Sweating disorders: symptoms

Essential hyperhidrosis

Essential hyperhidrosis, an idiopathic form of excess sweat production, occurs mainly in two variants: generalized hyperhidrosis, ie, manifested on the entire surface of the body, and local - on the hands, feet, in the armpits, which is much more common.

The etiology of this disease is unknown. There are suggestions that patients with idiopathic hyperhidrosis or increased the number of regional ekkrinovnyh flowing zkelez, or increased their response to conventional stimuli, and the number of glands is not changed. To explain the pathophysiological mechanisms of the development of local hyperhidrosis, the theory of double autonomous innervation of the eccrine glands of the palms, feet and underarm area, as well as the theory of the hypersensitivity of the eccrine system to high concentrations of circulating adrenaline and norepinephrine in emotional stress, are involved.

Patients with essential hyperhidrosis, as a rule, notice excessive sweating since childhood. The earliest age of onset of the disease is described in 3 months. However, during puberty, hyperhidrosis increases dramatically, and as a rule, patients turn to a doctor at the age of 15-20 years. The intensity of sweating disorders with this phenomenon can be different: from the mildest degree, when it is difficult to draw a border with normal sweating, to an extreme degree of hyperhidrosis leading to a violation of the patient's social adaptation. The phenomenon of hyperhidrosis in some patients causes great difficulties and limitations in professional activity (draftsmen, stenographers, dentists, salesmen, drivers, electricians, pianists and representatives of many other professions).

The prevalence of this form of hyperhidrosis is 1 per 2000 people in the general population. Apparently, hyperhidrosis occurs equally often in men and women, but women are much more likely to seek help. About 40% of patients note the presence of a similar phenomenon in one of the parents. It was noticed that the Japanese suffer from this disease 20 times more often than the residents of the Caucasian region.

Typically, the essential hyperhidrosis manifests itself symmetrically (bilaterally): it is more pronounced on the palms and soles. Its intensity can reach such a degree that sweat literally drains from the palms of the hands. The most powerful factor provoking these conditions is mental stress. The condition of patients significantly worsens in hot weather. Physical activity and taste stimulation also provoke excessive sweating, but to a lesser extent. During sleep, excessive sweating stops completely. With essential hyperhidrosis, the secretion and morphology of sweat glands have not been altered.

Pathophysiological mechanisms leading to the development of such pronounced hyperhidrotic reactions in young people without apparent causes remain unrecognized. Special studies of the state of vegetative apparatuses of the segmental level showed some insufficiency of the sympathetic mechanisms of regulation of the sweating functions. This may be due to the hypersensitivity of partially denervated structures to circulating catecholamines, and clinically manifested by hyperhidrosis.

The diagnosis of primary hyperhidrosis does not cause complications. However, one should keep in mind similar versions of secondary hyperhidrosis that are similar in clinical manifestations, which occurs in systemic diseases, often with neuroendocrine diseases, CNS diseases - parkinsonism, traumatic brain damage.

Family disautonomy (Riley-Dey's syndrome)

The disease belongs to the hereditary group with an autosomal recessive type of inheritance. The nucleus of all clinical manifestations is the defeat of the peripheral nervous system (PWN syndrome), which has a morphological verification. The clinic of this disease is characterized by a variety of symptoms. The most frequent of them is a decrease or absence of secretion of tears, a pronounced hyperhidrosis, aggravated by swelling, a change in pharyngeal, vestibular reflexes, a transient pustular rash on the skin, a pronounced salivation that persists even after infancy, emotional lability, impaired coordination of movements, hypo- and areflexia, reduction of pain sensitivity. In some cases, there is hypertension, periodic vomiting, transient thermoregulatory disorders, pollakiuria, seizures, recurrent corneal ulcers with rapid healing, scoliosis and other orthopedic changes, low growth. Intellect is usually not changed.

The pathogenesis of family disautonomy is unknown. Clinico-pathomorphological comparisons allow us to connect the main clinical symptoms with peripheral nerve damage. The absence of unmyelinated and thick myelinated fibers is attributed to the defeat of nerve growth factors and the evolutionary delay in the migration of neurons from the chain of nerve cells of the embryo located parallel to the spinal cord.

Buka's syndrome

Disease with autosomal dominant type of inheritance. It is characterized by innate changes of ectodermal character: early graying, palmar hyperhidrosis, palmoplantar keratosis, hypodontia with small molar teeth aplasia.

