Sweating disorders - Symptoms

Essential hyperhidrosis

Essential hyperhidrosis is an idiopathic form of excessive sweat production and occurs mainly in two forms: generalized hyperhidrosis, i.e., manifested over the entire surface of the body, and localized hyperhidrosis - on the hands, feet, and armpits, which is much more common.

The etiology of this disease is unknown. There are suggestions that patients with idiopathic hyperhidrosis have either an increased number of regional eccrine sweat glands or an increased reaction to common stimuli, while the number of glands is unchanged. To explain the pathophysiological mechanisms of local hyperhidrosis development, the theory of dual autonomic innervation of the eccrine glands of the palms, feet, and armpits is used, as well as the theory of increased sensitivity of the eccrine system to high concentrations of adrenaline and noradrenaline circulating in the blood during emotional stress.

Patients with essential hyperhidrosis, as a rule, note excessive sweating since childhood. The earliest age of onset of the disease is described as 3 months. However, during puberty, hyperhidrosis increases sharply, and, as a rule, patients consult a doctor at the age of 15-20 years. The intensity of sweating disorders in this phenomenon can vary: from the mildest degree, when it is difficult to draw the line with normal sweating, to the 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 restrictions in professional activities (draftsmen, stenographers, dentists, salespeople, drivers, electricians, pianists and representatives of many other professions).

The prevalence of this form of hyperhidrosis is 1 in 2,000 people in the general population. Apparently, hyperhidrosis occurs equally often in men and women, but women seek help much more often. About 40% of patients note the presence of such a phenomenon in one of their parents. It has been noted that the Japanese suffer from this disease 20 times more often than residents of the Caucasus region.

In a typical variant, 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 flows down the palms. 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 composition of the secretion and the morphology of the sweat glands are not changed.

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 the vegetative apparatus of the segmental level have shown some insufficiency of the sympathetic mechanisms regulating sweating functions. This may be a consequence of the presence of hypersensitivity of partially denervated structures to circulating catecholamines, and clinically manifest as hyperhidrosis.

The diagnosis of primary hyperhidrosis is not difficult. However, it is necessary to keep in mind the similar clinical manifestations of secondary hyperhidrosis, which occurs in systemic diseases, often in neuroendocrine diseases, CNS diseases - Parkinsonism, traumatic brain injuries.

Familial dysautonomia (Riley-Day syndrome)

The disease belongs to the group of hereditary diseases with an autosomal recessive type of inheritance. The core of all clinical manifestations is damage to the peripheral nervous system (PVN syndrome), which has morphological verification. The clinical picture of this disease is characterized by a variety of symptoms. The most common of them are decreased or absent secretion of tears, pronounced hyperhidrosis, which intensifies with excitement, changes in pharyngeal and vestibular reflexes, transient pustular rash on the skin, pronounced salivation, which persists after infancy, emotional lability, impaired coordination of movements, hypo- and areflexia, decreased pain sensitivity. In some cases, arterial hypertension, periodic vomiting, transient disorders of thermoregulation, pollakiuria, seizures, recurrent corneal ulcers with rapid healing, scoliosis and other orthopedic changes, short stature are observed. Intelligence is usually unchanged.

The pathogenesis of familial dysautonomia is unknown. Clinical and pathomorphological comparisons allow us to associate the main clinical symptoms with damage to the peripheral nerves. The absence of unmyelinated and thick myelinated fibers is explained by damage to nerve growth factors and an evolutionary delay in the migration of neurons from the chain of embryonic nerve cells located parallel to the spinal cord.

Buck syndrome

A disease with an autosomal dominant type of inheritance. It is characterized by congenital changes of ectodermal nature: early graying, palmar hyperhidrosis, palmoplantar keratosis, hypodontia with aplasia of small molars.

Gamstorp-Wohlfarth syndrome

A hereditary disease with an autosomal dominant type of inheritance, which is characterized by a neuromuscular symptom complex: myokymia, neuromyotonia, muscle atrophy, distal hyperhidrosis.

Lucy Frey's Auriculotemporal Syndrome

Paroxysmal hyperemia and hyperhidrosis in the parotid-temporal region. As a rule, these phenomena develop during the intake of hard, sour, spicy food, while imitation of chewing most often does not have a similar effect. The etiological factor may be facial trauma and past mumps of almost any etiology.

Chord Tympani Syndrome

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

Red granulosis of the nose

It manifests itself as pronounced sweating of the nose and adjacent areas of the face with reddening of the skin and the presence of red papules and vesicles. It is hereditary.

Blue spongy nevus

Blue spongiform nevus, a vesicular type of hemangioma localized primarily on the trunk and upper limbs, is characterized by night pain and regional hyperhidrosis.

Brunauer syndrome

A type of hereditary keratosis (autosomal dominant inheritance). Characterized by palmoplantar keratosis, hyperhidrosis, and the presence of a high, pointed (Gothic) palate.

Congenital pachyonychia

In congenital pachyonychia, a dominantly inherited disease characterized by onychogripposis (hyperkeratosis of the palms, soles, knees, elbows, tiny skin growths 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 soles is often found in Weir-Mitchell erythromelalgia as one of the manifestations of erythromelalgic crisis. In the phenomenon of Cassirer's acroasphyxia, as well as in the clinically developed form of Raynaud's disease, this phenomenon can be either a manifestation of attacks of angiospasm or occur in the interictal period.

