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J Appl Physiol 105: 384, 2008; doi:10.1152/japplphysiol.00159.2008
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LETTER TO THE EDITOR

Commentary on Viewpoint: The human cutaneous circulation as a model of generalized microvascular function

TO THE EDITOR: Can we use skin as a surrogate for generalized microvascular function (3)? If only it were unambiguously true. I wish to inject a note of caution. On the one hand, skin contains the most easily accessed and manipulated microvasculature. Also, cutaneous microvascular abnormalities are invariably found in generalized systemic illnesses such as diabetes, heart disease, and aging, which affect all microvessels. This argues in favor of using skin microvessels as a surrogate for other microvasculature. On the other hand, it remains unclear whether cutaneous pathophysiology during generalized illness is caused by the actual mechanisms of disease or whether it is an end organ effect depending on disease presence. Each regional microcirculation has specific structures and functions: the skin is highly specialized in anatomy (1) and autonomic physiology, which combine to optimize its primary thermoregulatory function. Specialization makes for special physiology. For example, autonomic physiology forms an essential framework for vascular control and is unique in the skin, which has a potent active vasodilation mechanism. The skin has a limited response to baroreflex mediated input (5), diminished β2-adrenergic response (4), contributes little to systemic arterial resistance during euthermia, but has a most potent venoarteriolar response (2). Local vasoregulation by autocrine and paracrine mechanisms may be shared among microvascular circulations and thus, cutaneous endothelial mechanisms share many features with other microcirculations. Even here caveats are warranted: for example, cutaneous reactive hyperemia appears to be nitric oxide independent (6). So, is the skin a useful surrogate for other microvasculature? Depends.

FOOTNOTES


Address for reprint requests and other correspondence: J. Steward, Suite 3050, 19 Bradhurst Ave., Hawthorne, NY 10532 (e-mail: stewart{at}nymc.edu)

REFERENCES

  1. Braverman IM. The cutaneous microcirculation. J Investig Dermatol Symp Proc 5: 3–9, 2000.[CrossRef][Web of Science][Medline]
  2. Henriksen O, Nielsen SL, Paaske WP, Sejrsen P. Autoregulation of blood flow in human cutaneous tissue. Acta Physiol Scand 89: 538–543, 1973.[Web of Science][Medline]
  3. Holowatz LA, Thompson-Torgerson CS, Kenney WL. Viewpoint: The human cutaneous circulation as a model of generalized microvascular function. J Appl Physiol; doi:10.1152/japplphysiol.00858.2007.[Free Full Text]
  4. Koss MC. Characterization of adrenoceptor subtypes in cat cutaneous vasculature. J Pharmacol Exp Ther 254: 221–227, 1990.[Abstract/Free Full Text]
  5. Wilson TE, Cui J, Crandall CG. Absence of arterial baroreflex modulation of skin sympathetic activity and sweat rate during whole-body heating in humans. J Physiol 536: 615–623, 2001.[Abstract/Free Full Text]
  6. Zhao JL, Pergola PE, Roman LJ, Kellogg DL Jr. Bioactive nitric oxide concentration does not increase during reactive hyperemia in human skin. J Appl Physiol 96: 628–632, 2004.[Abstract/Free Full Text]

Julian Stewart
 Pediatrics, Physiology, Medicine, New York Medical College, Valhalla, New York





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