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

Disease eccrine and apocrine sweat glands. To diseases ekkrinnah sweat glands include hyperhidrosis, dyshydrosis, red granularity of the nose, anhidrosis, and sweating. The diseases of apocrine sweat glands include bromhidrosis and osmidrosis, as well as chromhydrosis. In the practice of a dermatocosmetologist, inflammatory diseases of apocrine sweat glands, such as hydradenitis and inverse eels (suppurative hydradenite), can occur. The first is a kind of staphylococcal pyoderma, and the second is a variant of severe acne.

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

The pathogenesis of hyperhidrosis. Hyperhidrosis can be caused by the local influence of a number of drugs on the sweat glands, increased stimulation of the fibers of the sympathetic nervous system, as well as some central influences. When looking at the patient, you should keep in mind all of these mechanisms.

Clinical variants. Isolate common and localized hyperhidrosis, as well as symmetrical and asymmetric.

Common hyperhidrosis can be caused by central thermoregulatory effects. It is known that an increase in the temperature of the blood washing the hypothalamus leads to such thermoregulatory mechanisms as an increase in the secretion of sweat by the eccrine sweat glands and the dilatation of the blood vessels. Thermoregulatory sweating, in contrast to emotional, 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 exposure to alcohol intoxication, gout and after vomiting, common hyperhidrosis is also possible with diabetic neuropathy, hyperthyroidism, hyperpituitarism, obesity, menopause and malignant tumors, but the exact mechanisms of sweat hyperproduction in these conditions and diseases have not been adequately studied. A particular case of common symmetrical hyperhidrosis is hyperhidrosis in attacks of cholinergic urticaria.

Localized symmetrical hyperhidrosis can be caused by emotional influences. So, with emotional and mental tension, there is increased sweating in the armpits, palms and soles, less often in the inguinal folds and on the face. In a number of cases, diffuse symmetrical sweating is also possible.

Hyperhidrosis of the palms and soles may be permanent or episodic. With persistent hyperhidrosis, the situation worsens in the summer with occasional seasonality not typical. Young people have isolated plantar plantar hyperhidrosis, which occurs against the background of an imbalance in the autonomic nervous system. In such patients, acrocyanosis, livedo, lability of blood pressure are also revealed. Expressed palmar-plantar hyperhidrosis with abundant sweating is typical for adolescents, usually the condition improves significantly after reaching 25 years. Cases in the family are common, then the hyperhidrosis is combined with the palmar-plantar keratoderma. Palmar-plantar hyperhidrosis can be complicated by true dyshidrosis, contact dermatitis, foot mycosis and corynebacteriosis (the so-called "undercut" keratolysis, pitted keratolysis). Axillary hyperhidrosis is more often episodic than permanent. It is associated with heat and mental or emotional stress, is associated with an imbalance in the autonomic nervous system.

Localized physiological hyperhidrosis of the lips, forehead, nose can occur in some people against the background of acute and hot food intake, the exact mechanism of this reflex is not fully elucidated. Pathological hyperhidrosis against the background of food intake is characteristic not only in the face area, but also in other localizations. It can be caused by damage to the sympathetic nerves in the face and neck area due to trauma, surgical interventions and inflammatory processes in the auriculo-temporal region, for example the parotid salivary gland.

Asymmetric hyperhidrosis is associated with the defeat of the sympathetic nerve pathways from the brain centers to the terminal nerve endings. The patient is diagnosed with a pathology in the cerebral cortex, basal ganglia of the spinal cord or peripheral nerves. In such cases, hyperhidrosis is rarely manifested in the form of monosymptom, often there is another neurological symptomatology. There are cases of localized asymmetric hyperhidrosis in the projection of pathologically altered internal organs, around trophic ulcers.

Treatment of hyperhidrosis. Outwardly recommend antiperspirants and deodorants. The use of 1% formalin and 10% glutaraldehyde is severely limited due to a high risk of allergic dermatitis. Also shown is iontophoresis with anticholinergic drugs (eg, glycopyrronium bromide). Inside prescribe atropinopodobnye drugs (Belloid, Bemataminal, etc.), sedatives (tincture of motherwort, valerian, peony, Notta, Persen, Negrustin, etc.), less often ganglioblokatory.

Of the invasive methods of correction, sympathectomy was previously popular, while axillary hyperhidrosis also used excision of the skin flap with a large number of glands from the zone. Currently, with palmar-plantar and axillary hyperhidrosis, the administration of preparations of botulinum toxin type A, which is a strong blocker of cholinergic sympathetic fibers, innervating the sweat glands, is very popular. In severe cases of localized hyperhidrosis against the background of food intake, operative treatment aimed at replenishment of adequate conduction along sympathetic nerves and blocking parasympathetic innervation is shown.

Dyshidrosis is the condition of the skin of the palms and soles, which is manifested by cavity rashes.

Pathogenesis and symptoms of dyshidrosis. Consider true dyshidrosis and symptomatic. True dyshidrosis develops with excessive sweating of the palms and soles on the background of increased physical work, wearing warm shoes and gloves predisposing to the emergence of a local greenhouse effect. In this condition, on the one hand, the secretion of perspiration by the eccrine glands takes place, and on the other hand, the excretory ducts of these glands are clogged as a result of maceration of the stratum corneum in their mouths. As a result, there are long-term existing bubbles with a dense coating and serous contents.

Dyshidrosis as a symptom may occur with dyshidrotic eczema, a dysgidrotic form of mycosis of the feet, toxicodermia and other dermatoses. Diagnosis is established on the basis of a characteristic clinical picture, as well as data of mycological examination (with foot mycosis).

