Rosacea: disturbed defense against brain overheating

H. Brinnel1, J. Friedel2   , M. Caputa3, M. Cabanac4 and E. Grosshans2
(1) 
Service de Médecine, Hôpital-Maternité, BP 116, 69210 L'Arbresle, France
(2) 
Clinique Dermatologique, Faculté de Médecine de l'Université Louis Pasteur, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France
(3) 
Institute of Biology, Department of Animal Physiology, N. Copernicus University, 87100 Torun, Poland
(4) 
Département de Physiologie, Faculté de Médecine, Université Laval, G1K 7P4, Québec, (Canada)
Received: 15 October 1987  
Summary  Tympanic (Tty), esophageal (Tes), forehead, and hand skin temperatures, as well as the forehead evaporation rate were recorded in six men (four suffering from rosacea and two healthy controls) before, during, and after 1 h of warm bath (38° 13;39°C). During the last 30 min of the bath, the subject's face was vigorously fanned (14 m/s). Blood flow was explored with ultrasonic Doppler in the emissary veins of the cranium during normothermia before entering the bath, and during hyperthermia just after leaving it. Under normothermic conditions, Tty was higher than Tes in all subjects. In three patients, no blood flow could be detected in the ophthalmic emissary veins whereas in the fourth patient as well as in both control subjects, blood flowed from the intracranium to the face. During hyperthermia, face fanning decreased Tty by 0.25°±0.05°C (±SEM) below Tes in the control subjects whereas in all patients Tty remained warmer than Tes by 0.1°C. Doppler recordings showed a rapid inward blood flow from the skin to the brain in the controls during hyperthermia. In patients, however, there was no change from normothermia in the blood flow patterns of vena angularis oculi. Their forehead temperature was permanently higher than in control subjects. Venous blood flow from the skin to the brain appears to be suppressed in rosacea, thus inhibiting selective brain cooling in hyperthermic conditions. The importance of this mechanism in the pathogenesis of rosacea and its significance as a means of investigation are discussed.
Key words  Rosacea - Brain cooling - Vena angularis (oculi) - Vena facialis - Flushing

References
1.
Baker MA (1982) Brain cooling in endotherms in heat and exercise. Annu Rev Physiol 44:85–96
 
2.
Baker MA, Hayward JN (1967) Carotid rete and brain temperature of cat. Nature 216:139–141
 
3.
Bernstein JE (1982) Rosacea flushing. Int J Dermatol 21:24
 
4.
Bernstein JE (1983) Flushing. In: Goldsmith LA (ed) Biochemistry and physiology of the skin: Neuropeptides and the skin. Oxford University Press, Oxford, pp 1226–1227
 
5.
Bernstein JE, Soltani K (1982) Alcohol-induced rosacea flushing blocked by naloxone. Br J Dermatol 107:59–62
 
6.
Borrie P (1955) State of the blood vessels of the face in rosacea. Br J Dermatol 67:5–8, 73–75
 
7.
Brinnel H, Boy J, Cabanac M (1986) Intracranial temperature during passive heat exposure in humans. Brain Res 363:170–173
 
8.
Brinnel H, Cabanac M (1987) Hyperthermia and human brain cooling. In: Shiraki K, Youssef MK (eds) Man in stressful environments. Thermal and work physiology. C. C. Thomas, Springfield, pp 87–97
 
9.
Brinnel H, Cabanac M, Hales JRS (1987) Critical upper limits of body temperature, tissue thermosensitivity and selective brain cooling in hyperthermia. In: Hales JRS, Richardq DAB (eds) Heat stress, physical exertion and environment. Elsevier, Amsterdam, pp 209–240
 
10.
Brinnel H, Nagasaka T, Cabanac M (1987) Enhanced brain protection during passive hyperthermia in humans. Eur J Appl Physiol 56:540–545
 
11.
Cabanac M (1983) Face fanning: a possible way to prevent or to cure brain hyperthermia. In: Khogali M, Hales JRS (eds) Heat stroke and temperature regulation. Academic Press, Sydney, pp 213–221
 
12.
Cabanac M, Brinnel H (1985) Blood flow in the emissary veins of the human head during hyperthermia. Eur J Appl Physiol Occup Phys 54:172–176
 
