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: 2.28). 03/2003; 27(3):307-11. DOI: 10.1002/mus.10323
Source: PubMed


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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    • "Water-induced wrinkling of human non-hairy (glabrous) skin of the fingers, palms and soles is an as yet not fully understood phenomenon influenced by water temperature, pH, and tonicity [1], [2]. Interestingly, glabrous skin that lacks sweat glands, like the clitoris and glans penis, does not wrinkle after water immersion [3]. In the 1930s, Lewis and Pickering first described the absence of wrinkling in patients with median nerve palsy which suggested that the nervous system plays a central role in wrinkling [4]. "
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    ABSTRACT: Human non-hairy (glabrous) skin of the fingers, palms and soles wrinkles after prolonged exposure to water. Wrinkling is a sympathetic nervous system-dependent process but little is known about the physiology and potential functions of water-induced skin wrinkling. Here we investigated the idea that wrinkling might improve handling of wet objects by measuring the performance of a large cohort of human subjects (n = 40) in a manual dexterity task. We also tested the idea that skin wrinkling has an impact on tactile acuity or vibrotactile sensation using two independent sensory tasks. We found that skin wrinkling did not improve dexterity in handling wet objects nor did it affect any aspect of touch sensitivity measured. Thus water-induced wrinkling appears to have no significant impact on tactile driven performance or dexterity in handling wet or dry objects.
    PLoS ONE 01/2014; 9(1):e84949. DOI:10.1371/journal.pone.0084949 · 3.23 Impact Factor
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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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    • "The finger wrinkling test could be a complementary test to the above-mentioned tests, because one assumes that this test evaluates the autonomic nervous system of the limbs [4, 5]. The main underlying mechanism of wrinkling during water immersion is vasoconstriction by sympathetic input [6]. During the finger wrinkling test a hand is immersed in water at 40°C for 30 min [5] and the amount of wrinkling is subsequently evaluated. "
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    ABSTRACT: Tilt table testing mainly evaluates the systemic cardiovascular part of the autonomic nervous system, while it is assumed that the finger wrinkling test assesses the peripheral part of the autonomic nervous system. In this study we explored whether the finger wrinkling test could be a useful test for autonomic dysfunction and whether the clinical evaluation of wrinkling can be improved by digital analysis of photographs. As much as 20 healthy subjects and 15 patients underwent tilt table testing and finger wrinkling testing. During the finger wrinkling test the right hand was immersed in water at 40 degrees C. The degree of wrinkling was assessed with a 5-point clinical scale at baseline, 5, 15 and 30 min of immersion. Photographs were taken at the same intervals. Several features were evaluated using digital analysis: length and gradient of automatically detected wrinkle and mean, maximum, minimum, variance and derivative of grey value of pixels. Clinical scoring of wrinkling allowed differentiation between healthy subjects and patients with a normal and an abnormal response to tilt table testing. Relevant features obtained with digital analysis were mean grey value and the gradient of automatically detected wrinkle. McNemar's test showed no difference in test results between the tilt table test and the finger wrinkling test with a kappa of 0.68. The finger wrinkling test can be used as a screening test before tilt table testing. Visual evaluation of wrinkling is still superior to digital analysis of photographs.
    Clinical Autonomic Research 05/2010; 20(4):249-53. DOI:10.1007/s10286-010-0071-9 · 1.49 Impact Factor
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