Value of combining the thermal test with laser Doppler measurement of skin hemodynamics. Study of vascular acrosyndromes
Boccalon, H.; Marguery, M.C.; Ginestet, M.C.; Puel, P.
Journal des Maladies Vasculaires 12(1): 100-109
1987
ISSN/ISBN: 0398-0499 PMID: 2951470 Document Number: 296085
Different exploratory investigations of vascular acrosyndromes have failed to define their physiopathology. Capillaroscopy studies the specific morphologic aspects of certain connective tissue diseases, hemodynamic tests usually determine a global parameter, and those tests investigating cutaneous physiology alone come up against difficulties limiting their diffusion. The laser Doppler flowmeter (LDF) measures global skin flow in a reproducible, continuous simple manner, and was combined with standardized provocation tests during a prospective study to assess its value in angiology. The protocol involved a prospective study of 100 subjects during the winter 1984-1985: 21 healthy volunteers, 11 cases of acrocyanosis, 9 of acrorhigosis, 48 of Raynaud's phenomenon (22 primary and 26 secondary), 11 of connective tissue disease without Raynaud's phenomenon (table I). The LDD test measures skin microcirculation flow continuously in parallel with skin thermometry. Provocation tests included a standardized thermal test (fig. 1); the temperature is automatically reduced to 0 degree C in 15 minutes and then increased to 25 degrees C in 10 minutes in a jar into which the hand and forearm of the patients and any measuring captor are introduced. Respiratory provocation and additional pharmacologic tests were also completed. Interpretation of results involved calculation of the mean skin flow, Dm, pulsatile skin flow, Dp (fig. 2 and 3), at the basal state and then during temperature variations. The reference value of Dm is 2.741 +/- 0.378 V and is decreased in acrorhigosis, acrocyanosis and severe Raynaud's phenomenon. At 0 degrees C the decrease in Dm is 33 +/- 13% in healthy subjects. Specific values for different acrosyndromes and particularly the various types of Raynaud's phenomenon do not exist.