Water-immersion wrinkling is due to vasoconstriction

Department of Medicine, Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Muscle & Nerve (Impact Factor: 2.31). 03/2003; 27(3):307-11. DOI: 10.1002/mus.10323
Source: PubMed

ABSTRACT The underlying mechanism of the water-immersion skin wrinkling test, which is used as a test of sympathetic nerve function, remains elusive. We investigated changes of blood circulation in the hand occurring with water-immersion wrinkling by measuring the velocity of ulnar and digital artery blood flow, and of digit skin blood flow, in healthy subjects before and during wrinkling. Wrinkling was accompanied by significant reduction in blood flow velocity in all vessels, with a maximum in digital vessels. Our data show that water-immersion wrinkling is a function of digit pulp vasoconstriction. This test of sympathetic function can now be quantified using parameters of blood flow velocity, enabling its more widespread and accurate use.

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    • "In WIW, vasoconstriction has recently been shown to be present and its main underlying cause [27]. In a series of experiments, it was shown that with water immersion, digit and skin blood flow was significantly reduced [27]. Further support for vasoconstriction being causative, was leant by application of mildly vasoconstrictant cream, EMLA, resulting in wrinkling identical to that seen with WIW. "
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    ABSTRACT: Aquagenic wrinkling of the palms is an unusual and rare dermatosis characterized by rapidly appearing edema, whitish papules, and strong wrinkling of the palms after brief immersion in water. Aquagenic wrinkling of the palms is postulated to be a result of abnormal electrolyte fluxes that result in sodium retention within epidermal keratinocytes and osmotically induced cell volume increases. A clear understanding is lacking. It is closely linked to Cystic Fibrosis and has been proposed as a test of Cystic Fibrosis but can also be induced by Cyclooxygenase (COX-2) inhibitors and Aminoglycosides. Since both aquagenic wrinkling of the palms and water immersion wrinkling occur with water immersion, are restricted to the glabrous skin, and show features of sympathetic stimulation, I hypothesize that aquagenic wrinkling of the palms is part of the spectrum of water immersion wrinkling which has recently been shown to be due to sympathetic nervous system induced vasoconstriction of the palms and digits. Furthermore I hypothesize that both conditions are restricted to the glabrous palmar skin because of unique anatomical characteristics. Palmar skin is highly porous to water and contains abundant specialized vasculature densely innervated by sympathetic nerves and has unique epidermal anchoring for gripping purposes. I postulate that in conditions with sweat electrolyte disturbances such as Cystic Fibrosis or drug induced; the normal water immersion wrinkling response is exaggerated, leading to the typical clinical features of aquagenic wrinkling of the palms.
    Medical Hypotheses 09/2013; 81(5). DOI:10.1016/j.mehy.2013.09.015 · 1.07 Impact Factor
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    • "Upon mismatched deformation, the film undergoes compression and will wrinkle/buckle beyond a threshold. Such a mismatched deformation can be caused by the relative shrinkage of the substrate (underlying tissues) in the case of vasoconstriction upon immersion of a fingertip in water [8] [9]. Mechanically, the relative shrinkage of the underlying substrate is equivalent to the relative swelling of the film that would produce the same compressive stress state in the film that would lead to the same buckling morphology. "
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    ABSTRACT: Fingertips often wrinkle after extended exposure to water. The underlying mechanics issues, in particular the critical parameters governing the wrinkled morphology, are studied by using both finite element simulation and analytical modeling. The wrinkling behaviors, characterized by the wrinkle-to-wrinkle distance (wavelength), wrinkle depth (amplitude) and critical wrinkling stress/strain, are investigated as the geometry and material parameters of the fingertip are varied. A simple reduced model is employed to understand the effect of finger curvature and skin thickness, whereas a more refined full anatomical model provides the basis for analyzing the effect of a multilayered skin structure. The simulation results demonstrate that the stiffness of the stratum corneum and the dermal layer in the skin has a large effect on the wrinkling behavior, which agrees well with the analytical predictions. From the uncovered mechanical principles, potential ways for effectively slowing down and suppressing skin wrinkles are proposed; among them, increasing the modulus of the dermal layer in the skin appears to be the most effective.
    Acta biomaterialia 10/2009; 6(4):1487-96. DOI:10.1016/j.actbio.2009.10.025 · 5.68 Impact Factor
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    • "Indeed, the efficacy of botulinum toxin in treating hyperhidrosis arises from its ability to block the sympathetic innervation of eccrine sweat glands [14]. Although SSR involves the post-ganglionic, unmyelinated sympathetic fibers of the sudomotor pathway [15], as opposed to the vasoconstrictor sympathetic pathway which controls wrinkling [6], the presence of high levels of sympathetic activity may lower the threshold for generating a wrinkling response to any local changes in humidity , such as that produced by water immersion, or to other environmental parameters. However, with sufficient escalation of activity, the increased sympathetic bias alone may prove sufficient to compel such changes without the need for environmental cofactors. "
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    ABSTRACT: Various mechanisms have been argued for skin wrinkling, one of the hallmarks of aging. We hypothesize that chronic sympathetic bias is a previously unrecognized mechanism for wrinkling. In the acute setting of water immersion, reversible skin wrinkling is a well-known reflex mediated by the autonomic nervous system. We postulate that skin wrinkling results as a local maladaptive manifestation of a global chronic sympathetic bias that emerges during aging. The persistence of such changes may induce additional compensatory remodeling to cause permanent alteration of the skin. Sympatholytic agents may prove beneficial for arresting or ameliorating the development of wrinkles. Conditions that amplify sympathetic bias such as stress, smoking, amphetamine abuse, HIV, heart failure, and transplantation may accelerate wrinkling. Other common diseases of the skin may also arise as particular manifestations of aberrant autonomic activity through induction of vascular and immune dysfunctions. The temporal and spatial distribution of these dermatologic conditions may reflect variation of autonomic balance, which also regulates T helper immune balance. For all of these dermatologic conditions, local and systemic administration of drugs and medical devices that pharmacologically or electrically modulate autonomic nervous system activity may yield benefits as well.
    Medical Hypotheses 02/2006; 67(6):1274-6. DOI:10.1016/j.mehy.2005.12.051 · 1.07 Impact Factor
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