We tend to overlook our skin, but it performs many vital functions for our bodies – including coming to our rescue in emergencies.

Since it is designed to function within very precise limits, our body is very susceptible to small temperature changes. Since abnormalities in these changes occur, the body has various mechanisms to keep its temperature constant. One of these mechanisms works by changing the amount of blood in the veins underneath the skin. When talking about body temperature, it is important to distinguish between the internal and external body temperature. The internal temperature is the temperature of the brain and internal organs, while the external body temperature is the temperature of the skin.

Normally, arteries that transport clean blood, and veins that carry dirty blood, are not connected; therefore clean and dirty blood never mix. However, as a consequence of some illnesses or birth defects, an abnormal bridge between arteries and veins may be present. This kind of condition is usually called arteriovenous shunts, or arteriovenous fistula. In these kinds of situations, blood is pumped directly from arteries to veins. In other words, clean blood flows towards dirty blood. Normally, the clean blood has to travel the body, providing oxygen and other supplements to cells, while collecting carbon dioxide and returning to the heart to be cleaned again.

An incredible network for the transportation of substances from the blood in arteries and veins has been created. If this system, known as the "capillary network," did not exist, none of our organs could be fed, and the circulatory system would not be able to provide its vital function.

The system is necessary for two reasons. The speed of the blood in the arteries and veins is too fast for anything to be transported to the organs, and their walls are too thick to allow transportation of substances. Therefore, the blood travels from the arteries to the capillaries, and after the trading of oxygen and other substances with carbon dioxide is completed, it flows to the veins. If any kind of abnormalities exist, the blood flows directly from the arteries to the veins, therefore skipping the capillaries. As a consequence, the organs aren't fed and the blood gathers in the veins without fulfilling its purpose. Naturally, the oxygen and nutrition balance of the organs gets messed up. The blood is pumped out of the heart with no purpose and heart failure becomes inevitable.

The capillary network has been assigned the task of communication between arteries and veins. The skins is our only organ where the blood flows directly from arteries to veins; AV shunts accomplish a very important duty in this function.

There is a network of veins underneath the skin. The number of veins in this network is so many that if they were completely filled up, they could hold up to two liters of blood in the skin. Blood is pumped to the skin for two purposes: to provide oxygen and nutrients to the cells, and to collect carbon dioxide and waste products in the cells, as is done with every organ; and to monitor the internal temperature of the body by sending blood to the skin if the temperature gets too high, similar to what radiators in cars do when the engine gets too hot.

There is also the subcutaneous fat tissue underneath the skin which acts as an insulator. The vein network mentioned above is inside this fat tissue. There is a continuous flow of blood from the capillaries that feed the skin towards this network of veins. Moreover, especially in areas where the skin is exposed – such as the hands, feet, face and ears – there is a blood flow from the small arteries towards this network of veins. Contrary to other organs in the body, blood flows directly from the arteries to the veins. If this direct blood flow did not exist, the amount of blood in the skin's veins would be close to zero, because the amount of blood necessary for skin nutrition is very little. However when the internal temperature rises too much, the amount of blood, which is normally close to zero, can suddenly increase to as much as 30% of the blood pumped by the heart. In this case, the body's internal temperature is being transported to the skin. This is an incredibly efficient cooling system. However, if the weather is cold, the AV shunt veins are switched off and the skin's blood flow is decreased until close to zero, therefore maintaining internal temperature. The fat tissue underneath the skin also has a very important function, as it acts as insulation, helping maintain temperature.

Body temperature and the body's systems work in perfect coordination with each other. We can observe a very simplified version of this system in computer based air conditioners. However, when we reflect upon the incredibly sophisticated cooling system of the human body, we come to the conclusion that no other system is as perfect as that.

The hypothalamus, which has various vital duties for the brain, was also given the very important mission of controlling the body's temperature. There are hot and cold heat receptors in various parts of the hypothalamus. When body temperature increases, these receptors are activated. As a consequence of this warning, skin veins all over the body expand. Simultaneous with the expansion of the veins, sweat is excreted.

The hypothalamus also has the duty of suppressing the mechanisms that produce heat throughout the body. For example, trembling is stopped and general metabolism is slowed down to decrease body temperature. As metabolism slows down, the production of heat becomes minimal, and cooling takes place. In conditions where the body temperature is too cold, some hormones secreted in the hypothalamus trigger the pituitary, and then the thyroid, hormones. Since thyroid hormones are responsible for increasing metabolism, body temperature increases. However if body temperature increases above normal, the control of the hypothalamus on the thyroid is reversed, and thyroid hormones are decreased, therefore decreasing body temperature.

There is one more reason for placing so many veins in the perfect and miraculous body's skin: except for extremely cold weather conditions, quite a large amount of blood exists in these veins that are not used for nutritional purposes. Some of our organs act as storage for blood; two of the most important ones are the spleen and liver. Another one is the skin. In the course of losing blood, or an illness that increases the need for blood, the spleen and liver shrink. As a consequence of this shrinkage, the blood inside them is sent to the heart, through veins, and distributed to the areas in need of blood. This increases the heart rate.

A similar scenario occurs in the skin. The veins responsible for cooling shrink, and the blood they contain is sent to the heart with the help of the main veins, therefore helping the heart pump. During heavy loss of blood, the blood in the skin comes to the rescue. Patients who are losing blood have incredibly cold and pale skin. This is because the blood in the skin has reduced to a minimum.

The obverse of this happens in an illness called erythromelalgia, where more blood than normal flows from the arteries to the veins in the skin. This is mostly seen in the hands, feet, nose, and ears, since AV shunts are more prevalent in these areas of the skin. The symptom of this illness is burning pain, which is triggered by heat and soothed by cool temperatures. The nutrition of the skin decreases and some substances produced because of the absence of oxygen increases redness, heat, and pain, since some of the capillaries feeding the skin shut down and all of the blood flows from arteries to veins with the AV shunts.

Our skin protects our muscles and bones, and contributes to the beautiful esthetic of our body. It provides our sense of touch, and is therefore a means for us to experience the material world, as well as providing temperature control for our bodies. It can clearly be seen that the relationship between the skin and the veins could not have evolved by the consequence of coincidence.

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