title: 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.
authors.affiliation: Marian University College of Osteopathic Medicine, Indianapolis, Indiana; Ohio Musculoskeletal and Neurological Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio;
authors.forename: Kristen
authors.identifier: http://orcid.org/0000-0003-4116-3714
authors.initials: K
authors.lastname: Metzler-Wilson
authors.affiliation: Ohio Musculoskeletal and Neurological Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; School of Kinesiology, College of Health Professions, Marshall University, Huntington, West Virginia; and.
authors.forename: Kumika
authors.initials: K
authors.lastname: Toma
authors.affiliation: Department of Specialty Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; Oakview Dermatology, Athens, Ohio.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Sammons
authors.affiliation: Ohio Musculoskeletal and Neurological Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio;
authors.forename: Sarah
authors.initials: S
authors.lastname: Mann
authors.affiliation: Ohio Musculoskeletal and Neurological Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio;
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Jurovcik
authors.affiliation: Ohio Musculoskeletal and Neurological Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio;
authors.forename: Olga
authors.initials: O
authors.lastname: Demidova
authors.affiliation: Marian University College of Osteopathic Medicine, Indianapolis, Indiana; Ohio Musculoskeletal and Neurological Institute, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; Department of Specialty Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; twilson@marian.edu.
authors.forename: Thad E
authors.identifier: http://orcid.org/0000-0002-4345-1616
authors.initials: TE
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001369:Axons / Q000502:physiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012018:Reflex; D012393:Rosacea / Q000503:physiopathology*; D012867:Skin / Q000098:blood supply / Q000294:innervation*; D013546:Sweating; D013564:Sympathetic Nervous System / Q000502:physiology*; D014664:Vasodilation
keywords: autonomic dysfunction; heat stress; mental stress; physical stress; rosacea triggers; supraorbital nerve; sympathetic nervous system