Diseases of sweat glands: causes, symptoms, diagnosis, treatment

There are diseases of eccrine and apocrine sweat glands. Diseases of eccrine sweat glands include hyperhidrosis, dyshidrosis, red granularity of the nose, anhidrosis, and miliaria. Diseases of apocrine sweat glands include bromhidrosis and osmidrosis, as well as chromhidrosis. In the practice of a dermatocosmetologist, inflammatory diseases of apocrine sweat glands may be encountered, such as hidradenitis and inverse acne (hidradenitis suppurativa). The first is a type of staphylococcal pyoderma, and the second is a variant of severe acne.

Hyperhidrosis is a special condition of the eccrine sweat glands, accompanied by increased sweat production.

Pathogenesis of hyperhidrosis. Hyperhidrosis may be caused by the local effect of a number of drugs on the sweat glands, increased stimulation of the sympathetic nervous system fibers, and some central influences. When examining a patient, all of these mechanisms should be taken into account.

Clinical varieties. There are widespread and localized hyperhidrosis, as well as symmetrical and asymmetrical.

Generalized hyperhidrosis may be caused by central thermoregulatory influences. It is known that an increase in the temperature of the blood washing the hypothalamus leads to such thermoregulatory mechanisms as increased sweat secretion by eccrine sweat glands and dilation of blood vessels. Thermoregulatory sweating, unlike emotional sweating, increases during sleep. It occurs in many infectious processes and is often the first manifestation of malaria, tuberculosis, brucellosis and other diseases. A similar mechanism of action in alcohol intoxication, gout and after vomiting, generalized hyperhidrosis is also possible in diabetic neuropathy, hyperthyroidism, hyperpituitarism, obesity, menopause and malignant tumors, however, the exact mechanisms of sweat hyperproduction in these conditions and diseases have not been sufficiently studied. A special case of generalized symmetrical hyperhidrosis is hyperhidrosis during attacks of cholinergic urticaria.

Localized symmetrical hyperhidrosis may be caused by emotional influences. Thus, with emotional and mental stress, increased sweating occurs in the armpits, palms and soles, less often in the groin folds and on the face. In some cases, diffuse symmetrical sweating is also possible.

Hyperhidrosis of the palms and soles can be constant or episodic. With constant hyperhidrosis, the situation worsens in the summer; with episodic hyperhidrosis, seasonality is not typical. Isolated plantar hyperhidrosis occurs in young people, which occurs against the background of an imbalance in the autonomic nervous system. Such patients also have acrocyanosis, livedo, and lability of blood pressure. Severe palmar-plantar hyperhidrosis with profuse sweating is typical for adolescents; the condition usually improves significantly after reaching the age of 25. Cases in families are not uncommon, in which case hyperhidrosis is combined with palmar-plantar keratoderma. Palmar-plantar hyperhidrosis can be complicated by true dyshidrosis, contact dermatitis, athlete's foot, and corynebacteriosis (the so-called "pitted" keratolysis). Axillary hyperhidrosis is more often episodic than constant. It is associated with heat and mental or emotional stress, and is linked to an imbalance in the autonomic nervous system.

Localized physiological hyperhidrosis of the lips, forehead, nose may occur in some people against the background of eating spicy and hot food, the exact mechanism of this reflex has not been clarified in detail. Pathological hyperhidrosis against the background of eating is typical not only in the face area, but also in other localizations. Its cause may be damage to the sympathetic nerves in the face and neck area due to trauma, surgical interventions and inflammatory processes in the auriculotemporal region, for example, the parotid salivary gland.

Asymmetric hyperhidrosis is associated with damage to the sympathetic nerve pathways from the brain centers to the terminal nerve endings. The patient has pathology in the cerebral cortex, basal ganglia of the spinal cord or peripheral nerves. In such cases, hyperhidrosis rarely manifests itself as a monosymptom; other neurological symptoms are often present. There are known cases of localized asymmetric hyperhidrosis in the projection of pathologically altered internal organs, around trophic ulcers.

