Skin Microcirculation Research Articles

Characterization of microvessels in the human forehead dermis using intravascular dual perfusion and immunofluorescence staining

Skin microcirculation provides essential insights in clinical practice. However, the specific characteristics and distribution patterns of dermal microarterioles and microvenules remain insufficiently explored. This study aimed to analyze their structural differences and distribution in the human forehead skin using an innovative intravascular dual perfusion technique combined with immunofluorescence staining to distinguish microvessel types within the dermis. Using two post-mortem cadaver specimens, lead oxide-gelatin perfusion was applied to label microarterioles, and latex was used for microvenules. Tissue sections underwent hematoxylin and eosin and immunofluorescence staining, with cluster of differentiation 31 (CD31) serving as a general vascular marker and monocarboxylate transporter 1 (MCT1) as a venule-specific marker. The analysis revealed significant structural differences between dermal layers: vessels in the deep dermis had larger diameters and thicker walls than those in the superficial layer, while microvessel density was higher in the superficial dermis. These findings demonstrate distinct patterns and significant differences in microvessel distribution between the superficial and deep dermal layers, reflecting their layer-specific functional demands. Furthermore, MCT1 was identified as a specific marker for microvenules, and a novel method combining CD31 and MCT1 immunofluorescent staining was introduced to differentiate dermal microarterioles from microvenules. These results offer valuable implications for surgical planning, skin grafting, and diagnostics related to microcirculation.

Topical Heparin and Heparinoid-Containing Products as Treatments for Venous Disorders: Compounds, Effects, Clinical Implications, and Recommendations.

Background: Although considerable data are available on oral venoactive drugs, very little information has been published on the types and outcomes of topical treatments for venous disease (VD). This comprehensive review assesses the efficacy and safety of topical heparin and heparinoid-containing products (HCPs) for VD treatment. Methods: This narrative review adhered to established methodologies and standards, utilizing the Scale for the Assessment of Narrative Review Articles (SANRA) for quality assessment. A comprehensive literature search was conducted across MEDLINE (PubMed), Scopus, and Web of Science, covering publications from January 1, 1950, to December 1, 2024. Findings were presented in a narrative format, following structured recommendations to ensure clarity and coherence. Results: Topical heparin and HCPs provide anticoagulation, enhance microcirculation, and regulate skin permeability, with effects influenced by the concentration and formulation. While they effectively improve skin microcirculation in healthy individuals, research on their intracellular effects is limited. Mucopolysaccharide polysulfate (MPS) in heparinoids offers similar vascular benefits and promotes antithrombotic and anti-inflammatory actions. Moisture and gentle abrasion enhance heparin absorption. Topical heparin and HCPs effectively treat superficial vein thrombosis (SVT) and varicose veins (VVs). Products like Hirudoid significantly alleviate SVT symptoms, including pain and swelling. Clinical trials demonstrate substantial symptom improvement with heparin gel (1000 IU/g). For varicose veins, Xioglican cream stabilizes symptoms and improves quality of life, while other formulations like Essaven Gel and Venoruton enhance microcirculation. Conclusions: Managing VD with topical treatments is complicated by the outdated literature and inconsistent methodologies. There is a clear need for systematic research to establish guidelines on the administration, dosage, and frequency of topical treatments. The recommendations in this review aim to provide a foundation for future studies to improve the management of SVT and VVs disease.