Gamstorp-Wohlfarth Syndrome

Hereditary disease with autosomal dominant type of inheritance, which is characterized by a neuromuscular symptom complex: myochemistry, neuro-myotonia, muscular atrophy, distal hyperhidrosis.

Auriculotemporal syndrome of Lucy Frey

Paroxysmally occurring hyperemia and hyperhidrosis in the parotid-temporal region. As a rule, these phenomena develop during the reception of solid, acidic, spicy food, while chewing imitation often does not have a similar effect. Etiological factor can serve as trauma to the face and transferred parotitis of almost any etiology.

Syndrome of a drum string

The syndrome (chorda tympani syndrome) is characterized by increased perspiration in the chin area in response to taste irritation. It occurs after surgical trauma as a result of cross-stimulation of sympathetic fibers located next to the parasympathetic fibers of the submaxillary gland.

Red granulosis of the nose

It manifests a pronounced sweating of the nose and neighboring areas of the face with reddening of the skin and the presence of red papules and vesicles. Is hereditary in nature.

Blue spongy nevus

For blue spongy nevus - a vesicoid form of hemangioma, localized mainly on the trunk and upper limbs, characterized by night pain and regional hyperhidrosis.

Brunauer's Syndrome

A variety of hereditary keratoses (autosomal dominant inheritance). Characterized palmar-plantar keratosis, hyperhidrosis, the presence of high, acute (gothic) sky.

Congenital pachyonichia

With congenital pachyonihia - a dominant inherited disease characterized by onychripposis, (hyperkeratosis of the palms, soles, knees, elbows, tiny dermal outgrowths and leukoplakia of the mucous membranes of the oral cavity, hyperhidrosis of the palms and soles occurs.

Erythromelalgia Weir-Mitchell

Hyperhidrosis of the palms and feet often occurs with erythromelalgia of Weir-Mitchell as one of the manifestations of the erythromelalgic crisis. With the phenomenon of Cassirer's acroasplacement, as well as with the clinically developed form of Raynaud's disease, this phenomenon can be either the manifestation of angiospasm attacks, or occur during the interictal period.

Axillary hyperhidrosis

A condition that is often difficult to tolerate by patients. More often the disease is hereditary and occurs in persons of both sexes, but mostly in men. It is usually observed in young people, rarely at an older age and is not observed in children. As a rule, sweating is more intense in the right armpit. It is believed that excessive sweating is associated with increased activity of the eccrine sweat glands. In patients with severe axillary hyperhidrosis, hyperplasia of the sweat glands is histologically detected with the presence of cystlike extensions.

The syndrome of "bloody sweat" (haemathidrosis)

The condition in which sweat secretion is bloody as a consequence of blood leakage on undamaged skin areas is characterized by the syndrome of "bloody sweat". He appears with nervous excitement, fear, sometimes without any apparent cause. It is rare, mainly in women suffering from neurotic disorders of a hysterical nature and menstrual irregularities. It should be noted that in patients suffering from hysteria, bleeding can occur as a result of autotraumatism. 3-4 days before the appearance of blood on the skin marked burning. Typical localization is symmetric to the shin, the rear of the hand. At first, droplets of light pink liquid appear on the skin, which gradually turn into a darker color of the blood. This is an important diagnostic sign, indicating the percolation of blood through intact skin. Bleeding usually lasts from a few minutes to several hours. During the period of remission, barely noticeable brownish pigmentation remains on the skin. The characteristic clinical picture in the absence of hematological disorders allows us to differentiate the syndrome of "bloody sweat" from hemorrhagic diathesis.

The phenomenon of anhidrosis can be one of the manifestations of PTS and is more common in the picture of the Shay-Drageer syndrome.

Guilford-Tendlau Syndrome

Congenital suffering due to disruption of the development of the outer germinal membrane. It is characterized by complete anhidrosis with pronounced disorders of heat exchange, hypotrichosis, hypo- and anodontia, lack of smell and taste. Sometimes there is atrophic rhinitis, saddle nose and other malformations. There are more erased forms of the syndrome.

The Nigeli Syndrome

Hypodidosis of the palms and feet, a feeling of discomfort in the warmth due to the lack of function of the sweat glands is present in the Negeli syndrome, accompanied, in addition, by the net pigmentation of the skin, moderately pronounced palmar-plantar hyperkeratosis, unusual appearance of redness and blisters on the skin.

