Augmented supraorbital skin sympathetic nerve activity responses to symptom trigger events in rosacea patients

Kristen Metzler-Wilson, Kumika Toma, Dawn L. Sammons, Sarah Mann, Andrew J. Jurovcik, Olga Demidova, Thad E. Wilson

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


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; fluxT00/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.

Original languageEnglish
Pages (from-to)1530-1537
Number of pages8
JournalJournal of Neurophysiology
Issue number3
StatePublished - Jul 1 2015

Bibliographical note

Publisher Copyright:
© 2015 the American Physiological Society.


  • Autonomic dysfunction
  • Heat stress
  • Mental stress
  • Physical stress
  • Rosacea triggers
  • Supraorbital nerve
  • Sympathetic nervous system

ASJC Scopus subject areas

  • General Neuroscience
  • Physiology


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