Impaired microcirculation in the skin and subclinical atherosclerosis in individuals with dysglycaemia in a large population-based cohort

Background and aimDysglycaemia is a known risk factor for cardiovascular disease and microcirculatory dysfunction is associated with an increased cardiovascular disease risk. The aim of this study was to investigate the prevalence of impaired microcirculation, coronary atherosclerosis, and arterial stiffness in individuals with normo- and dysglycaemia.MethodsThe study included 3,300 participants with microcirculatory measurements and information on glycaemic status, aged 50–65 years, from the Linköping site of the Swedish CArdio-Pulmonary bioImage Study (SCAPIS). Microvascular function was assessed in forearm skin using an arterial occlusion and release protocol determining peak blood oxygen saturation (OxyP). Data on pulse wave velocity (PWV) and the Coronary Artery Calcification Score (CACS) were collected. Participants were categorised into three glycaemic categories: normoglycaemia, prediabetes and diabetes.ResultsOxyP was lower in the prediabetes group − 1.2%-units, 95% CI (-1.8 to -0.6) and in study participants with diabetes − 2.4%-units, 95% CI (-3.1 to -1.6) compared to the normoglycaemic group 84.3%, 95% CI (83.6 to 84.9). PWV and CACS were higher in participants with dysglycaemia. Prevalent impaired function at three vascular levels (lowest quartile of OxyP + PWV ≥ 10 m/s and CACS ≥ 100) were observed in 0.8%, 2.3% and 7.6% in the glycaemic categories respectively. The difference between the normoglycaemic and the diabetes category and the difference between the pre-diabetes and the diabetes category was significant, p = < 0.05.ConclusionsPatients with prediabetes and diabetes are more likely to have impaired microcirculation in the forearm skin and macrovascular disorders such as arterial stiffness and atherosclerosis in the coronary arteries compared to normoglycaemic individuals.Graphical abstract

Two-Week Low-Salt Diet Improves Acetylcholine-Induced Microvascular Dilation in Biologically Naïve Psoriasis Patients.

Background/Objectives: Patients with psoriasis exhibit endothelial dysfunction (EDy), which increases their cardiovascular risk. Excessive salt intake impairs endothelium-dependent vascular reactivity. However, research on EDy in psoriasis has focused primarily on larger vessels, leaving skin microcirculation unexplored. This study aimed to investigate the effects of a low-salt diet (LS diet, ~3.75 g/day) on microvascular reactivity in patients with chronic plaque psoriasis. Methods: Laser Doppler flowmetry was used to assess skin microcirculation blood flow in response to vascular occlusion (postocclusive reactive hyperemia, PORH), acetylcholine (acetylcholine-induced dilation, AChID), sodium nitroprusside (SNP-induced dilation, SNPID), and local heating (local thermal hyperemia, LTH). Blood and 24 h urine samples were collected for biochemical and inflammatory parameters and dietary adherence monitoring. Results: The results showed significant reductions in systolic (p = 0.021) and mean arterial blood pressure (p = 0.007) after the LS diet. AChID increased by 16% (p = 0.029) regardless of blood pressure changes, especially in normolipemic, normotensive patients without excess visceral fat. Importantly, significant sex differences were observed, with significant improvement in endothelial function observed only in women (p = 0.031 vs. p = 0.477). PORH did not change significantly; however, a Fourier transformation analysis revealed that the endothelial component of the PORH was significantly improved following the LS diet protocol. The duration of psoriasis negatively correlated with changes in AChID (R = -0.46, p = 0.036) and LTH (R = -0.45, p = 0.041) after the LS diet, indicating that prolonged low-grade inflammation reduced endothelial function reversibility. Additionally, lower triglyceride, uric acid, and BMI levels were significant predictors of better endothelial function improvement following the LS diet. Conclusions: This study supports the beneficial effect of the early introduction of an LS diet in the treatment protocols for patients with psoriasis.

Boosting Skin Microcirculation for Androgenetic Alopecia: Does It Work?

Boosting Skin Microcirculation for Androgenetic Alopecia: Does It Work?

