The Role of the Skin in Interoception: A Neglected Organ?

In the past 2 decades, interoception has received increasing attention in the fields of psychology and cognitive science, as well as neuroscience and physiology. A plethora of studies adopted the perception of cardiac signals as a proxy for interoception. However, recent findings have cast doubt on the methodological and intrinsic validity of the tasks used thus far. Therefore, there is an ongoing effort to improve the existing cardiac interoceptive tasks and to identify novel channels to target the perception of the physiological state of the body. Amid such scientific abundancy, one could question whether the field has been partially neglecting one of our widest organs in terms of dimensions and functions: the skin. According to some views grounded on anatomical and physiological evidence, skin-mediated signals such as affective touch, pain, and temperature have been redefined as interoceptive. However, there is no agreement in this regard. Here, we discuss some of the anatomical, physiological, and experimental arguments supporting the scientific study of interoception by means of skin-mediated signals. We argue that more attention should be paid to the skin as a sensory organ that monitors the bodily physiological state and further propose thermosensation as a particularly attractive model of skin-mediated interoception.

Interoception as independent cardiac, thermosensory, nociceptive, and affective touch perceptual submodalities

Interoception includes signals from inner organs and thin afferents in the skin, providing information about the body's physiological state. However, the functional relationships between interoceptive submodalities are unclear, and thermosensation as skin-based interoception has rarely been considered. We used five tasks to examine the relationships among cardiac awareness, thermosensation, affective touch, and nociception. Thermosensation was probed with a classic temperature detection task and the new dynamic thermal matching task, where participants matched perceived moving thermal stimuli in a range of colder/warmer stimuli around thermoneutrality. We also examined differences between hairy and non-hairy skin and found superior perception of dynamic temperature and static cooling on hairy skin. Notably, no significant correlations were observed across interoceptive submodality accuracies (except for cold and pain perception in the palm), which indicates that interoception at perceptual levels should be conceptualised as a set of relatively independent processes and abilities rather than a single construct. DATA AVAILABILITY STATEMENT: Data of this study are available as a supplementary file.

Wireless and Flexible Skin Moisture and Temperature Sensor Sheets toward the Study of Thermoregulator Center

A disorder in the thermoregulator center in a human body leads to some potential diseases such as fever and hyperthyroidism. To predict these diseases early, monitoring the health condition of the human body due to the influence of thermoregulation disorders is important. Although extensive works are performed on sweat-rate detection by constructing microfluidic channels, skin-moisture evaporation before sweating remains unknown. This work proposes a wireless and flexible sensor sheet to investigate the thermoregulatory responses of different people under cold stimulation and exercise by measuring the temperature and moisture variations on the finger skin. An integrated flexible sensor system consists of a ZnIn₂ S₄ nanosheet-based humidity sensor and carbon nanotube/SnO₂ temperature sensor. The results exhibit distinct thermoregulation abilities of five volunteers. Interestingly, the sudden increase in finger moisture that results from the excitation by the sympathetic nerve is observed during the cold-stimulus test. Although further studies are required to predict the potential diseases resulted from thermoregulation disorders in human body, this study provides a possibility of continuous and real-time monitoring of thermoregulatory activities via skin moisture and temperature detection using a flexible sensor sheet.

Individualized analysis of skin thermosensory thresholds and sensitivity in heat-sensitive people with multiple sclerosis

We investigated whether and how multiple sclerosis (MS) alters thresholds for perceiving increases and decreases in local skin temperature, as well as the sensitivity to progressively greater temperature stimuli, amongst heat-sensitive people with MS. Eleven MS patients (5 M/6 F; 51.1 ± 8.6 y, EDSS 5.7 ± 1.9) and 11 healthy controls (CTR; 7 M/4 F; 50.3 ± 9.0 y) performed warm and cold threshold tests on a hairy skin site, on both sides of the body. They also underwent a thermosensitivity test where they rated (visual analogue scale) perceived magnitude of 4 local skin stimuli (i.e. 22, 26, 34, 38°C). Individual thresholds and slopes of linear regression for thermosensitivity were z-transformed for each MS patient, and used to determine individual thermosensory abnormalities. When considering both threshold and thermosensitivity, six out of our 11 heat-sensitive patients (54.5%) exhibited skin thermosensory abnormalities. Those abnormalities varied amongst patients in terms of type (threshold vs. thermosensitivity), quality (warm vs. cold), location (left vs. right side of the body) and extent. Each of those six patients presented unique thermosensory profiles. While some patients experienced thermosensory loss in both thresholds and sensitivity and on both sides of the body, others experienced cold thermosensory loss on one side of the body only. The observed individual variability in thermosensory function among heat-sensitive MS patients highlight the need for a patient-centered approach to assessing thermosensory dysfunction and its potential implications for heat stress vulnerability in this patient group.

