"Warmth-insensitive fields": evidence of sparse and irregular innervation of human skin by the warmth sense

Although more acute in some areas of the body than in others, temperature sensitivity is assumed to be present throughout the skin. Only when very small stimuli have been used (e.g., approximately 1 mm2) has sensitivity to warming or cooling appeared discontinuous. Here we report the discovery of patches of skin several square centimeters in area within which heating cannot be detected until skin temperature exceeds the thresholds of C heat-sensitive nociceptors (>41 degrees C). These warmth-insensitive fields (> or = 5 cm2), which appear to lack low-threshold warm fibers, were also found to have reduced responsiveness to non-painful heating and significantly higher heat pain thresholds compared to surrounding areas of skin. The existence of such sites corroborates reports that warm fibers are rare in human cutaneous nerves and confirms the classical theory that cutaneous innervation by the warmth sense is punctate and sparse. The insensitive areas also provide unique opportunities for assessing the contribution of the low-threshold warmth system to perception of heat and heat pain, and their existence in healthy young adults contraindicates use of warmth sensitivity in neurological assessments of C-fiber function.