Skin Wrinkling for the Assessment of Sympathetic Function in the Limbs

Vasudevan, Thodur; Rij, André M. van; Nukada, Hitoshi; Taylor, P.

doi:10.1046/j.1440-1622.2000.01744.x

Cited by 40 publications

(22 citation statements)

References 10 publications

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“…In the study, patients with symptomatic peripheral vascular disease were screened for potential chemical lumbar sympathectomy using three tests of sympathetic function. The presence of sole skin wrinkling was shown to identify intact sympathetic innervation as well as or better than two other tests of sympathetic function (starch-iodine test and the sympathetic skin response) [19]. Importantly, this study also showed that peripheral artery disease of the leg did not affect wrinkling.…”

Section: Observational Studiessupporting

confidence: 52%

“…Two studies have attempted to correlate wrinkling with other measures of autonomic dysfunction [6,19]. The first, conducted in diabetics, correlated cardiovascular tests of autonomic function with water immersion skin wrinkling.…”

Section: Observational Studiesmentioning

confidence: 99%

“…Interestingly, peripheral arterial disease has been shown not to interfere with wrinkling (in the absence of edema and neuropathy) [19]. The most likely explanation is that volume changes and not hemodynamics are the primary prerequisite for wrinkling.…”

Section: Factors Affecting Water Immersion Skin Wrinklingmentioning

confidence: 99%

“…The term describes the reversible undulations of the surface skin that occur after 5 to 30 minutes of water immersion. Based on clinico-pathological correlations gathered over 70 years, this phenomenon has been adapted as a bedside test of limb sympathetic nerve function [2,3,6,9,14,18,19].Although water immersion skin wrinkling is a simple and convenient way of determining intactness of the sympathetic neural supply to the hands and feet, the test is associated with problems of endpoint assessment. Test quantification is based on visual assessment of the degree of skin wrinkling after water immersion and is open to considerable variation in interpretation due to its subjective nature.…”

Section: Introductionmentioning

confidence: 99%

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Water immersion wrinkling

Wilder-Smith

2004

Clinical Autonomic Research

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Water immersion skin wrinkling is an indicator of limb sympathetic function. Routine clinical usage of this enigmatic phenomenon is hampered by poor endpoint quantification, which involves counting skin folds. The recent discovery of the importance of vasoconstriction in immersion wrinkling suggests digital blood flow or volume changes as better endpoints. Water probably initiates the wrinkling process by altering epidermal electrolyte homeostasis as it diffuses into the porous skin of the hands and soles via its many sweat ducts. Altered epidermal electrolyte homeostasis would lead to a change in membrane stability of the surrounding dense network of nerve fibers and trigger increased vasomotor firing with subsequent vasoconstriction. Vasoconstriction, through loss of volume, leads to negative digit pulp pressure resulting in a downward pull on the overlying skin, which wrinkles as it is distorted. The degree of wrinkling would directly depend on the change in digit tip volume and implies any process inducing loss of digit volume will precipitate wrinkling. This review discusses the physiology of water immersion wrinkling and explores its potential as an indicator of limb sympathetic dysfunction.

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Section: Observational Studiessupporting

confidence: 52%

Section: Observational Studiesmentioning

confidence: 99%

Section: Factors Affecting Water Immersion Skin Wrinklingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Water immersion wrinkling

Wilder-Smith

2004

Clinical Autonomic Research

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“…In combination with the mechanical properties of the glabrous finger skin, this reduction in pulp volume results in the typical pattern of ridges and valleys on the tips of fingers and toes [1]. The dependence of finger wrinkling on the autonomic nervous system has led to the use of finger wrinkles as a clinical indicator of autonomic function [2,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Water-induced finger wrinkles improve handling of wet objects

2013

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Upon continued submersion in water, the glabrous skin on human hands and feet forms wrinkles. The formation of these wrinkles is known to be an active process, controlled by the autonomic nervous system. Such an active control suggests that these wrinkles may have an important function, but this function has not been clear. In this study, we show that submerged objects are handled more quickly with wrinkled fingers than with unwrinkled fingers, whereas wrinkles make no difference to manipulating dry objects. These findings support the hypothesis that water-induced finger wrinkles improve handling submerged objects and suggest that they may be an adaptation for handling objects in wet conditions.

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Water‐immersion wrinkling is due to vasoconstriction

Wilder-Smith

Chow

2003

Muscle and Nerve

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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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Skin Wrinkling for the Assessment of Sympathetic Function in the Limbs

Cited by 40 publications

References 10 publications

Water immersion wrinkling

Water immersion wrinkling

Water-induced finger wrinkles improve handling of wet objects

Water‐immersion wrinkling is due to vasoconstriction

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