Syndrome of Christ - Siemens - Turena

The syndrome is characterized by multiple anomalies of the external embryonic leaf (autosomal recessive or dominant inheritance). They detect anhidrosis, hypotrichosis, anodontia, hypodontia, pseudoprogenesis; saddle nose, prominent forehead, thick lips, thin wrinkled eyelids, underdeveloped eyelashes and eyebrows: pigment anomalies (peripheral pallor of the face). Hypoplasia of sebaceous glands of the skin leads to eczema, pipoplasia of the sweat glands causes intolerance to an elevated temperature of the external environment, hyperpyrexia. Mental and physical development is normal.

Sjögren's Syndrome

Disease of unknown etiology, including a triad of symptoms: dry keratoconjunctivitis (dry eyes), xerostomia (dry mouth) and chronic arthritis. Clinically, patients often experience symptoms of decreased secretion on the surface and other mucous membranes, including the respiratory tract, gastrointestinal tract and genitourinary tract. Quite often expressed caries, bronchitis and pneumonia. Almost half of the patients have parotid glands.

Horner's Syndrome

The so-called Horner partial syndrome with cluster headache is described when there is no anhidrosis. On the contrary, it is known that during a severe attack of a cluster headache almost all patients notice a pronounced hyperhidrosis of the face on the side of the headache. However, in a special study, it was found that in a calm state in patients, along with other signs of Horner's syndrome, hypohidrosis, less noticed by patients, is also noted on the same side. When provocation (for example, "attack" of cluster pain or physical exercises) develops an obvious hyperhidrosis of the face. The mechanism of development of hyperhidrosis with cluster headache, usually bilateral, more pronounced on the side of the headache, is unknown.

The syndrome of Adi

The syndrome of Eidi (papillotonia) can be a manifestation of autonomic dysfunction and in rare cases can be combined with progressive generalized anhidrosis. The syndrome of Adi is the result of postganglionic lesions of parasympathetic pupillary fibers. Its classical symptoms are moderately dilated pupils that do not respond to light and convergence. Over time, the accommodation and the pupillary reflex tend to regress, but the response to light is lost stably. In all cases of the disease, the pupil has pharmacological signs of denervation hypersensitivity: a gradual infusion of parasympathomimetic substance - 0.125% solution of pilocarpine hydrochloride - causes miosis in patients with the syndrome of Adid, while its effect on the diameter of the normal pupil is insignificant.

There are several cases of the syndrome of Adi, which has bilateral manifestations and is combined with progressive anhidrosis and a decrease in tendon reflexes on the legs, hyperthermia. With the introduction of parasympathomimetics, these patients also have signs of post-provender hypersensitivity. By now, it is very difficult to localize a defect related to anhidrosis. It can only be noted that the described symptom complex - the syndrome of Adid, anhidrosis, hyperthermia - may have a common origin and is a sign of partial disautonomy.

Hyperhidrosis may accompany peripheral vegetative failure in some conditions. In diabetes mellitus, its manifestations often accompany or even precede manifestations of sensorimotor neuropathy. The consequence of degeneration of postganglionic shipmotory axons is sweating disorders - head, chest and distal anhidrosis, as well as intolerance to heat load.

With parkinsonism, vegetative disorders are obligatory. In this case, a combination of dry skin with local hyperhidrosis in the area of hands, feet and face is often observed, and also paroxysms of diffuse hyperhidrosis can be observed. It is assumed that these disorders are a consequence of the progressive vegetative failure that occurs in parkinsonism.

Sweating disorders are an important clinical phenomenon for a variety of somatic, endocrine and other diseases. Generalized hyperhidrosis, along with tachycardia, anxiety, dyspnea, impaired function of the gastrointestinal tract and increased blood pressure, is characteristic of thyrotoxicosis. In itself, the hyperhidrosis in terms of physiology is aimed at reducing pathologically increased heat production in the body, as a consequence of an increase in tissue metabolism.

Hyperhidrosis, tachycardia and headache (with increased arterial pressure) are a triad of obligate symptoms of pheochromocytoma. Paroxysmal conditions observed with pheochromocytoma arise from the release of catecholamines from the tumor into the blood, which activate peripheral adrenoreceptors. The generalized hyperhidrotic reaction is associated with both the effects of catecholamines on peripheral organs, and is a consequence of a general increase in the level of metabolism.

Generalized hyperhidrosis is noted in 60% of patients with acromegaly. The pathophysiological mechanisms of these conditions are closely interrelated. In addition, it was shown that bromocriptine leads to a significant reduction in hyperhidrosis in these patients.

[1], [2], [3]