Spatial heterogeneity of skin perfusion and reproducibility of Laser Doppler flowmetry results with thermal functional tests in healthy volunteers

Introduction. Skin microcirculation is characterized by natural spatial and temporal variation of perfusion due to the structure of the cutaneous microvasculature and the influence of regulatory factors.Objective. To evaluate spatial heterogeneity of skin perfusion and inter day individual reproducibility of Laser Doppler flowmetry (LDF) with local thermal tests in healthy volunteers.Materials and methods. The study included 51 healthy volunteers (female/man – 35/16; age 25 [24; 26] years). The study protocol included 2 days of measurements with an interval of 3–7 days. After measuring basic anthropometric and physiological parameters, all subjects underwent LDF on the dorsal and ventral side of the forearm at rest (Mbaseline), then during cooling (Mcold) and heating (Mheat). Comparison of variables on the dorsal and ventral sides of the forearm, as well as assessment of the dynamics of skin perfusion during thermal tests were carried out using the Wilcoxon matched pairs test. The inter-day individual reproducibility of skin perfusion was measured by using the intraclass correlation coefficient (ICC) and coefficient of variation (CV, %). Data are expressed as median and interquartile range.Results. Mbaseline (7.8 [4.8; 11.1]), Mcold (7.5 [4.8; 10.5]) and Mheat 7.5 [4.2; 10.9] in the skin of the dorsum of the forearm were statistically significantly lower (p&lt;0.001) than on the ventral side: Mbaseline 10.4 [5.9; 13.0], Mcold 9.9 [5.6; 13.3], Mheat 9.5 [5.2; 12.5]. When assessing the dynamics of skin perfusion during the thermal tests, statistically significant changes in skin blood flow were revealed, both during cooling and heating on both sides of the forearm (p&lt;0.01 vs Mbaseline). Mcold (CV=8.3 %, ICC=0.56) and Mheat (CV=19.9 %, ICC=0.563) on the dorsal forearm had the best inter-day reproducibility.Conclusion. Skin perfusion, assessed by LDF is statistically significantly higher on the ventral side of the forearm compared to the dorsum . The inter-day reproducibility of LDF during local heating and cooling tests is higher on the skin of the dorsal side of the forearm than on the ventral side.

Photoplethysmography in assessment of skin microcirculation in pregnant women with gestational arterial hypertension

Introduction. One of the urgent problems of modern obstetrics is gestational arterial hypertension (GAH), which entails a whole range of complications for both mother and fetus. In this regard, it is necessary to search for economically accessible, informative and safe methods for early diagnosis of uteroplacental blood flow disorders in pregnant women.The aim of the study was to investigate the features of peripheral and uteroplacental blood flow in pregnant women with GAH, to assess the state of the vascular wall of pregnant women using photoplethysmography and to determine its association with uteroplacental blood flow disorders. Materials and methods. A total of 78 patients with 22 to 40 weeks of pregnancy, divided into two groups, were clinically examined: the first group (n=42) were pregnant women with GAH, the second group the control group (n=36) consisted of patients with physiological course of gestation. The study included assessment of the objective clinical status of the pregnant woman, recording and contour analysis of photoplethysmograms, ultrasound examination of the uteroplacental and fetoplacental blood flow, and statistical processing of the results.Results. When comparing the anthropometric characteristics of the studied groups, an increase in BMI was found in the group of pregnant women with GAG (p&lt;0.05). Contour analysis of photoplethysmography (PPG) data showed an increase in the augmentation index in pregnant women with GAG by 73.47 % (p=0.054), an increase in central arterial pressure by 3.6 % (p&lt;0.05). Changes in peripheral hemodynamics in pregnant women with hypertensive disorder were associated with impaired fetoplacental blood flow (rxy = 0.52-0.86, p &lt; 0.05), which was accompanied by lower fetal biometry parameters (p&lt;0.05).Conclusion. Hemodynamic disturbances in the mother-placenta-fetus system correlate with changes in the parameters of peripheral circulation, which allows us to consider the additional use of the photoplethysmography method as promising in terms of early diagnostics and prevention of perinatal complications in mother and fetus.