13.
Cabanac M, Brinnel H (1987) The pathology of human temperature regulation: thermiatrics. Experientia 43: 19–27
 
14.
Cabanac M, Caputa M (1979) Natural selective cooling of the human brain: evidence of its occurrence and magnitude. J Physiol (Lond) 286:255–264
 
15.
Cabanac M, Caputa M (1979) Open loop increase in trunk temperature produced by face cooling in working humans. J Physiol (Lond) 289:163–174
 
16.
Cabanac M, Germain M, Brinnel H (1987) Tympanic temperature during hemiface cooling. Eur J Appl Physiol 56:534–539
 
17.
Caputa M (1980) Thermal gradients in the oesophagus of man during exercise and passive warming. J Therm Biol 5:248–251
 
18.
Caputa M (1981) Selective brain cooling: an important component of thermal physiology. In: Selenvi Z, Szekely M (eds) Contributions to thermal physiology. Pergamon Press, Oxford, pp 183–192
 
19.
Caputa M, Cabanac M (1980) Muscular work as thermal behavior in humans. J Appl Physiol 48:1020–1023
 
20.
Caputa M, Kadziela W, Narebski J (1976) Significance of cranial circulation for the brain homeothermia in rabbits. II. The role of cranial venous lakes in the defense against hyperthermia. Acta Neurobiol Exp 36:625–638
 
21.
Caputa M, Perrin G, Cabanac M (1978) Ecoulement sanguin réversible dans la veine ophtalmique: mécanisme de refroidissement sélectif du cerveau humain. CR Acad Sci [III] 287:1011–1014
 
22.
Cheadle WB (1884) Acne rosacea. Practitioner 13:1–8
 
23.
Cuntliffe WJ, Tan SG, Tebbs E (1975) Rosacea, migraine and Dixarit. Br J Dermatol [Suppl 11] 93:11–12
 
24.
Grosshans E (1977) Bilan des notions étiologiques actuelles de la rosacée. J Agrégés 10:427–433
 
25.
Grosshans E, Friedel J (1987) Physiopathologie de la Rosacée et ses implication thérapeutiques. Actualités Dermatologiques. Séance Académique en l'honneur du Professeur Achten. Bruxelles, 17 October 1987. Nouvelles Dermatologiques 6 [Suppl 4]:466–470
 
26.
Guarrera AM, Parodi A, Cipriani C, Divano C, Rebora A (1982) Flushing in rosacea: a possible mechanism. Arch Dermatol Res 272:311–316
 
27.
Haxthausen H (1930) Changes in skin vessels from protracted action of climatic factors and their significance in various skin diseases. Br J Dermatol 42:105
 
28.
Marks R (1968) Conncepts in the pathogenesis of rosacea. Br J Dermatol 80:170–177
 
29.
Narebski J (1985) Human brain homeothermy during sleep and wakefulness: an experimental and comparative approach. Acta Neurobiol Exp 45:63–75
 
30.
Parodi A, Guarrera M, Rebora A (1980) Flushing in rosacea: an experimental approach. Arch Dermatol Res 269:269–273
 
31.
Rebora A (1987) Rosacea. J Invest Dermatol, 88 [Suppl 3]: 569–605
 
32.
Søbye P (1950) Aetiology and pathogenesis of rosacea. Acta Derm Venereol (Stockh) 30:137–153
 
33.
Still J (1982) On the number of subjects used in animal behavior experiments. Anim Behav 30:873–880
 
34.
Wilkin JK (1979) Heat, not caffeine, induces flushing in erythematotelangiectatic rosacea. J Invest Dermatol 73: 310–312
 
35.
Wilkin JK (1980) Vasodilator rosacea. Arch Dermatol 116:598
 
36.
Wilkin JK (1980) Oral thermal induced flushing in erythematotelangiectatic rosacea. J Invest Dermatol 76: 15–18
 
37.
Wilkin JK (1982) A quantitative, non-invesive method for the characterization of flushing reactions. J Invest Dermatol 78:276–279
 
38.
Wilkin JK (1983) Rosacea: a review. Int J Dermatol 22:393–400
 
39.
Wilkin JK (1986) Quantitative assessment of alcohol-provoked flushing. Arch Dermatol 122:63–65
 
40.
Wilkin JK, Josephs JA (1980) Infrared photographic studies of rosacea. Arch Dermatol 116:676–678

source