Effect of Radiofrequency Electromagnetic Fields on Thermal Sensitivity in the Rat

The World Health Organization and the French Health Safety Agency (ANSES) recognize that the expressed pain and suffering of electromagnetic field hypersensitivity syndrome (EHS) people are a lived reality requiring daily life adaptations to cope. Mechanisms involving glutamatergic N-methyl d-aspartate (NMDA) receptors were not explored yet, despite their possible role in hypersensitivity to chemicals. Here, we hypothesized that radiofrequency electromagnetic field (RF-EMF) exposures may affect pain perception under a modulatory role played by the NMDA receptor. The rats were exposed to RF-EMF for four weeks (five times a week, at 0 (sham), 1.5 or 6 W/kg in restraint) or were cage controls (CC). Once a week, they received an NMDA or saline injection before being scored for their preference between two plates in the two-temperatures choice test: 50 °C (thermal nociception) versus 28 °C. Results in the CC and the sham rats indicated that latency to escape from heat was significantly reduced by −45% after NMDA, compared to saline treatment. Heat avoidance was significantly increased by +40% in the 6 W/kg, compared to the sham exposed groups. RF-EMF effect was abolished after NMDA treatment. In conclusion, heat avoidance was higher after high brain-averaged specific absorption rate, affording further support for possible effect of RF-EMF on pain perception. Further studies need to be performed to confirm these data.

The nitric oxide dependence of cutaneous microvascular function to independent and combined hypoxic cold exposure

When separated from local cooling, whole body cooling elicited cutaneous reflex vasoconstriction via mechanisms independent of nitric oxide removal. Hypoxia elicited cutaneous vasodilatation via mechanisms mediated primarily by nitric oxide synthase, rather than xanthine oxidase-mediated nitrite reduction. Cold-induced vasoconstriction was blunted by the opposing effect of hypoxic vasodilatation, whereas the underpinning mechanisms did not interrelate in the absence of local cooling. Full vasoconstriction was restored with nitric oxide synthase inhibition.

Adaptive changes in physiological and perceptual responses during 10-day heat acclimation training using a water-perfused suit

Background

While active heat acclimation strategies have been robustly explored, not many studies highlighted passive heat acclimation strategies. Particularly, little evidence demonstrated advantages of utilizing a water-perfused suit as a passive heating strategy. This study aimed to explore heat adaptive changes in physiological and perceptual responses during 10-day heat acclimation training using a water-perfused suit.

Methods

Nineteen young males were divided into three experimental groups: exercise condition (N = 6, HA_EXE, 1-h exercise at 6 km h⁻¹ followed by 1-h rest in a sitting position), exercise and passive heating condition (N = 6, HA_EXE+SUIT, 1-h exercise at 6 km h⁻¹ followed 1-h passive heating in a sitting position), and passive heating condition (N = 7, HA_SUIT, 2-h passive heating in a sitting position). All heating programs were conducted for 10 consecutive days in a climatic chamber maintained at 33 °C with 60% relative humidity. The passive heating was conducted using a newly developed water-perfused suit with 44 °C water.

Results

Greater whole-body sweat rate and alleviated perceptual strain were found in HA_SUIT and HA_EXE+SUIT after 5 and/or 10 days (P < 0.05) but not in the exercise-only condition (HA_EXE). Lower rectal temperature and heart rate were found in all conditions after the training (P < 0.05). Heat adaptive changes appeared earlier in HA_SUIT except for sweat responses.

Conclusions

For heat acclimation in hot humid environments, passive and post-exercise heat acclimation training using the suit (water inflow temperature 44 °C) were more effective than the mild exercise (1-h walking at 6 km h⁻¹). This form of passive heating (HA_SUIT) may be an especially effective strategy for the elderly and the disabled who are not able to exercise in hot environments.