Relationship between skin temperature and blood flow during exposure to radio frequency energy: implications for device development

BackgroundThe ST response to high frequency EM heating may give an indication of rate of BF in underlying tissue. This novel method, which we have termed REFLO (Rapid Electromagnetic Flow) has potential for applications such as detection of PAD. The method utilizes the relationship between blood flow rate and tissue temperature increase during exposure to radio frequency (RF) energy. We are developing an REFLO device to screen for peripheral artery disease (PAD). PAD is characterized by impaired blood flow to the legs, as reflected in the skin microcirculation. The REFLO system incorporates a radio frequency transmitter and a compact transducer housing a micropatch antenna and an infrared (IR) temperature sensor. At high RF frequencies (> 6 GHz) tissue heating is confined to the skin, such that an indication of blood flow may be inferred from the temperature response to controlled heating. The objective of this study is to determine the extent to which the magnitude and depth of heating as well as device sensitivity are functions of (i) RF frequency and (ii) thickness of the dermal tissue layer.ResultsResults show that it is feasible to measure blood flow rate with REFLO technology. Surface temperature increases were found to be more dependent upon the magnitude of power absorption than location of absorption within the skin. While surface temperature response does depend upon radio wave frequency and thickness of the dermis layer, such dependencies are mild. Sensitivity to blood flow rate was found to be proportional to the magnitude of absorbed power.ConclusionResults show that it is feasible to discriminate between blood flow rates using REFLO technology at frequencies within the 10–94 GHz range. All frequencies analyzed produced similar levels of sensitivity to blood flow rate despite significant differences in penetration depth. These results are being used in the development of a preclinical prototype for quick and easy detection of asymptomatic PAD in humans.

Sex and age-related day-to-day variability in the skin microcirculation during post-occlusive reactive hyperemia.

Little is known about the day-to-day variability of different skin microcirculation parameters, and how this variability is influenced by age and sex. The aim was to examine the day-to-day variability of microcirculatory parameters in relation to age and sex. The cutaneous microcirculation was measured using a fiber optic probe integrating laser Doppler flowmetry (LDF) and diffuse reflectance spectroscopy (DRS) to measure oxygen saturation, red blood cell (RBC) tissue fraction, speed-resolved and conventional perfusion. Measurements at two separate days were compared during baseline, a 5-min occlusion and during the following post-occlusive reactive hyperemia (PORH) period on the volar forearm and dorsal foot in totally 48 men and women aged 20-30 and 50-60 years, respectively. Variability was expressed as the coefficient of variation CV and repeatability as the intraclass correlation coefficient ICC. Peak oxygen saturation during PORH had the lowest day-to-day variability for the forearm (CV = 2.1 %) and the foot (CV = 3.8 %) as well as an excellent repeatability (ICC = 0.80 and ICC = 0.82, respectively). Older women had a higher day-to-day variability in baseline conventional perfusion compared to younger women on the forearm (p = 0.007). On the foot, older women had a lower day-to-day variability than younger women for baseline oxygen saturation (p = 0.006) and peak RBC tissue concentration (p = 0.008). Older men had a lower day-to-day variability than younger men for baseline oxygen saturation (p = 0.012) but a higher variability for baseline and peak RBC tissue concentration (p = 0.008 and p = 0.002) on the foot. Peak oxygen saturation had the lowest day-to-day variability of the measured parameters. A lower value of peak oxygen saturation has previously been associated with increasing systematic coronary risk implying that this is a suitable parameter for measuring microcirculatory dysfunction. Sex and age only affected the day-to-day variability of very few parameters.

