A comparative study with histamine-induced itch. PLoS One 2011; 6: e17786. DOI:

Reddy VB, Iuga AO, Shimada SG, LaMotte RH, Lerner EA. Cowhage-evoked itch is mediated by a novel cysteine protease: a ligand of protease-activated receptors. J Neurosci 2008; 28: 4331-4335. DOI:

Darsow U, Scharein E, Simon D, Walter G, Bromm B, Ring J. New aspects of itch pathophysiology: component analysis of atopic itch using the 'Eppendorf Itch Questionnaire'. Int Arch Allergy Imm 2001; 124: 326-331. DOI:

Misery L, Weisshaar E, Brenaut E, Evers AWM, Huet F, Ständer S, et al. Pathophysiology and management of sensitive skin: position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI). J Eur Acad Dermatol Venereol 2020; 34: 222-229. DOI:

Buhé V, Vié K, Guéré C, Natalizio A, Lhéritier C, Le Gall-Ianotto C, et al. Pathophysiological study of sensitive skin. Acta Derm Venereol 2016; 96: 314-318. DOI:

Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M. The neurobiology of itch. Nat Rev Neurosci 2006; 7: 535-547. DOI:

Schmelz M, Schmidt R, Bickel A, Handwerker HO, Torebjörk HE. Specific C-receptors for itch in human skin. J Neurosci 1997; 17: 8003-8008. DOI:

Wei JY, Tuckett RP. Response of cat ventrolateral spinal axons to an itch-producing stimulus (cowhage). Somatosens Mot Res 1991; 8: 227-239. DOI:

Hawro T, Lehmann S, Deuring E, Weller K, Altrichter S, Church MK, et al. Comparison of pruritus and sensory qualities induced by capsaicin, histamine and cowhage. J Eur Acad Dermatol Venereol 2019; 33: 1755-1761. DOI:

Kim EJ, Lee DH, Kim YK, Eun HC, Chung JH. Adiponectin deficiency contributes to sensitivity in human skin. J Invest Dermatol 2015; 135: 2331-2334. DOI:

Caterina MJ, Pang Z. TRP channels in skin biology and pathophysiology. Pharmaceuticals (Basel) 2016; 9: 77. DOI:

Reddy VB, Azimi E, Chu L, Lerner EA. Mas-related G-protein coupled receptors and cowhage-induced itch. J Invest Dermatol 2018; 138: 461-464. DOI:

Kwa KAA, Pijpe A, Rashaan ZM, Tuinebreijer WE, Breederveld RS, van Loey NE. Course and predictors of pruritus following burns: a multilevel analysis. Acta Derm Venereol 2018; 98: 636-640. DOI:

André F, Fluhr JW, Hawro T, Church MK, Maurer M, Metz M. Characterization of cowhage-induced pruritus in inflamed and non-inflamed skin. J Eur Acad Dermatol Venereol 2020; 34: 202-206. DOI:

Bahali AG, Onsun N, Su O, Ozkaya DB, Dizman D, Topukcu B, et al. The relationship between pruritus and clinical variables in patients with psoriasis. An Bras Dermatol 2017; 92: 470-473. DOI:

Misery L, Jean-Decoster C, Mery S, Georgescu V, Sibaud V. A new ten-item questionnaire for assessing sensitive skin: the Sensitive Scale-10. Acta Derm Venereol 2014; 94: 635-639. DOI:

Legeas C, Misery L, Fluhr JW, Roudot A, Ficheux A, Brenaut E. Proposal for cut-off scores for sensitive skin on sensitive scale-10 in a group of adult women. Acta Derm Venereol 2021; 101: adv00373. DOI:

Marriott M, Holmes J, Peters L, Cooper K, Rowson M, Basketter DA. The complex problem of sensitive skin. Contact Dermatitis 2005; 53: 93-99. DOI:

Jourdain R, Bastien P, de Lacharrière O, Rubinstenn G. Detection thresholds of capsaicin: a new test to assess facial skin neurosensitivity. J Cosmet Sci 2005; 56: 153-166. DOI:

Gibson RA, Robertson J, Mistry H, McCallum S, Fernando D, Wyres M, et al. A randomised trial evaluating the effects of the TRPV1 antagonist SB705498 on pruritus induced by histamine, and cowhage challenge in healthy volunteers. Plos One 2014; 9: e100610. DOI:

Richters R, Falcone D, Uzunbajakava N, Verkruysse W, van Erp P, van de Kerkhof P. What is sensitive skin? A systematic literature review of objective measurements. Skin Pharmacol Phys 2015; 28: 75-83. DOI:

Ozawa M, Tsuchiyama K, Gomi R, Kurosaki F, Kawamoto Y, Aiba S. Neuroselective transcutaneous electric stimulation reveals body area-specific differences in itch perception. J Am Acad Dermatol 2006; 55: 996-1002. DOI:



How to Cite

Zuo, Y., Jiang, P., Wan, R., Li, L., Gong, Q., & Hua, W. (2021). Characterization of Cowhage-induced Pruritus in Sensitive Skin: An Observational Laboratory Study. Acta Dermato-Venereologica, 101(11), adv00587.