DISTURBANCE OF THERMOREGULATORY SKIN PERF USION IN REFLEX SYMPATHETICDYSTROPHY

Patients with reflex sympathetic dystrophy (RSD) were examined for the ir neurovascular functions (n = 27). At the time of investigation the median duration of the disease was 8 weeks (2 - 100). Patients with si gns and symptoms of the disease of less than 8 weeks were classified a s acute RSD (n = 14) and patients with signs and symptoms of more than 8 weeks as chronic RSD (n = 13). For control, healthy subjects were i nvestigated (n = 19). After acclimatisation for 2 hours, the skin temp erature was measured simultaneously at the affected and unaffected lim b by infrared thermography. After baseline recording for 2 minutes the limbs were immersed in cold water (5 degrees C) and rewarming was reg istered. The control group showed no side differences concerning skin temperature and rewarming. The acute RSD patients showed significant w armer skin temperatures at rest at the affected limb (p < 0.001), and rewarming occurred significantly faster on the affected side (p < 0.03 ). In contrast, the chronic RSD patients showed no side differences. C oncerning the total patient group, a significant correlation between s ide differences of skin temperature and duration of symptoms was found (p < 0.002). There was a barely significant correlation between side differences of rewarming and duration of disease (p = 0.06). Our resul ts demonstrate a marked disturbance of autonomic control of skin perfu sion at the affected extremity in acute RSD patients. Higher skin temp erature at rest and faster rewarming after cold water immersion indica te a lower sympathetic tone of the affected extremity. Such side diffe rences disappear in the course of disease.