Treatment of hyperhidrosis. Antiperspirants and deodorants are recommended for external use. The use of 1% formalin and 10% glutaraldehyde is sharply limited due to the high risk of developing allergic dermatitis. Iontophoresis with anticholinergic drugs (for example, glycopyrronium bromide) is also indicated. Atropine-like drugs (Belloid, Bemataminal, etc.), sedatives (tincture of motherwort, valerian, peony, Notta, Persen, Negrustin, etc.), and less often ganglionic blockers are prescribed internally.

Sympathectomy was previously popular among invasive correction methods; excision of a skin flap with a large number of glands from the specified area was also used for axillary hyperhidrosis. Currently, for palmar-plantar and axillary hyperhidrosis, the introduction of botulinum toxin type A preparations is very popular. It is a strong blocker of cholinergic sympathetic fibers that innervate the sweat glands. In severe cases of localized hyperhidrosis against the background of food intake, surgical treatment is indicated, aimed at restoring adequate conductivity along the sympathetic nerves and blocking parasympathetic innervation.

Dyshidrosis is a skin condition of the palms and soles that manifests itself as blistering rashes.

Pathogenesis and symptoms of dyshidrosis. True dyshidrosis and symptomatic dyshidrosis are considered. True dyshidrosis develops with increased sweating of the palms and soles against the background of increased physical work, wearing warm shoes and gloves, predisposing to the occurrence of a local greenhouse effect. In this condition, there is, on the one hand, hypersecretion of sweat by the eccrine glands, and on the other, blockage of the excretory ducts of these glands as a result of maceration of the stratum corneum in their mouths. As a result, long-term blisters with a dense cover and serous contents appear.

Dyshidrosis as a symptom may occur with dyshidrotic eczema, dyshidrotic form of mycosis of the feet, toxicoderma and other dermatoses. The diagnosis is established on the basis of a characteristic clinical picture, as well as mycological examination data (in case of mycosis of the feet).

Treatment of dyshidrosis. In case of true dyshidrosis, drying and disinfecting agents are prescribed. Belladonna preparations may be prescribed internally.

Red granularity of the nose (granulosis rubra nasi) is a genetically determined disease of the eccrine sweat glands of the skin of the nose. Pathogenesis and clinical features. The type of inheritance is not fully understood. The onset of the disease, as a rule, in childhood - from 6 months to 10 years of age. Many patients have circulatory disorders, palmar-plantar hyperhidrosis. The developed clinical picture may be preceded by intense sweating in the area of the tip of the nose for several years. Later, diffuse erythema appears, first - the tip of the nose, and then - more widespread, capturing the skin of the cheeks, upper lip, chin. Small beads of sweat are visible against the background of erythema. Later, small erythematous spots, papules and even vesicles are formed in the projection of the sweat glands. The disease usually spontaneously passes by the beginning of puberty. In some patients it may be longer, in which case telangiectasias and small cysts of the eccrine sweat glands form.

Treatment. Gentle skin care is recommended, vegetative stabilizing drugs are prescribed internally, in some cases the issue of removing individual glands or cysts using a laser and electrocoagulation is decided.

Anhidrosis is a special condition of the eccrine sweat glands, accompanied by a lack of sweat production.

Pathogenesis of anhidrosis. Anhidrosis may be associated with pathology of the eccrine sweat glands themselves, as well as with various disorders of their innervation. On the part of the sweat glands, there may be aplasia, congenital photodermal dysplasia, their blockage in prickly heat, eczema and atopic dermatitis, lichen planus, psoriasis, ichthyosis. Chronic atrophic acrodermatitis, scleroderma, Sjogren's disease, and skin lymphomas also lead to a decrease in sweat production. Anhidrosis is possible with organic lesions of the brain and spinal cord (syringomyelia, leprosy, sympathectomy, etc.), hysteria, hyperthermia, as well as with oral administration of ganglion blockers and anticholinergic drugs.