Assessment of skin microcirculation in different morphotypes of face and neck aging

Annotation. Objective – to establish the relationship between facial aging morphotypes and skin microcirculation indicators, which may form the basis for improving diagnostic and treatment methods for age-related changes. The study included 52 female patients aged 50 and older. Among the examined patients, the following facial aging morphotypes were identified: gravitational (28.8%), fine-wrinkled (15.4%), deformational (34.6%), and combined (21.2%). The microcirculation of the face was studied by the method of laser Doppler flowmetry. To obtain statistical data, we calculated the average arithmetic value (M), the probability of differences in the results of the study (p) relative to the indicators of different groups. The results were considered statistical when the probability ratio was less than or equal to 0.05. The microcirculation index in patients with the fine-wrinkled morphotype was significantly lower than that in individuals with the deformational morphotype by 1.5 times (p=0.005). There was also a significant difference between the microcirculation index in patients with gravitational and fine-wrinkled morphotypes (p=0.03), gravitational and combined morphotypes (p=0.04), and fine-wrinkled and combined morphotypes (p=0.002). So the best facial microcirculation indicators were found in patients with deformational and combined aging morphotypes, while the lowest were observed in patients with gravitational and fine-wrinkled morphotypes. Future research should focus on studying the relationship between microcirculatory disorders and morphological changes in the skin across different aging types, which may contribute to the development of new methods for preventing and treating age-related skin changes.

Impairment of Microcirculation Parameters in Patients with a History of Diabetic Foot Ulcers.

Background and Objectives: According to the International Working Group on Diabetic Foot (IWGDF) risk classification, the estimated risk of developing a diabetic foot ulcer (DFU) is much higher in patients with a history of DFUs (Grade 3) compared to those with a peripheral neuropathy but without a history of DFUs (Grades 1 and 2). It has been suggested that microcirculation impairment is involved in DFU genesis and could be taken into account to refine the existing risk classification. The aim of this study was to evaluate microcirculation parameters in patients with diabetes according to their estimated DFU risk. Materials and Methods: A total of 172 patients with type 2 diabetes associated with a peripheral neuropathy and/or a history of DFUs were included and classified into two groups (Grade 1-2 and Grade 3) according to the IWGDF classification. All patients underwent an evaluation of peripheral neuropathy, plantar sudomotor function, and skin microcirculation parameters. These different parameters were compared between both groups. Results: There was no significant difference between the two groups in terms of age, diabetes duration, transcutaneous oxygen pressure level, skin microcirculatory reactivity, neuropathy disability score, neuropathy symptom score, or thermal sensitivity. Patients in Grade 3 were more likely to present with retinopathy (OR 3.15, 95%CI [1.53; 6.49]) and severe sudomotor dysfunction (OR 2.73 95%CI [1.29; 5.80] but less likely to have abnormal VPT (OR 0.20 95%CI [0.05; 0.80]). Conclusions: The present study found more retinopathy and a more pronounced alteration to sudomotor function in Grade 3 patients, suggesting that these parameters could be considered to better identify patients at high risk of DFUs.

Soluble P-Selectin as an Indicator of Cutaneous Microangiopathy in Uncomplicated Young Patients with Type 1 Diabetes.

This study aimed to analyze the relationship between cutaneous microcirculation reactivity, retinal circulation, macrocirculation function, and specific adhesion molecules in young patients with uncomplicated type 1 diabetes. Fifty-five patients with type 1 diabetes mellitus (T1DM), aged 8 to 18 years, were divided into subgroups based on skin microcirculation reactivity. The cutaneous microcirculatory vessels were considered reactive if post-test PORH coverage increased compared to pre-test coverage. Optical coherence tomography (OCT) was conducted to detect early retinopathic changes. Macrocirculation was described using pulsatility indices (PIs) determined for common carotid (CCA) and peripheral arteries of the upper and lower limbs. The ankle-brachial index was also assessed. There were no significant differences in retinal circulation and macrocirculation between the studied subgroups. However, there were significant differences between the various subgroups concerning the age at onset of diabetes and the sP-selectin levels but not ICAM-1 and sVCAM-1. The sP-selectin differences remained true after adjusting for age at onset. The sP-selectin level was significantly higher in the subgroup of patients with non-reactive cutaneous microcirculation. The results of our study indicate that sP-selectin may be considered as an immunological marker for cutaneous abnormalities, which serve as an early indicator of endothelial dysfunction in young patients with type 1 diabetes in the absence of classical complication.

