Shashi Gunda

Skin heat dissipation: the influence of diabetes, skin thickness, and subcutaneous fat thickness.

BACKGROUND It is well established that diabetes impairs vascular endothelial function. However, the impact of impaired endothelial function on thermal conductivity of the skin, especially in relation to a constant versus a sudden heat stress, has not been established. Further, there is some evidence that aging reduces skin dermal thickness and subcutaneous fat thickness. Since these are important determinates of heat dissipation by the skin, these parameters also need to be examined in people with diabetes. METHODS Ninety subjects (30 younger individuals, 30 patients with diabetes, and 30 patients age-matched to the diabetes subjects) participated in two series of experiments to determine (1) the thickness of the subcutaneous fat layer and skin thickness and the skin response to a sudden heat stress and (2) the response to a continuous heat stress on the lower back. Skin thickness and subcutaneous fat thickness were assessed by ultrasound, and skin blood flow was examined by infrared laser Doppler flow meter. RESULTS People with diabetes had significantly less resting blood flow, blood flow in response to a single or continuous heat load, less subcutaneous fat, and thinner skin than either age-matched controls or younger people (P < 0.05). Subjects with diabetes also had the lowest concentration of red blood cells in their skin, implying a reduction in the number of capillaries in the skin. CONCLUSIONS Thinning of the skin and probably a reduction in capillaries in the dermal layer contribute to a reduction in the blood flow response to heat. People with diabetes, in particular, have reduced skin heat dissipation because of less resting blood flow and thinner skin than that seen in age-matched controls.

Dry heat, moist heat and body fat: are heating modalities really effective in people who are overweight?

Surface heating modalities are commonly used in physical therapy and physical medicine for increasing circulation, especially in deep tissues, to promote healing. However, recent evidence seems to indicate that in people who are overweight, heat transfer is impaired by the subcutaneous fat layer. The present investigation was conducted on 10 subjects aged 22–54 years, whose body mass index averaged 25.8±4.6. Subcutaneous fat above the quadriceps muscle varied from 0.51 to 0.86 cm of thickness. Three heating modalities were examined: the application of dry heat with a commercial chemical heat pack, hydrocollator heat packs (providing a type of moist heat), and a whirlpool, where conductive heat loss through water contact would be very high. The temperature of the skin and the temperature in the muscle (25 mm below the skin surface) were assessed by thermocouples. The results of the experiments showed that for heating modalities that are maintained in skin contact for long periods of time, such as dry heat packs (in place for 6 hours), subcutaneous fat did not impair the change in deep muscle temperature. In contrast, when rapid heat modalities were used, such as the hydrocollator and the whirlpool (15 minutes of sustained skin contact), the transfer of heat from the skin to deep muscle was significantly impaired in people with thicker subcutaneous fat layers. We observed that the greater the impairment in heat transfer to muscle from skin covered by body fat, the warmer the skin temperature increase during the modality.

Does skin moisture influence the blood flow response to local heat? A re-evaluation of the Pennes model

Pennes first described a model of heat transfer through the limb based only on calories delivered from a heat source, calories produced by metabolism and skin blood flow. The purpose of this study was to determine the effect of a moist versus a dry heat source on the skin in eliciting a blood flow response to add data to this model. Ten subjects were examined, both male and female, with a mean age of 32.5 ± 11.6 years, mean height of 172.8 ± 12.3 cm, and mean weight of 77.6 ± 19.5 kg. Skin temperature was measured by a thermocouple placed on the skin and skin blood flow measured by a laser Doppler flow meter. The results of the experiments using a dry heat pack (commercially available chemical 42°C cell dry heat source), moist hydrocollator pack (72.8°C) separated from the skin by eight layers of towels, and whirlpool at 40°C, showed that moist heat caused a significantly higher skin blood flow (about 500% greater) than dry heat (p < 0.01). Most of the greater increase in skin blood flow with moist heat was due to the greater rate of rise of skin temperature with moist versus dry heat while some of the increase in blood flow was due to the moisture itself. This could either be related to the greater heat flux across the skin with moist air or due to changing the ionic environment around skin thermo receptors by keeping the skin moist during heating. Skin thermo receptors are believed to be temperature sensitive calcium gated channels in endothelial cells which couple calcium influx to a release of nitric oxide. If true, reducing moisture in the skin might have the effect of altering ionic flux through these receptors. A correct model of skin heat flux should therefore take heat moisture content into consideration.

Interrelationships between body fat and skin blood flow and the current required for electrical stimulation of human muscle

There is variability between individuals in the current needed to elicit a contraction in human muscle with surface electrodes. To understand what might be causing some of this variability, 25 subjects whose average age was 24.4+/-2.3 years, whose height was 165.5+/-9.5 cm, and whose average weight was 70.3+/-21 kg were examined. Electrical stimulation was applied above the motor point of the quadriceps, biceps, and lateral gastrocnemius muscles. To assess body fat, 2D ultrasound was used with a 1cm stand off. Electrical stimulation was applied with sine wave stimulation at 100 micros pulse width and at a frequency of 30 Hz. To alter skin blood flow, aside from the natural difference in skin blood flow at rest, hot packs and cold packs were used for 5 min. The average fat thickness below the quadriceps and gastrocnemius muscles was 0.75+/-0.13 cm and under the biceps was 0.48+/-0.16 cm. Without the use of hot or cold packs, the currents for the quadriceps and gastrocnemius muscles were significantly higher than that of the biceps (p<0.01). While there was some relationship between stimulation current and blood flow without the application of hot or cold packs, when hot packs were applied, skin blood flow increased as did the current required to stimulate muscle to threshold. When cold packs were applied, there was a decrease in the current required to stimulate these muscles. In conclusion, there is a causal relationship between skin blood flow, the thickness of the fat layer below the skin, and the current required to stimulate the muscle.

Impact of hydrotherapy on skin blood flow: How much is due to moisture and how much is due to heat?

ABSTRACT Hydrotherapy and whirlpool are used to increase skin blood flow and warm tissue. However, recent evidence seems to show that part of the increase in skin blood flow is not due to the warmth itself but due to the moisture content of the heat. Therefore, two series of experiments were accomplished on 10 subjects with an average age of 24.2 ± 9.7 years and free of diabetes and cardiovascular disease. Subjects sat in a 37°C hydrotherapy pool under two conditions: one in which a thin membrane protecting their skin from moisture while their arm was submerged in water and the second where their arm was allowed to be exposed to the water for 15 minutes. During this period of time, skin and body temperature were measured as well as skin blood flow by a Laser Doppler Imager. The results of the experiments showed that the vapor barrier blocked any change in skin moisture content during submersion in water, and while skin temperature was the same as during exposure to the water, the blood flow with the arm exposed to water increased from 101.1 ± 10.4 flux to 224.9 ± 18.2 flux, whereas blood flow increased to only 118.7 ± 11.4 flux if the moisture of the water was blocked. Thus, a substantial portion of the increase in skin blood flow associated with warm water therapy is probably associated with moisturizing of the skin rather than the heat itself.