Temperature modulation of microvascular, inflammatory and perceptual responses to mechanical loading of the skin in young and older adults and in spinal cord injury patients

Cooling the skin may increase its tolerance to mechanical loading and decrease the risk of developing pressure ulcers. Yet, the mechanisms of action (e.g. cooling-modulation of cytotoxic, post-occlusive hyperaemia), and their individual variability, remain unclear. We investigated the effects of different cooling levels (24{degrees}C and 16{degrees}C) on microvascular, inflammatory and perceptual responses to mechanical loading of the sacrum in healthy young (N=23) and older adults (N=19), and in spinal cord injury patients (SCI; N=10). Healthy participants underwent 45-min loading (~60 mmHg) and 20-min unloading of the sacrum, using an instrumented indenter probe set at either 38{degrees}C (control condition), 24{degrees}C or 16{degrees}C. SCI participants completed a more conservative protocol (i.e. 25min, ~45mmHg loading, 38{degrees}C and 16{degrees}C conditions). Pre-insult skin structure was characterised with optical coherence tomography; skin blood flow (SkBF) at the loading site was continuously measured, alongside thermal acceptability; and post-insult inflammatory responses were determined via skin-sebum cytokines analyses. Compared to control, 24{degrees}C- and 16{degrees}C-cooling induced a similar ~8-fold decrease in peak post-occlusive reactive hyperaemia in healthy participants, with similar temperature-related differences observed in SCI. Pro-inflammatory cytokines decreased post-insult; yet this occurred similarly across all temperatures and groups. The majority of participants ([≥]70%) rated both 24{degrees}C- and 16{degrees}C-cooling as thermally acceptable. We conclude that cooling is a potent modulator of the skin microvascular response to mechanical loading in younger, older, and vulnerable skin (SCI). These findings can inform design parameters for thermal technology aimed at preventing the loss of skin integrity (e.g. integrating 24{degrees}C-cooling in support surfaces and skin wearables).