Thermosensory micromapping of warm and cold sensitivity across glabrous and hairy skin of male and female hands and feet

The ability of hands and feet to convey skin thermal sensations is an important contributor to our experience of the surrounding world. Surprisingly, the detailed topographical distribution of warm and cold thermosensitivity across hands and feet has not been mapped, although sensitivity maps exist for touch and pain. Using a recently developed quantitative sensory test, we mapped warm and cold thermosensitivity of 103 skin sites over glabrous and hairy skin of hands and feet in male (M; 30.2 ± 5.8 yr) and female (F; 27.7 ± 5.1 yr) adults matched for body surface area (M: 1.77 ± 0.2 m2; F: 1.64 ± 0.1 m2; P = 0.155). Findings indicated that warm and cold thermosensitivity varies by fivefold across glabrous and hairy skin of hands and feet and that hands (warm/cold sensitivity: 1.25/2.14 vote/°C) are twice as sensitive as the feet (warm/cold sensitivity: 0.51/0.99 vote/°C). Opposite to what is known for touch and pain sensitivity, we observed a characteristic distal-to-proximal increase in thermosensitivity over both hairy and glabrous skin (i.e., from fingers and toes to body of hands and feet), and found that hairy skin is more sensitive than glabrous. Finally, we show that body surface area-matched men and women presented small differences in thermosensitivity and that these differences are constrained to glabrous skin only. Our high-density thermosensory micromapping provides the most detailed thermosensitivity maps of hands and feet in young adults available to date. These maps offer a window into peripheral and central mechanisms of thermosensory integration in humans and will help guide future developments in smart skin and sensory neuroprostheses, in wearable, energy-efficient personal comfort systems, and in sport and protective clothing.

NEW & NOTEWORTHY We provide the most detailed thermosensitivity maps across glabrous and hairy skin of hands and feet in men and women available to date. Our maps show that thermosensitivity varies by fivefold across hands and feet, distal regions (e.g., fingers, toes) are less sensitive than proximal (e.g., palm, sole), hands are twice as sensitive as feet, and men and women present small thermosensitivity differences. These findings will help guide developments in sensory neuroprostheses, wearable comfort systems, and sport/protective clothing.

Thermoregulatory dysfunction in multiple sclerosis

Multiple sclerosis (MS) is a progressive neurologic disorder that disrupts axonal myelin in the central nervous system. Demyelination produces alterations in saltatory conduction, slowed conduction velocity, and a predisposition to conduction block. An estimated 60-80% of MS patients experience temporary worsening of clinical signs and neurologic symptoms with heat exposure (Uhthoff's phenomenon). This heat intolerance in MS is related to the detrimental effects of increased temperature on action potential propagation in demyelinated axons, resulting in conduction slowing and/or block. Additionally, MS may produce impaired neural control of autonomic and endocrine functions. Isolating and interpreting mechanisms responsible for autonomic dysfunction due to MS can be difficult as it may involve sensory impairments, altered neural integration within the central nervous system, impaired effector responses, or combinations of all of these factors. MS lesions occur in areas of the brain responsible for the control and regulation of body temperature and thermoregulatory effector responses, resulting in impaired neural control of sudomotor pathways or neural-induced changes in eccrine sweat glands, as evidenced by observations of reduced sweating responses in MS patients. Although not comprehensive, some evidence exists concerning treatments (cooling, precooling, and pharmacologic) for the MS patient to preserve function and decrease symptom worsening during heat stress. This review focuses on four main themes influencing current understanding of thermoregulatory dysfunction in MS: (1) heat intolerance; (2) central regulation of body temperature; (3) thermoregulatory effector responses; and (4) countermeasures to improve or maintain function during thermal stress.

Central neural substrates involved in temperature discrimination, thermal pain, thermal comfort, and thermoregulatory behavior

A phylogenetically novel pathway that emerged with primate encephalization is described, which conveys high-fidelity cutaneous thermosensory activity in "labeled lines" to a somatotopic map in the dorsal posterior insular cortex. It originates in lamina I of the superficial dorsal horn and ascends by way of the lateral spinothalamic tract and a distinct region in posterolateral thalamus. It evolved from the homeostatic sensory activity that represents the physiologic (interoceptive) condition of the body and drives the central autonomic network, which underlies all affective feelings from the body. Accordingly, human discriminative thermal sensations are accompanied by thermally motivated behaviors and thermal feelings of comfort or discomfort (unless neutral), which evidence suggests are associated with activity in the insular, cingulate, and orbitofrontal cortices, respectively. Yet, the substrates for thermoregulatory behavior have not been established, and several strong candidates (including the hypothalamus and the bed nucleus of the stria terminalis) are discussed. Finally, the neural underpinnings for relationships between thermal affect and social feelings (warm-positive/cold-negative) are addressed, including the association of hyperthermia with clinical depression.