556 Topically applied N,N-dimethylglycine sodium salt enhances human skin microcirculation by inducing endothelial nitric oxide release

556 Topically applied N,N-dimethylglycine sodium salt enhances human skin microcirculation by inducing endothelial nitric oxide release

Characterization of microcirculatory endothelial functions in a D-Galactose-induced aging model

Characterization of microcirculatory endothelial functions in a D-Galactose-induced aging model

Effect of ultrahigh frequency ozone therapy on oxidative metabolism in the blood of rats with ischemic skin flaps: A preclinical experimental randomized study

Background. Maintaining and restoring skin microcirculation in surgical flaps, as well as accelerating rehabilitation after skin flap transplantation, in order to mitigate the consequences of burns and injuries, remain a pressing issue. In addition to various timings and techniques for plastic surgery, physiotherapeutic approaches prove to be efficient and include low-intensity electromagnetic radiation in millimeter waves as their prominent techniques. In recent years, experts have paid an increasing attention to the application of low-intensity electromagnetic radiation across different frequency ranges for the enhancement of microcirculation in patients after surgical correction of burn consequences. However, this approach is yet to be further validated. Objective. To investigate the effect of different combinations of ultrahigh frequency electromagnetic radiation with ozone therapy on the oxidative metabolism of blood in rats using a model of ischemic skin flaps. Methods. A preclinical experimental randomized study was conducted on 100 adult male Wistar rats weighing between 200 and 250 grams. Five equal-sized groups of animals were formed in the study: Group 1: intact (no interventions), and Groups 2, 3, 4, and 5: after surgical intervention (modeling of ischemic skin flaps). Animals in Group 2 (control group) received no therapeutic procedures. Rats in Groups 3 and 5 underwent a 10-minute course of electromagnetic radiation exposure with a dose of 0.06 mJ for seven days. Animals in Group 3 were exposed to electromagnetic radiation of ultrahigh frequency with a range of 53–78 GHz. Animals in Group 4 received injections of ozonized saline solution (with a saturating ozone concentration in the ozonized oxygen mixture of 3000 µg/L) daily for 7 days, administered intraperitoneally at a volume of 1 mL. Group 5 underwent a combined treatment: daily exposure to ultrahigh frequency electromagnetic radiation along with intraperitoneal ozone therapy (the application modalities of these treatments were similar to those used in Groups 3 and 4, respectively). The intensity of lipid peroxidation, peroxide resistance in erythrocytes, and overall antioxidant system activity were assessed in order to investigate the balance of pro- and antioxidant systems in plasma and erythrocytes. Additionally, the study involved determination of the level of malondialdehyde content and evaluation of the activity of superoxide dismutase and catalase in erythrocytes. The obtained date were analyzed, using MS Office 2013 (Microsoft Corporation, USA) and Statistica 10 (StatSoft, USA). Results. The conducted analysis revealed an antioxidant effect from ultrahigh frequency electromagnetic radiation, with this effect being enhanced by ozone therapy. In addition, the study detected the inhibition of free radical oxidation under the ultrahigh frequency electromagnetic radiation and ozone therapy. Conclusion. Thus, the positive effects of the studied therapeutic factors manifest at the systemic level, as evidenced by the optimization of biochemical parameters and indicators of oxidative metabolism in the plasma of animal blood. It has been established that ultrahigh frequency electromagnetic radiation, administered in a noise mode, exerts a regulatory effect on pro- and antioxidant systems in the body, as demonstrated in a model of transplanted skin flap. This intervention leads to a reduction in the severity of oxidative stress and an enhancement of antioxidant reserves in the blood. The observed effect is further amplified with the additional application of ozone therapy.