Treatment of dyshidrosis. With true dyshidrosis, prescribe drying and disinfectants. Inside can be shown preparations of belladonna.

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 clinic. The type of inheritance is not fully understood. The onset of the disease, usually in childhood - from 6 months of age to 10 years. Many patients have circulatory disorders, palmar-plantar hyperhidrosis. An expanded clinic can be preceded by intense perspiration in the tip of the nose for several years. In the future there is diffuse erythema, first - the tip of the nose, and then - the more common, exciting skin of the cheeks, upper lip, chin. On the background of erythema, small droplets of sweat are seen. In the future, small erythematous spots, papules and even vesicles are formed in the projection of sweat glands. The disease usually spontaneously passes to the beginning of the period of puberty. In some patients, it may be longer, in such cases, telangiectasias and small cysts of eccrine sweat glands are formed.

Treatment. Showing careful skin care, inside prescribe vegeto-stabilizing drugs, in some cases solve the problem of removing individual glands or cysts with the help of a laser and electrocoagulation.

Anhidrosis - a special condition of the swollen sweat glands, is accompanied by the absence of sweat production.

Pathogenesis of anhidrosis. Anhidrosis can be associated with the pathology of the immediate eccrine sweat glands, as well as with various violations of the innervation of the latter. From the sweat glands can be aplasia, congenital fetal dysplasia, their blockage in case of rye, eczema and atopic dermatitis, red flat lichen, psoriasis, ichthyosis. To reduce the production of sweat, chronic atrophic acrodermatitis, scleroderma, Sjogren's disease, and skin lymphomas also result. Anhidrosis is possible with organic lesions of the head and spinal (syringomyelia, leprosy, sympathectomy, etc.) of the brain, hysteria, hyperthermia, as well as ingestion of ganglion blockers and anticholinergic drugs.

Symptoms of anhidrosis. Clinically manifested by xerosis of the skin. The spread of anhidrosis can lead to significant violations of thermoregulation up to a pronounced hyperthermia. This is typical for patients with congenital anhydrite ectodermal dysplasia.

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

Sweating is an inflammatory disease of the eccrine sweat glands.

The pathogenesis of sweating. The disease is characteristic of newborns and infants, but can occur in adults. The development of sweets contributes to the overall overheating associated with high ambient temperatures, often in combination with high humidity. It is typical for the summer season. In addition, sweating can occur with increased physical exertion, against a background of fever for various infectious diseases and other conditions.

Symptoms of sweating. First, there is a so-called red sweating, the rashes in which are represented by multiple spot spots, resulting from the persistent expansion of the vessels around the mouths of the eccrine sweat glands. The rashes are symmetrical, located on the trunk and in the folds of the skin, fresh elements can appear for several days. In the future, transparent, up to 2 mm in diameter bubbles with whitish contents and a whisk of erythema along the periphery can be formed. This is the so-called white sweating, or periportite (ostioporitis). This disease is attributed to the group of staphylococcal pyoderma.

Treatment of sweating. Suitable care for the skin, wearing loose clothing made of cotton fabrics, external disinfectant or antibacterial agents is indicated.

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

Characteristic for conditions accompanied by increased permeability of the vascular wall: diencephalic disorders, vasculitis, physical and mental trauma. Bloody sweats often appear on the face (forehead, nose), foreheads, in the area of okolonogtevymi rollers, sometimes in other areas. The condition usually paroxysmal, can amplify at a psychoemotional stress and proceed from several minutes up to several hours. Some patients have symptoms-precursors - a few days before the release of bloody sweat there is pain and burning. Hematidrosis is similar to the phenomenon of bloody milk. When correcting hematidrosis take into account the pathogenetic background, recommend sedatives and drugs that strengthen the vascular wall.

Bromhidrosis - unpleasant odor of sweat, osmidrosis - fetid perspiration.

These conditions occur in young men and are associated with the presence in the secretion of sweat glands of a number of amino acids (for example, tyrosine, leucine, etc.), fatty acids, as well as the products of microflora, primarily corynebacteria. There are episodes in young women with dyshormonal conditions on the background of the menstrual cycle. Bromhidrosis and osmidrosis are typical for patients with chronic kidney disease, accompanied by chronic kidney failure, gout, diabetes, as well as eating garlic and taking a number of medications. The principles of correction of bromhidrosis and osmidrosis are similar to those for localized hyperhidrosis. Patients are given recommendations on diet (exclusion of garlic), thorough hygiene, and externally prescribe antibacterial agents.

Chromhydrosis - colored sweat.

Allocate pseudochromhydrosis and true chromhydrosis. Pseudochrombrosis is characterized by the release of colorless sweat, which is already painted on the surface of the skin. The most frequent cause of it are corynebacteria, which are often present on the skin and hair in the armpits. In the management of such patients, careful hygiene is recommended, and external antibacterial agents are prescribed externally. The coloration of sweat can also be associated with the washing out of dyes from the clothing fabric. True chromhydrosis is extremely rare, states are described, accompanied by yellow, blue, green, black, purple, brown coloration of sweat.

It is associated with the ingestion of certain medicines or dyes. Can be accompanied by a local discoloration of the skin. The phenomenon of colored milk is analogous to the true chromhydrase. If the cause of true chromhydrosis is not detected, the only method of correction is surgical excision of skin areas in the axillary regions.

[1], [2], [3], [4], [5], [6]