Violation of sweating

Disturbances of sweating are related to one of the frequent and at the same time poorly understood symptoms of the disturbance of the functioning of the autonomic nervous system. The sweating system, along with the cardiovascular, respiratory systems and skin provides a highly adaptable person to the conditions of hot climate, physical work at normal and elevated ambient temperature.

The presence of a relationship between temperature, humidity of the environment, physical activity, the level of mental stress and the nature of perspiration reactions allows all cases of everyday sweating in humans to be divided into two types:

1. thermoregulatory sweating, which occurs on the entire surface of the body for adequate thermoregulation in response to changes in ambient temperature and during physical exertion;
2. psychogenic sweating that occurs in various areas as a result of mental stress - on the palms, in the armpits, the plantar part of the feet and individual parts of the face or on the entire surface of the body.

In understanding the mechanisms of "thermoregulatory" sweating, there is still no single idea: is it always dependent on the rise in the temperature of the blood and the subsequent activation of the central structures responsible for thermoregulation, or is the activation of these structures a result of the reflex influence of peripheral thermoreceptors. At the same time, the physical properties of blood seem to have a great influence on the excitability of the central thermoregulation apparatus: sweating occurs more quickly and is more abundant when the viscosity of the blood decreases.

The sweat glands come in two types - eccrine and apocrine. Ekkrinovye glands are distributed on all surface of a body and allocate a solution of chloride of sodium. Their main function is thermoregulation, maintaining a constant body temperature. Less common apocrine glands develop from the hair follicles and are mainly under the arms and in the genital area: it is believed that only these glands determine the body odor. On the palms and soles the process of water allocation is different than on the whole surface of the body: the intensity of imperceptible perspiration in these areas is 5-20 times higher than on the general surface of the body, the sweat glands on them are very dense and the secretion of sweat is continuous.

In sweat glands located in the armpit, as well as on the palms and soles, individual differences in morphological development and secretory activity are expressed much more sharply than in glands scattered on the surface of the body. Perspiration on the palms and soles is very different in nature from perspiration on the general surface of the body: it does not increase under the influence of conventional thermal stimuli, but it is easily amplified by the action of psychic or sensory agents.

The psychogenic sweating arising as a result of mental stress is fundamentally different from the thermoregulatory one in that it reaches the intensity without the latent period, which corresponds to the degree of irritation, lasts as long as the stimulus acts, and immediately ceases as soon as the action of the stimulus is removed. The purpose of this sweating is poorly understood. However, it is obvious that it primarily reacts to irritants that cause stress, and plays no role in regulating body temperature. There are a number of interesting assumptions that apocrine sweating is an ancient mechanism that plays some role in sexual behavior.

There are qualitative and quantitative disorders of sweating, the latter occurring much more often in the clinic.

Absolute loss of sweating - anhidrosis (anhidrosis) - an extremely rare clinical symptom; often there is a reduction in its intensity - gipogidroz (hypohidrosis) or increase - hyperhydrosis (hyperhidrosis). Qualitative disorders of sweating are associated with a change in the composition and color of the secretion of sweat (chromhidrosis). Changing the color of sweat is noted when a person gets iron, cobalt, copper, potassium iodide. In chronic nephritis, uremia sometimes marked uridroz (uridrosis) - selection of urea and uric acid on the hair and the armpit as minute crystals. Steatidrosis (steathidrosis) is observed with a significant admixture of the secretion of sebaceous glands, as a result of which the sweat becomes fat. Depending on the prevalence of the clinical phenomenon, sweating disorders can be generalized and local.

Classification of sweating

All types of sweating disorders can be divided into two groups - primary (essential) and secondary, when they serve as a manifestation of a disease. Hyperhidrosis, depending on the prevalence, is divided into two large groups:

Generalized hyperhidrosis:

• Essential;
• with hereditary diseases: Riley-Deia syndrome (family disautonomy), Buka's syndrome, Hamstorp-Wohlfarth syndrome;
• with acquired diseases: obesity, hyperthyroidism, acromegaly, pheochromocytoma, alcoholism, chronic infections (tuberculosis, brucellosis, malaria), neuroses, neurogenic tetany, drug reactions due to anticholinesterase medications.

Local hyperhidrosis:

• facial: auriculotemporal syndrome Lucy Frey, a syndrome of a drum string, syringomyelia, red granulosis of the nose, blue spongy nevus;
• palmar and foot: Brunauer's syndrome, pachyonichia, peripheral veins pathology, polyneavopathy, erythromelalgia, Cassirer acroasperm, primary (essential);
• axillary hereditary hyperhidrosis.

Sweating disorders that occur as a type of hypohydrosis, as a rule, are secondary for a variety of diseases: diabetes, hypothyroidism, Sjögren's syndrome, hereditary diseases (Guilford-Tendlau syndrome, Negeli syndrome, Christ-Siemens-Touraine syndrome), age-related hypohidrosis in the elderly, ichthyosis, drug hypohydrosis with prolonged use of ganglion blockers, and also as a manifestation of peripheral vegetative disturbance.

Pathogenesis of sweating disorders

The study of sweating disorders in terms of their topical affiliation is of fundamental importance for clarifying the localization of the pathological process, which is important in the conduct of differential diagnosis. There are central and peripheral disorders of sweating. In cerebral sweating disorders, which are more often due to cerebral strokes accompanied by hemiplegia, first of all there is hyperhidrosis on the side of hemiplegia - hemihyperhidrosis. More rarely in such cases, there is hemygipohydrosis. With predominantly cortical lesions (in the region of pre- or postcentral convolutions) of a small extent, contralateral hyperhidroses of a monotype may occur, for example, involving one arm or leg, half the face. However, the area of the cortex that is capable of influencing the intensity of sweating is much greater (sweating is not affected only by the occipital lobe and the anterior poles of the frontal lobes). Unilateral sweating disorders were noted in brain stem lesions at the level of the bridge and especially the medulla oblongata, as well as subcortical formations.

Sweating disorders - Pathogenesis

Symptoms of sweating

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).

Sweating disorders - Symptoms

Treatment of sweating disorders

Treatment of patients with sweating is very difficult. Since sweating disorders are more likely to be secondary, the management tactics of such patients should primarily be directed to primary-care therapy.

Conservative treatment of patients with hyperhidrosis includes general and local measures of influence. General therapy consists in the use of tranquilizers to control emotional disorders, closely associated with hyperhidrotic reactions. Biological feedback, hypnosis and psychotherapy have a beneficial effect on the condition of patients, especially with the essential form of hyperhidrosis. Traditional in the treatment of such patients is the use of anticholinergic drugs (atropine, etc.), which cause such side effects as dry mouth, blurred vision or constipation.

X-ray irradiation of the skin is an outdated method aimed at inducing atrophy of the sweat glands. In addition to the harmful effects of irradiation, its use is associated with the risk of various dermatitis. An essential result can be obtained by alcoholization of the stellate node.

Sweating disorders - Treatment