Cutaneous circulation
Dr Pushpa Lata Sachan
Associate professor
C I M S & H ,Lucknow
Cutaneous circulation
•Functional anatomy –Blood supply of the skin
of apical regions ( Fingers, feet , toes ,palm,
nose lip ,ear lobes etc.) is different from non
apical regions (the body tarso) of the body .
• Apical areas an arteriolar network exist at the
boundary of dermis and subcutaneous tissue .
From this network arterioles ascend from
deep dermis to superficial layer of dermis .
Capillary loops originate from superficial
dermal network and perfuse the dermal papilla
and epidermis .
Non apical areas – here vascular pattern is
modified .
Arteriovenous anastomoses mainly occur in
superficial dermal tissue.
It Is very few or absent in non apical areas
Normal blood flow to the skin varies from 1 to 150 ml
per 100g of tissue per min .
The skin blood vessel are supplied by sympathetic
fibers .
No parasympathetic innervation is seen in the skin .
Activation of sympathetic fibers results in
vasoconstriction .
Vasodilation occurs by decreasing the sympathetic
activity .
Regulation of cutaneous blood flow
Is regulated by decreasing the sympathetic activity .
Cutaneous blood flow is regulated by neural ,thermal
and metabolic factors .
Neural regulation – cutaneous blood vessels are
supplied by sympathetic vasoconstrictor fibers .
There is no vasodilator system supplying the skin
blood vessels .
Thermal regulation
Thermal regulation – cutaneous blood flow is mainly
regulated by body temperature .
Increased body temperature causes vasodilation and
decreased body temperature causes vasoconstriction .
HYPOTHALAMIC CONTROL MECHANISM
Temperature
Regulation centre of
Hypothalamus
EXPOSURE
Metabolic regulation
Is not important for cutaneous circulaton .
Local production of bradykinin in the sweat causes
cutaneous vasodilation .
Applied physiology
Vascular response to injury –
White response
Triple response
White response – Skin is stroked lightly with pointed
object , stroke line become pale this is called as white
reaction .
This occur due to decreased blood flow in the
capillaries due to contraction of precapillary sphincter
in response to injury .
The response is observed in about 15 second .
Triple response
When the skin is stroked with pointed object -the
response to injury manifest as triple response .
This is called as triple response as it three
component red , wheal and flare .
Red reaction – the skin becomes red in about 10
seconds .Redness occur due to capillary dilation
that increases capillary blood flow .Capillary
dilation occur due to direct response of capillaries
to pressure .
Wheal –swelling is called wheal .This occur within few
minutes following red reaction.
It occur due to increased permeability of capillaries
and post capillary venules .
Histamine released from local mast cells causes
vasodilation and increases capillary permeability that
result in extravasation of fluid .
Flare - Spreading out of redness from the site of injury
to surrounding area is called as flare .
It occur due to arteriolar dilation .
arteriolar dilation occur by activation of axon reflex .
From the site of injury impulse is conducted in the
afferent fiber .
Sensory neuron give branches to blood vessel .
The impulse in addition to its conduction to the spinal
cord orthodomically, it also relayed antidromically to
blood vessels
Axon reflex is an example of antidromic
conduction of impulse.
The ending of sensory fibers on the blood vessels
release substance P and CGRP that produce arteriolar
dilation .
Redness spreads out from injury to surrounding skin
in the form of flare .
Reactive hyperemia
This is defined as increased blood flow in an area
when blood supply to the area is reestablished
following a brief period of occlusion .
The blood flow to the skin increase when the
circulation is reestablish after the short period of
occlusion.
Reactive hyperemia also occur in visceral organs .
It occur due to vasodilation produced by hypoxia
during occlusion .
When circulation reestablished blood flow increases
through dilated blood vessels and skin becomes red
