Water‐immersion wrinkling is due to vasoconstriction

  title={Water‐immersion wrinkling is due to vasoconstriction},
  author={Einar P. V. Wilder-Smith and Adeline W L Chow},
  journal={Muscle \& Nerve},
The underlying mechanism of the water‐immersion skin wrinkling test, which is used as a test of sympathetic nerve function, remains elusive. We investigated changes of blood circulation in the hand occurring with water‐immersion wrinkling by measuring the velocity of ulnar and digital artery blood flow, and of digit skin blood flow, in healthy subjects before and during wrinkling. Wrinkling was accompanied by significant reduction in blood flow velocity in all vessels, with a maximum in digital… 

Water immersion wrinkling

The physiology of water immersion wrinkling is discussed and its potential as an indicator of limb sympathetic dysfunction is explored and digital blood flow or volume changes are suggested as better endpoints.

Paradoxical response to water immersion in replanted fingers

The paradoxical cutaneous vasodilatation and absence of wrinkling in the denervated fingers suggests that sympathetic innervation is important in water-immersion skin wrinkling.

Water Immersion-Induced Skin Wrinkling: More Accurately Reflects Neurovascular Coupling rather than Just Neural Function

  • J. Lazar
  • Medicine
    Archives in Neurology & Neuroscience
  • 2019
This work proposes WISW to more accurately reflect neurovascular coupling and suggests it could be a measure of peripheral sympathetic function, to reflect autonomic function and small fibre neural function.

Characterizing the Water Immersion Finger Wrinkling Test in Healthy Subjects

An attempt to describe the WISW test in terms of optimal duration required for water immersion, inter-observer variabil i ty on the outcome measures, different methods to assess the wrinkling induced by water immersion and the effect of age and gender on the rate of formation of water immersion induced wrinkles.

A proof-of-concept assessment in healthy volunteers of stimulated skin wrinkling to determine the presence or absence of digital nerve blockade

A proof-of-concept study to examine if blinded observers could differentiate the presence or absence of a digital nerve block in healthy volunteers by assessing photographs of skin-wrinkling taken during the use of the SSW test with EMLA cream showed that observers identified significant differences in wrinkling following the application of the EML a cream between blocked and unblocked digits at all time intervals.

A comparative analysis of water immersion induced hand wrinkling in dermatological diseases

There is a significant variation in the water immersion induced hand wrinkling pattern in patients with Dermatoses like Psoriasis, Vitiligo, and Hand Dermatitis due to structural alterations in the epidermis and dermis and Estrogen and the sympathetic nervous system play a significant role in water immersion-induced wrinkling.

Evaluation of the finger wrinkling test: a pilot study

The finger wrinkling test can be used as a screening test before tilt table testing and visual evaluation of wrinkling is still superior to digital analysis of photographs.



Heat-induced finger vasoconstriction controlled by skin sympathetic nerve activity.

It is concluded that, with the subject in a warm state, blood vessels of the finger respond to local heating with vasoconstriction, and this finger vasconstriction is evoked reflexively, largely through the increased sympathetic outflow to the resistance vessels ofThe finger.

Skin wrinkling for the assessment of sympathetic function in the limbs.

The wrinkle test is a reliable test of sympathetic function, is inexpensive and is easy to perform at the bedside, and can adequately evaluate sympathetic blockade.

Contribution of arteriovenous anastomoses to vasoconstriction induced by local heating of the human finger.

The results suggest that the decrease in finger blood flow in response to local heating may be limited to AVAs, and superficial vessels may not contribute to this heat-induced vasoconstriction of the finger.

Heat-induced vasoconstriction in the fingers: a mechanism for reducing heat gain through the hand heated locally

A rise in skin temperature to above the core temperature produces paradoxical vasoconstriction in the finger, which may be a mechanism to reduce heat gain through the hand heated locally at higher temperatures.

Decreased Skin Wrinkling in Diabetes Mellitus

Markedly decreased skin wrinkling was observed in diabetic subjects and in manual workers, but did not correlate with cardiovascular tests of autonomic function, control, type or duration of diabetes, or diabetic complications.

Skin wrinkling on immersion of hands: a test of sympathetic function.

Skin wrinkling of the fingers following immersion in warm water depends on intact sympathetic innervation and affords a simple and reliable clinical test of sympathetic function.

New and Simple Test of Nerve Function in Hand

A simple objective test of innervation and regeneration of sensory nerves in the hand by immersion in warm water is described. The test results are shown to correpond to operation findings.

The fine structure of human digital arterio-venous anastomoses (Hoyer-Grosser's organs)

SummaryHoyer-Grosser's organs were studied in human digital biopsies. The fine structure of both the supplying arteries and collecting veins was found to be inconspicuous.Endothelial cells in the AV