Afferent thermosensory function in relapsing-remitting multiple sclerosis following exercise-induced increases in body temperature

NEW FINDINGS

What is the central question of this study? Between 60 and 80% of multiple sclerosis (MS) patients experience transient worsening of symptoms with increased body temperature (heat sensitivity). As sensory abnormalities are common in MS, we asked whether afferent thermosensory function is altered in MS following exercise-induced increases in body temperature. What is the main finding and its importance? Increases in body temperature of as little as ∼0.4°C were sufficient to decrease cold, but not warm, skin thermosensitivity (∼10%) in MS, across a wider temperature range than in age-matched healthy individuals. These findings provide new evidence on the impact of heat sensitivity on afferent function in MS, which could be useful for clinical evaluation of this neurological disease. In multiple sclerosis (MS), increases in body temperature result in transient worsening of clinical symptoms (heat sensitivity or Uhthoff's phenomenon). Although the impact of heat sensitivity on efferent physiological function has been investigated, the effects of heat stress on afferent sensory function in MS are unknown. Hence, we quantified afferent thermosensory function in MS following exercise-induced increases in body temperature with a new quantitative sensory test. Eight relapsing-remitting MS patients (three men and five women; 51.4 ± 9.1 years of age; Expanded Disability Status Scale score 2.8 ± 1.1) and eight age-matched control (CTR) subjects (five men and three women; 47.4 ± 9.1 years of age) rated the perceived magnitude of two cold (26 and 22°C) and two warm stimuli (34 and 38°C) applied to the dorsum of the hand before and after 30 min cycling in the heat (30°C air; 30% relative humidity). Exercise produced similar increases in mean body temperature in MS [+0.39°C (95% CI: +0.21, +0.53) P = 0.001] and CTR subjects [+0.41°C (95% CI: +0.25, +0.58) P = 0.001]. These changes were sufficient to decrease thermosensitivity significantly to all cold [26°C stimulus, -9.1% (95% CI: -17.0, -1.5), P = 0.006; 22°C stimulus, -10.6% (95% CI: -17.3, -3.7), P = 0.027], but not warm, stimuli in MS. Contrariwise, CTR subjects showed sensitivity reductions to colder stimuli only [22°C stimulus, -9.7% (95% CI: -16.4, -3.1), P = 0.011]. The observation that reductions in thermal sensitivity in MS were confined to the myelinated cold-sensitive pathway and extended across a wider (including milder and colder) temperature range than what is observed in CTR subjects provides new evidence on the impact of rising body temperature on afferent neural function in MS. Also, our findings support the use of our new approach to investigate afferent sensory function in MS during heat stress.

Characteristics of the local cutaneous sensory thermoneutral zone

Skin temperature detection thresholds have been used to measure human cold and warm sensitivity across the temperature continuum. They exhibit a sensory zone within which neither warm nor cold sensations prevail. This zone has been widely assumed to coincide with steady-state local skin temperatures between 32 and 34°C, but its underlying neurophysiology has been rarely investigated. In this study we employ two approaches to characterize the properties of sensory thermoneutrality, testing for each whether neutrality shifts along the temperature continuum depending on adaptation to a preceding thermal state. The focus is on local spots of skin on the palm. Ten participants (age: 30.3 ± 4.8 yr) underwent two experiments. Experiment 1 established the cold-to-warm inter-detection threshold range for the palm's glabrous skin and its shift as a function of 3 starting skin temperatures (26, 31, or 36°C). For the same conditions, experiment 2 determined a thermally neutral zone centered around a thermally neutral point in which thermoreceptors' activity is balanced. The zone was found to be narrow (~0.98 to ~1.33°C), moving with the starting skin temperature over the temperature span 27.5-34.9°C (Pearson r = 0.94; P < 0.001). It falls within the cold-to-warm inter-threshold range (~2.25 to ~2.47°C) but is only half as wide. These findings provide the first quantitative analysis of the local sensory thermoneutral zone in humans, indicating that it does not occur only within a specific range of steady-state skin temperatures (i.e., it shifts across the temperature continuum) and that it differs from the inter-detection threshold range both quantitatively and qualitatively. These findings provide insight into thermoreception neurophysiology.NEW & NOTEWORTHY Contrary to a widespread concept in human thermoreception, we show that local sensory thermoneutrality is achievable outside the 32-34°C skin temperature range. We propose that sensory adaption underlies a new mechanism of temperature integration. Also, we have developed from vision research a new quantitative test addressing the balance in activity of cutaneous cold and warm thermoreceptors. This could have important clinical (assessment of somatosensory abnormalities in neurological disease) and applied (design of personal comfort systems) implications.