The relationship of hemorheological blood values and blood velocity of microcirculatory bloodstream in rats` skin vessels

Non-invasive study of blood rheology is relevant, but quite complex issue. When systemic blood viscosity and hematocrit levels deviate, blood flow indicators in different parts of microvasculature change. Purpose of the study – research of blood flow characteristics in skin microcirculatory bloodstream of rats obtained by high-frequency ultrasound Dopplerography (HFUD) with given changes in rheological blood indicators. The studies were carried out on pubescent male Wistar rats. 3 experimental groups were formed. Group 1 (n = 21) “Hemodilution” – viscosity 1.99 ± 0.02 mPa*s, hematocrit 31.48 ± 0.31%. Group 2 (n = 32) “Reference values” – animals with unchanged blood levels – viscosity 2.84 ± 0.03 mPa*s, hematocrit 41.60 ± 0.3%. Group 3 (n = 32) “Erythrocytosis” – viscosity 3.95 ± 0.04 mPa*s, hematocrit 54.56 ± 0.23%. Dynamic blood viscosity in vitro studies were carried out on oscillatory viscometer. In order to evaluate hematocrit level heparinized whole blood was centrifuged in glass capillaries using; hematocrit values were assessed taking into account sedimentation of formed elements column using a hematocrit reader card. Blood flow in skin microcirculatory bloodstream of rats` left thigh area was estimated by HFUD method using Minimax-Doppler-K hardware and software system, with ultrasound transducer (frequency 20 MHz). Statistical analysis showed the models are correct. Blood indicators of the animals in three experimental groups differed statistically and significantly in terms of blood viscosity and hematocrit. Discriminant analysis was used to determine the relations between rheological blood parameters and characteristics of blood velocity in microcirculatory bloodstream which made it possible to identify the most significant characteristics of blood flow that tend to change depending on altered blood composition. These include: mean systolic velocity Vas (p 0.01), mean velocity Vam (p 0.001), mean volume velocity Qam (p 0.001), vascular resistance index RI (p 0.01) and the percentage of blood cells moving in low-speed H' (p = 0.03). The reliability of selected characteristics was checked with one-way analysis of variance; and their significance in determining membership in “Hemodilution”, “Reference values” or “Erythrocytosis” groups according to HFUD data was confirmed. Based on this analysis classification functions were generated for non-invasive dynamic blood viscosity determination according to ultrasound Dopplerography data.

Correlation of Nail Capillary Morphology with Metabolic Syndrome and Disease Severity in Psoriatic Patients

Abstract Background Capillaroscopy is a non-invasive technique which allows direct, in vivo imaging of skin microcirculation to detect microvascular abnormalities. An important association of psoriasis is metabolic syndrome, with a prevalence of 40% in psoriatic patients. Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. Patients with metabolic syndrome have an increased risk for cardiovascular diseases and atherosclerosis. Aim of the Work Describe the morphology, frequency and extent of nailfold capillary changes in psoriatic patients and identify patients’ characteristics possibly associated with such changes. Study if nail capillaroscopy can detect early endothelial dysfunction, occurring in psoriasis patients with metabolic syndrome, at the level of the dermal capillary microvasculature. Settings and Design cross-sectional study Materials and Methods Sixty five psoriasis patients were divided into two groups according to the presence or absence of metabolic syndrome. Naill capillaroscopy was done and compared between both groups. Results Psoriatic patients with metabolic syndrome showed significant differences in nail capillarascopy findings compared to those without metabolic syndrome, reflecting the greater endothelial dysfunction. Conclusion nail capillaroscopy can be a very important tool in detecting early endothelial dysfunction in psoriatic patients manifested by edema and tortuous capillaries. Moreover, it can reflect the degree of vascular compromise allowing proper identification of patients at high risk for cardiovascular events, which warrants aggressive early treatment

