The ability of different areas of the skin to absorb heat from a locally applied heat source: the impact of diabetes.

BACKGROUND: When heat is applied to the skin, heat is conducted away because of the latent heat transfer properties of the skin and an increase in skin circulation, but little attention has been paid to the heat transfer properties of skin in different areas of the body and in people with diabetes. research design: Thirty subjects in the age range of 20-75 years had a thermode (44°C) applied to the skin of their arm, leg, foot, and back for 6 min to assess the heat transfer characteristics of skin in these four areas of the body. Skin blood flow and skin temperature were monitored over the 6-min period. RESULTS: For the younger subjects, blood flow was not statistically different in response to heat in three areas of the body, starting at less than 200 flux measured by a laser Doppler imager and ending at approximately 1,200 flux after heat exposure. The foot had higher resting blood flow and higher blood flow in response to heat. Temperature and the rate of rise of temperature were also not different in any of the areas. The heat added to raise temperature, however, varied by body region. The arm required the least, whereas the leg and foot required the most. For the older group and subjects with diabetes, the heat required for any region of the body was much less to achieve the same increase in skin temperature, and blood flows were also much less; the subjects with diabetes showed the least blood flow and required the fewest calories to heat the skin. Whereas the foot required the greatest number of calories to heat the tissue in younger and older subjects, in subjects with diabetes, the foot took proportionally fewer calories. CONCLUSION: Thus, specific areas of the body are damaged more by diabetes than other areas.

The contribution of skin blood flow in warming the skin after the application of local heat; the duality of the Pennes heat equation.

As predicted by the Pennes equation, skin blood flow is a major contributor to the removal of heat from an external heat source. This protects the skin from erythema and burns. But, for a person in a thermally neutral room, the skin is normally much cooler than arterial blood. Therefore, if skin blood flow (BF) increases, it should initially warm the skin paradoxically. To examine this phenomenon, 10 young male and female subjects participated in a series of experiments to examine the contribution of skin blood flow in the initial warming the skin after the application of local heat. Heat flow was measured by the use of a thermode above the brachioradialis muscle. The thermode was warmed by constant temperature water at 44°C entering the thermode at a water flow rate of 100 cm(3)/min. Skin temperature was measured by a thermistor and blood flow in the underlying skin was measured by a laser Doppler imager in single point mode. The results of the experiments showed that, when skin temperature is cool (31-32°C), the number of calories being transferred to the skin from the thermode cannot account for the rise in skin temperature alone. A significant portion of the rise in skin temperature is due to the warm arterialized blood traversing the skin from the core areas of the body. However, as skin temperature approaches central core temperature, it becomes less of a heat source and more of a heat sync such that when skin temperature is at or above core temperature, the blood flow to the skin, as predicted by Pennes, becomes a heat sync pulling heat from the thermode.