Axillary hyperhidrosis

A condition that is often difficult for patients to bear. The disease is often hereditary and occurs in both sexes, but mainly in men. It is usually observed in young people, rarely in older people 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 pronounced axillary hyperhidrosis, hyperplasia of the sweat glands with the presence of cystic expansions is histologically detected.

Haemathidrosis syndrome

The condition in which the sweat secreted is bloody due to blood seeping through intact skin areas is characterized by the "bloody sweat" syndrome. It appears during nervous excitement, fear, sometimes for no apparent reason. 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 may occur as a result of autotraumatization. A burning sensation is noted 3-4 days before the blood appears on the skin. Typical localization is symmetrical to the shins, the back of the hand. At first, droplets of light pinkish liquid appear on the skin, which gradually turn into a darker color of blood. This is an important diagnostic sign indicating blood seeping through intact skin. Bleeding usually lasts from several minutes to several hours. During the period of remission, a barely noticeable brownish pigmentation remains on the skin. The characteristic clinical picture in the absence of hematological disorders allows us to differentiate the “bloody sweat” syndrome from hemorrhagic diathesis.

The phenomenon of anhidrosis can be one of the manifestations of PVN and is more often found in the picture of Shy-Drager syndrome.

Guilford-Tendlau syndrome

Congenital disorder resulting from developmental disorder of the outer embryonic membrane. Characterized by complete anhidrosis with pronounced heat exchange disorders, hypotrichosis, hypo- and anodontia, absence of smell and taste. Sometimes atrophic rhinitis, saddle nose and other developmental defects are observed. There are more erased forms of the syndrome.

Naegeli syndrome

Hypohidrosis of the palms and soles, a feeling of discomfort in warmth due to insufficient function of the sweat glands is present in Naegeli syndrome, which is also accompanied by reticular pigmentation of the skin, moderate palmar-plantar hyperkeratosis, and the unusual occurrence of redness and blisters on the skin.

Christ-Siemens-Touraine syndrome

The syndrome is characterized by multiple anomalies of the outer germ layer (autosomal recessive or dominant inheritance). Anhidrosis, hypotrichosis, anodontia, hypodontia, pseudoprogenia are detected; saddle nose, prominent forehead, thick lips, thin wrinkled eyelids, poorly developed eyelashes and eyebrows: pigment anomalies (peripheral pallor of the face). Hypoplasia of the sebaceous glands of the skin leads to eczema, hypoplasia of the sweat glands causes intolerance to elevated temperatures of the external environment, hyperpyrexia. Mental and physical development is normal.

Sjogren's syndrome

A disease of unknown etiology, including a triad of symptoms: keratoconjunctivitis sicca (dry eyes), xerostomia (dry mouth) and chronic arthritis. Clinically, patients often have symptoms of decreased secretion on the surface and other mucous membranes, including the respiratory tract, gastrointestinal tract and genitourinary tract. Severe caries, bronchitis and pneumonia are common. Almost half of patients have enlarged parotid glands.

Horner's syndrome

The so-called partial Horner's syndrome has been described in cluster headaches, when anhidrosis is absent. On the contrary, it is known that during a severe attack of cluster headache, almost all patients report pronounced hyperhidrosis of the face on the side of the headache. However, a special study has established that in a calm state, patients, along with other signs of Horner's syndrome, also have hypohidrosis on the same side, which is less noticeable by patients. When provoked (for example, an "attack" of cluster pain or physical exercise), obvious hyperhidrosis of the face develops. The mechanism of hyperhidrosis development in cluster headaches, usually bilateral, more pronounced on the side of the headache, is unknown.

Adie syndrome

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

Several cases of Adie syndrome have been described, which have bilateral manifestations and are combined with progressive anhidrosis and decreased tendon reflexes in the legs, hyperthermia. When parasympathomimetics are administered, these patients also show signs of postdenervation hypersensitivity. At present, it is very difficult to localize the defect related to anhidrosis. It can only be noted that the described symptom complex - Adie syndrome, anhidrosis, hyperthermia - may have a common origin and is a sign of partial dysautonomia.

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

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

Sweating disorders are an important clinical phenomenon for a number of somatic, endocrine and other diseases. Generalized hyperhidrosis, along with tachycardia, anxiety, shortness of breath, gastrointestinal dysfunction and increased blood pressure, is characteristic of thyrotoxicosis. At the same time, hyperhidrosis itself, from a physiological point of view, is aimed at reducing pathologically increased heat production in the body, as a consequence of increased tissue metabolism.

Hyperhidrosis, tachycardia, and headache (with elevated blood pressure) are the triad of obligatory symptoms of pheochromocytoma. Paroxysmal conditions observed in pheochromocytoma occur due to the release of catecholamines from the tumor into the blood, which activate peripheral adrenergic receptors. Generalized hyperhidrotic reaction is associated with both the effect of catecholamines on peripheral organs and is a consequence of a general increase in the level of metabolism.

Generalized hyperhidrosis is observed in 60% of patients with acromegaly. The pathophysiological mechanisms of these conditions are closely interrelated. In addition, bromocriptine has been shown to significantly reduce hyperhidrosis in these patients.

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