Augmented supraorbital skin sympathetic nerve activity responses to symptom trigger events in rosacea patients

Abstract

Facial flushing in rosacea is often induced by trigger events. However, trigger causation mechanisms are currently unclear. This study tested the central hypothesis that rosacea causes sympathetic and axon reflex-mediated alterations resulting in trigger-induced symptomatology. Twenty rosacea patients and age/sex-matched controls participated in one or a combination of symptom triggering stressors. In protocol 1, forehead skin sympathetic nerve activity (SSNA; supraorbital microneurography) was measured during sympathoexcitatory mental (2-min serial subtraction of novel numbers) and physical (2-min isometric handgrip) stress. In protocol 2, forehead skin blood flow (laser-Doppler flowmetry) and transepithelial water loss/sweat rate (capacitance hygrometry) were measured during sympathoexcitatory heat stress (whole body heating by perfusing 50°C water through a tube-lined suit). In protocol 3, cheek, forehead, forearm, and palm skin blood flow were measured during nonpainful local heating to induce axon reflex vasodilation. Heart rate (HR) and mean arterial pressure (MAP) were recorded via finger photoplethysmography to calculate cutaneous vascular conductance (CVC; flux·100/MAP). Higher patient transepithelial water loss was observed (rosacea 0.20 ± 0.02 vs. control 0.10 ± 0.01 mg·cm(-2)·min(-1), P < 0.05). HR and MAP changes were not different between groups during sympathoexcitatory stressors or local heating. SSNA during early mental (32 ± 9 and 9 ± 4% increase) and physical (25 ± 4 and 5 ± 1% increase, rosacea and controls, respectively) stress was augmented in rosacea (both P < 0.05). Heat stress induced more rapid sweating and cutaneous vasodilation onset in rosacea compared with controls. No axon reflex vasodilation differences were observed between groups. These data indicate that rosacea affects SSNA and that hyperresponsiveness to trigger events appears to have a sympathetic component.

Noninvasive objective skin measurement methods for rosacea assessment: a systematic review

“…In general, a wide range of TEWL values was reported (11·5–35·8 g m ‐2 h −1 ). Patients showed higher TEWL values compared with controls . However, some studies showed no differences at the nasolabial fold, lateral chin, forehead and nose .…”

“…Transepidermal water loss (TEWL) was assessed in 16 studies . TEWL is widely accepted as a reference parameter to investigate epidermal permeability barrier function .…”

“…91 Seven studies used open measurement chambers, 75,77,80,83,[86][87][88] two studies unventilated closed measurement chambers, 66,90 and in seven studies the measurement principle was not specified. 73,74,76,81,84,85,89 In general, a wide range of TEWL values was reported (11Á5-35Á8 g m -2 h À1 ). Patients showed higher TEWL values compared with controls.…”

Relationship between rosacea and dietary factors: A multicenter retrospective case–control survey

“…However, it is not always made at high temperatures. 36 Clinically, a-adrenergic or b-adrenergic receptors blockers contribute to telangiectasia by modulating neuronal dysregulation in rosacea. 31 Therefore, we thought the risks of tea may be because of its own properties.…”

Pathogenese und Klinik der Rosazea als Schlüssel für eine symptomorientierte Therapie

“…Vermutlich reagieren betroffene Patienten stärker und länger auf physiologische oder pathophysiologische Stimuli, was zu einer Aktivierung des autonomen und/oder sensorischen Nervensystems der Haut führt . Ionenkanälen vom Typ TRP ( transient receptor potential ) auf Nerven und/oder Endothelzellen , Stickstoffmonoxid (NO) und Neuropeptiden wie Substanz P oder PACAP ( pituitary adenylate cyclase‐activating polypeptides ) kommen hierbei wahrscheinlich eine kritische Bedeutung zu.…”