Symptoms of anhidrosis. Clinically manifested by xerosis of the skin. Spreading anhidrosis can lead to significant disturbances of thermoregulation up to pronounced hyperthermia. This is typical for patients with congenital anhidrotic ectodermal dysplasia.

Treatment of anhidrosis. Maximum effective impact on predisposing factors, effective therapy of concomitant dermatoses.

Miliaria is an inflammatory disease of the eccrine sweat glands.

Pathogenesis of prickly heat. The disease is typical for newborns and infants, but can also occur in adults. The development of prickly heat is promoted by general overheating associated with high ambient temperatures, often in combination with high humidity. It is typical for the summer. In addition, prickly heat can occur with increased physical activity, against the background of fever in various infectious diseases and in other conditions.

Symptoms of miliaria. At first, the so-called red miliaria appears, the rash is represented by multiple point spots that arise as a result of persistent dilation of the vessels around the mouths of the eccrine sweat glands. The rash is symmetrical, located on the body and in the folds of the skin, fresh elements may appear within a few days. Later, transparent blisters up to 2 mm in diameter with whitish contents and a crown of erythema along the periphery may form. This is the so-called white miliaria, or periporitis (ostioporitis). This disease is classified as a group of staphylococcal pyoderma.

Treatment of prickly heat. Adequate skin care, wearing loose cotton clothing, external disinfectants or antibacterial agents are indicated.

Hematidrosis, or bloody sweat, is a rare pathology associated with diapedesis of red blood cells from the capillaries surrounding the eccrine sweat glands.

It is typical for conditions accompanied by increased permeability of the vascular wall: diencephalic disorders, vasculitis, physical and mental trauma. Bloody sweat most often appears on the face (forehead, nose), forearms, in the area of the periungual folds, and sometimes in other areas. The condition is usually paroxysmal, can intensify with psychoemotional stress and last from several minutes to several hours. Some patients experience precursor symptoms - pain and burning appear several days before the release of bloody sweat. The phenomenon of bloody milk is similar to hematidrosis. When correcting hematidrosis, the pathogenetic background is taken into account, sedatives and drugs that strengthen the vascular wall are recommended.

Bromhidrosis is an unpleasant smell of sweat, osmidrosis is a foul-smelling sweat.

These conditions occur in young men and are associated with the presence of a number of amino acids (e.g., tyrosine, leucine, etc.), fatty acids, and waste products of microflora, primarily corynebacteria, in the sweat gland secretion. There are episodes in young women with dyshormonal conditions against the background of the menstrual cycle. Bromhidrosis and osmidrosis are typical for patients with chronic kidney diseases accompanied by chronic renal failure, gout, diabetes, as well as when eating garlic and taking a number of medications. The principles of correcting bromhidrosis and osmidrosis are similar to those for localized hyperhidrosis. Patients are given recommendations on diet (excluding garlic), careful hygiene, and antibacterial agents are prescribed externally.

Chromhidrosis is colored sweat.

There are pseudochromhidrosis and true chromhidrosis. Pseudochromhidrosis is characterized by the release of colorless sweat, which is colored already on the surface of the skin. Its most common cause is corynebacteria, which are often present on the skin and hair in the armpits. When managing such patients, careful hygiene is recommended, antibacterial agents are prescribed externally. The color of sweat can also be associated with the washing out of dyes from the fabric of clothing. True chromhidrosis is extremely rare, conditions accompanied by yellow, blue, green, black, purple, brown sweat have been described.

Associated with ingestion of certain medications or dyes. May be accompanied by localized skin discoloration. Similar to true chromhidrosis is the phenomenon of colored milk. If the cause of true chromhidrosis is not identified, the only method of its correction is surgical excision of skin areas in the armpits.

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