Skin Microcirculation in Obesity Using Modern Non-Invasive Research Methods (review)

This review presents literature data from the past 30 years on the microcirculation system in human skin in obesity. The data are analyzed separately using three types of noninvasive research methods – videocapillaroscopy, laser Doppler flowmetry, and photoplethysmography – which provide information on the structural and functional state of various components of the skin microvascular bed: the capillary (exchange link), precapillary (superficial vascular plexus), and deep vascular plexus (distribution link). At the capillary bed level, obesity is associated with changes in capillary shape and a decrease in their number. At the precapillary arteriolar level, impaired endothelial function and a reduced response to dilator stimuli are observed. Large distributing arterioles of the deep vascular plexus exhibit increased stiffness and resistivity indices. Most studies examine microcirculation in obese patients with associated conditions such as diabetes, metabolic syndrome, hypertension, and others, the presence of which can significantly impact microcirculatory blood flow parameters. Studies examining skin microcirculation in obese patients without any comorbidities are rare. A review of the literature also revealed no studies examining the structural and functional characteristics of microcirculation depending on the obesity phenotype.

1. Kovaleva MA, Zhmerenetskiy KV. Review of direct methods for studying microcirculation and evaluating the data obtained. Journal of Medical and Biological Research. 2020;8(1):79–88. (In Russ.). Doi: 10.17238/issn2542-1298.2020.8.1.79.

2. Fedorovich AA. Microcirculation of the human skin as an object of research. Regional blood circulation and microcirculation. 2017;16(4):11–26. (In Russ.). Doi: 10.24884/16826655-2017-16-4-11-26.

3. Zelinsky ВA, Sokur SA. Pathophysiology of the microcirculatory bed in obesity. Problems of Endocrinology. 1995;41(4):21–23. (In Russ.). Doi: 10.14341/probl11458.

4. de Jongh RT, Serné EH, Ijzerman RG, et al. Impaired microvascular function in obesity: implications for obesity-associated microangiopathy, hypertension, and insulin resistance. Circulation. 2004;109(21):2529–2535. Doi: 10.1161/01.CIR. 0000129772.26647.6F. PMID: 15136505.

5. Serné EH, de Jongh RT, Eringa EC, et al. Microvascular dysfunction: a potential pathophysiological role in the metabolic syndrome. Hypertension. 2007;50(1):204–211. Doi: 10.1161/HYPERTENSIONAHA.107.089680.

6. Holowatz LA, Thompson-Torgerson CS, Kenney WL. The human cutaneous circulation as a model of generalized microvascular function. J Appl Physiol (1985). 2008;105(1):370–372. Doi: 10.1152/japplphysiol.00858.2007.

7. Boiko VV, Soboleva GN, Fedorovich АА, Kirdjaschkina TA. Atherosclerosis and microcirculation. Results of the pilot study of microcirculation in patients with coronary artery disease. RussianCardiology Bulletin. 2016;11(2):48–55. (In Russ.). eLIBRARY ID: 26151560.

8. Martini R, Bagno A. The wavelet analysis for the assessment of microvascular function with the laser Doppler fluxmetry over the last 20 years. Looking for hidden informations. Clin Hemorheol Microcirc. 2018;70(2):213–229. Doi: 10.3233/CH-189903.

9. Fedorovich AA, Korolev AI, Ososkov VS, et al. New trends in the development of the direction of non-invasive study of microcirculation in human skin. Descriptive review. Cardiovascular Therapy and Prevention. 2025;24(6):94–104. (In Russ.). Doi: 10.15829/1728-8800-2025-4412.

10. Shikama M, Sonoda N, Morimoto A, et al. Association of abdominal obesity with crossing capillaries in the finger nailfold in type 2 diabetes mellitus. Diabetol Int. 2021;12(3):260–267. Doi: 10.1007/s13340-020-00480-4.

11. Lavie L. Oxidative stress in obstructive sleep apnea and intermittent hypoxi--revisited--the bad ugly and good: implications to the heart and brain. Sleep Med Rev. 2015;20:27–45. Doi: 10.1016/j.smrv.2014.07.003.

12. Shikama M, Suga S, Tajima T, et al. Association between maximum lifetime body mass index and nailfold capillary changes in patients with type 2 diabetes mellitus. Cureus. 2024;16(12):e75411. Doi: 10.7759/cureus.75411.

13. Bogusz-Górna K, Polańska A, Dańczak-Pazdrowska A, et al. Non-invasive detection of early microvascular changes in juveniles with type 1 diabetes. Cardiovasc Diabetol. 2023;22(1):285. Doi: 10.1186/s12933-023-02031-y.

14. Warmke N, Griffin KJ, Cubbon RM. Pericytes in diabetes-associated vascular disease. J Diabetes Complications. 2016;30(8):1643–1650. Doi: 10.1016/j.jdiacomp.2016.08.005.

15. Paavonsalo S, Hariharan S, Lackman MH, Karaman S. Capillary rarefaction in obesity and metabolic diseases-organspecificity and possible mechanisms. Cells. 2020;9(12):2683. Doi: 10.3390/cells9122683.

16. Nakajima T, Nakano S, Kikuchi A, Matsunaga YT. Nailfold capillary patterns correlate with age, gender, lifestyle habits, and fingertip temperature. PLoS One. 2022; 17(6):e0269661. Doi: 10.1371/journal.pone.0269661.

17. Miyoshi K, Chikamori M, Ando T, et al. Quantitative image analysis of nailfold capillaries during an in-hospital education program for type 2 diabetes or obesity. Microvasc Res. 2025;161:104830. Doi: 10.1016/j.mvr.2025.104830.