12. Vascular pain: Ischemic pain in the extremities and Raynaud's syndrome

Peripheral artery diseases (PAD) and Raynaud's syndrome are associated with substantial morbidity. PAD, through the restriction of blood flow to the extremities, may lead to critical limb ischemia with symptoms of pain at rest which may eventually progress to severe limb ischemia with gangrene. This serious and painful clinical condition requires extensive medical care, is limb-threatening and, in case of delayed or unsuccessful treatment, is associated with a high mortality rate. In Raynaud's syndrome, the blood supply to certain parts of the body, usually the fingers and toes and less frequently the nose or ears, is restricted because of vasculopathy of the smaller vessels at acral sites. Under certain circumstances, with cold as the most well-known provoking factor, blood flow restriction occurs, leading to demarcated color changes and symptoms such as pain, paresthesia, and numbness. In severe cases of Raynaud syndrome tissue ischemia may lead to necrosis and the need for amputation of the affected area. In this narrative review, the literature on the diagnosis and interventional pain treatment of PAD and Raynaud's syndrome was updated and summarized. This review focused on interventional pain treatment. In PAD, the effects of the intervention on limb salvage, ulcer healing, and ischemic pain were summarized. Additionally, results with respect to skin microcirculation and quality of life were reported if available. In Raynaud's syndrome, we focused on the effect of the intervention on peripheral blood flow metrics and pain intensity during attacks. In PAD, prevention and treatment of risk factors are important. Initially, conservative treatment and pharmacological therapy are preferred first-line therapies. However, when disease progression occurs, interventional management may be considered. The literature search yielded conflicting evidence for sympathectomy as a treatment for PAD. Spinal cord stimulation (SCS) as a treatment modality for advanced PAD had high-quality evidence for limb salvage in subgroups of patients but conflicting evidence for other outcome measures such as pain, wound healing, and quality of life. The literature search for interventional pain management in Raynaud's syndrome was limited to only one randomized controlled trial (RCT) studying the effect of thoracic sympathectomy. This study had several limitations and hence the level of evidence for this interventional treatment is very low. No RCTs studying SCS in patients with Raynaud's syndrome were found. In both PAD and Raynaud's syndrome, additional RCTs are needed to substantiate interventional (pain) management and bolster the evidence base for sympathectomy and SCS as treatment options.

The Sensory Neuron-Mast Cell Axis Regulation of Skin Microcirculation in Diabetes: Implication for Diabetes-Related Cutaneous Complications.

The Sensory Neuron-Mast Cell Axis Regulation of Skin Microcirculation in Diabetes: Implication for Diabetes-Related Cutaneous Complications.

Management of triggering factor effects in sensitive skin syndrome with a dermo-cosmetic product.

Environmental factors are important in the generation or aggravation of sensitive skin syndrome (SSS). Creams can be useful for patients with SSS, particularly when triggering factors cannot be avoided. Several clinical studies have investigated the safety and efficacy of specific creams in patients with SSS, but the majority were assessed with a single type of triggering factor and were non-comparative. Therefore, this study's aim was to investigate, the benefit of a specific dermo-cosmetic product in response to physical and chemical factors in subjects with SSS. Three clinical studies were performed on subjects presenting SSS. The physical impact was assessed in a stripping test, and in a randomized intra-individual study with a newly developed heat-cold stress model. To assess chemical factors, a capsaicin test on the nasolabial fold was performed. The product significantly reduced the increase in skin microcirculation caused by stripping after 30 min versus. The untreated condition (45.8% vs. 62.0%; p < 0.01). Immediately and at D28, the product induced a significant increase in skin hydration even after a heat-cold stress, while the overall score of unpleasant symptoms significantly decreased compared with the control (8.1 vs. 10.7 and 3.7 vs. 8.0, respectively; p < 0.01). Regarding chemical factors, a significant difference in the sensation intensity (p < 0.001) was observed after capsaicin stress, also in terms of the sensation duration due to the product application versus the control (192 s vs. 403 s; p < 0.001). These studies show that topical application of a dermo-cosmetic product can prevent unpleasant symptoms and improve the skin state in SSS exposed to physical and chemical triggering factors.