18. Kraemer-Aguiar LG, Laflor CM, Bouskela E. Skin microcirculatory dysfunction is already present in normoglycemic subjects with metabolic syndrome. Metabolism. 2008;57(12):1740–1746. Doi: 10.1016/j.metabol.2008.07.034.

19. Kagota S, Iwata S, Maruyama K, et al. Functional relationship between arterial tissue and perivascular adipose tissue in metabolic syndrome. Yakugaku Zasshi. 2016;136(5):693– 697. [Japanese]. Doi: 10.1248/yakushi.15-00262-2.

20. Cheng C, Daskalakis C. Association of adipokines with insulin resistance, microvascular dysfunction, and endothelial dysfunction in healthy young adults. Mediator Inflamm. 2015:594039. Doi: 10.1155/2015/594039.

21. de Jongh RT, Ijzerman RG, Serné EH, et al. Visceral and truncal subcutaneous adipose tissue are associated with impaired capillary recruitment in healthy individuals. J Clin Endocrinol Metab. 2006;91(12):5100–5106. Doi: 10.1210/jc.2006-1103.

22. Buss C, Maranhao PA, de Souza MDGC, et al. Obesity blunts cephalic-phase microvascular responses to food. Physiol Behav. 2020;225:113087. Doi: 10.1016/j.physbeh.2020.113087.

23. Korolev AI, Fedorovich AA, Gorshkov AYu, et al. Skin microvascular change in men with normal arterial pressure depending on body mass index. The RussianJournal of Preventive Medicine. 2020;23(5):144–151. (In Russ.). Doi: 10.17116/profmed202023051144.

24. Morrissey C, Montero D, Raverdy C, et al. Effects of exercise intensity on microvascular function in obese adolescents. Int J Sports Med. 2018;39(6):450–455. Doi: 10.1055/a-0577-4280.

25. van der Heijden DJ, van Leeuwen MAH, Janssens GN, et al. Body mass index is associated with microvascular endothelial dysfunction in patients with treated metabolic risk factors and suspected coronary artery disease. J Am Heart Assoc. 2017;6(9):e006082. Doi: 10.1161/JAHA.117.006082.

26. Lanting SM, Way KL, Sabag A, et al. Degree of adiposity and obesity severity is associated with cutaneous microvascular dysfunction in type 2 diabetes. Microvasc Res. 2021;136:104149. Doi: 10.1016/j.mvr.2021.104149.

27. Andreieva IO, Riznyk OI, Myrnyi SP, Surmylo NN. State of cutaneous microcirculation in patients with obesity. Wiad Lek. 2021;74(9cz1):2039–2043. Doi: 10.36740/WLek202109103.

28. Limberg JK, De Vita MD, Blain GM, Schrage WG. Muscle blood flow responses to dynamic exercise in young obese humans. J Appl Physiol (1985). 2010;108(2):349–355. Doi: 10.1152/japplphysiol.00551.2009.

29. Fusco E, Pesce M, Bianchi V, et al. Preclinical vascular alterations in obese adolescents detected by laser-Doppler flowmetry technique. Nutr Metab Cardiovasc Dis. 2020;30(2):306–312. Doi: 10.1016/j.numecd.2019.09.007.

30. Gryglewska B, Głuszewska A, Zarzycki B, et al. Postocclusive reactive hyperemic response of skin microcirculation among extremely obese patients in the short and long term after bariatric surgery. Microcirculation. 2020;27(3):e12600. Doi: 10.1111/micc.12600.

31. Ministrini S, Fattori C, Ricci MA, et al. Microcirculatory improvement induced by laparoscopic sleeve gastrectomy is related to insulin sensitivity retrieval. Obes Surg. 2018;28(10):3151–3158. Doi: 10.1007/s11695-018-3290-0.

32. da Silva LH, Panazzolo DG, Marques MF, et al. Lowdose estradiol and endothelial and inflammatory biomarkers in menopausal overweight/obese women. Climacteric. 2016;19(4):337–43. Doi: 10.1080/13697137.2016.1180676.

33. Walter LM, Tamanyan K, Limawan AP, et al. Overweight and obese children with sleep disordered breathing have elevated arterial stiffness. Sleep Med. 2018;48:187–193. Doi: 10.1016/j.sleep.2018.05.007.

34. Drapkina OM, Deeva TA, Ivashkin VT. Evaluation of endothelial function and estimation of the degree of apoptosis in patients with metabolic syndrome and non-alcoholic fatty liver disease. Therapeutic Archive. 2015;87(5):76–83. (In Russ.). Doi: 10.17116/terarkh201587576-83.

35. Dadaeva VA, Korolev AI, Fedorovich AA, et al. The condition of the vascular wall in overweight and obese men. Тhe RussianJournal оf Preventive Medicine. 2021;24(6):85–89. (In Russ.). Doi: 10.17116/profmed20212406185.

36. Vasilieva ME, Kashchenko VA, Shmidt EV, et al. Improvement of microvascular function in patients with morbid obesity after bariatric surgery revealed by imaging photoplethysmography. Obes Surg. 2025;35(3):1001–1008. Doi: 10.1007/s11695-025-07741-8.

37. Lanka P, Segala A, Farina A, et al. Non-invasive investigation of adipose tissue by time domain diffuse optical spectroscopy. Biomed Opt Express. 2020;11(5):2779–2793. Doi: 10.1364/BOE.391028.

38. Boonya-Ananta T, Rodriguez AJ, Ajmal A, et al. Synthetic photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to body mass index (BMI). Sci Rep. 2021;11(1):2570. Doi: 10.1038/s41598-021-82124-4.

39. Rodriguez AJ, Boonya-Ananta MT, Gonzalez M, et al. Skin optical properties in the obese and their relation to body mass index: a review. J Biomed Opt. 2022;27(3):030902. Doi: 10.1117/1.JBO.27.3.030902.