81 - Hyperhidrosis and Anhidrosis Flashcards
Eccrine sweat glands are innervated by _____ nerve fibers
Sympathetic
Main neurotransmitter on eccrine glands
Acetylcholine
Excessive sweating of the palms and soles, axillae, craniofacial region, groin, or a combination of body sites
Typically begins in childhood or during puberty, and continues to persist into adulthood
Primary focal hyperhidrosis
Hyperhidrosis has been reported to predispose the patient to increased risk of
Cutaneous infection, such as pitted keratolysis, dermatophytosis, and verruca vulgaris or plantaris
To establish a diagnosis of primary focal hyperhidrosis, symptoms should be present for at least _____ without apparent cause
6 months
To establish a diagnosis of primary focal hyperhidrosis, at least the following characteristics should be included
Bilateral and relatively symmetric
Age of onset typically before age of 25 years
Cessation of sweating from the focal areas during sleep
Frequency of at least once per week
Positive family history
Sweating impairs daily activities
Helpful to identify the involved areas of hyperhidrosis at baseline, but does not provide any information on severity of the disease
Minor starch-iodine test
Objective measurement of the amount of sweat production, but is not practical for routine clinical use
Gravimetric (weight-based) assessment
First-line therapy for hyperhidrosis
Over-the-counter antiperspirants
Aluminum chloride hexahydrate (10% to 35%)
Topical glycopyrrolate (0.5%-2%
Aluminum chloride hexahydrate works best when applied to dry skin at _____ and washed off after 6 to 8 hours
Bedtime
If the patient fails to respond to topical therapy, _____ may be administered to areas of extensive sweating
Intradermal injection of botulinum toxin
Microwave energy is readily absorbed by water molecules and as a result can easily target tissues with high water content, such as the eccrine glands
Electromagnetic energy thermolysis
Y/N: Eccrine glands do not regenerate
Yes
Use the passage of a direct electrical current onto the skin
Tap water iontophoresis therapy
Severe cases of palmar hyperhidrosis that failed conservative management may be considered for
Endoscopic thoracic sympathectomy
Systemic medications that are commonly used for hyperhidrosis
Anticholinergics (glycopyrrolate and oxybutynin)
Clonidine
Anticholinergic agents are contraindicated in those with
Myasthenia gravis
Paralytic ileus
Pyloric stenosis
Focal, regional, or generalized sweating that often persists during sleep
Tends to present in adulthood
Secondary hyperhidrosis
Usually asymmetric gustatory sweating in the distribution of the auriculotemporal nerve after injury or surgery in the region of the parotid gland
Frey syndrome
Frey syndrome can also be seen in infants and children, often after
Birth trauma with forceps delivery
Daytime paroxysmal hyperhidrosis affecting the head, neck and upper trunk can occasionally affect
Older postmenopausal women
Y/N: Hot flashes are typically associated with paroxysmal localized hyperhidrosis, and hormonal replacement therapy is usually effective
No - not associated; ineffective
Excessive sweating has been reported in association with certain cutaneous disorders
Blue rubber bleb nevus syndrome Perilesional skin of a glomus tumor Tufted angioma Eccrine angiomatous hamartoma or eccrine nevus Grierson-Gopalan disease Pachydermoperiostosis Pretibial myxedema
Rare skin hamartoma histologically defined as focal hyperplasia or hypertrophy of eccrine glands
Eccrine nevus
Hyperhidrotic isolated patch of skin with no epidermal changes
Frequently located on the forearm
Eccrine nevus
Secondary hyperhidrosis has been previously reported in association with
Diabetes mellitus Hypoglycemia Thyrotoxicosis Carcinoid syndrome Hyperpituitarism (acromegaly) Congestive heart failure Dumping syndrome Menopause Malignancy Drug withdrawal Exogenous bacterial pyrogens: tuberculosis, malaria, brucellosis, subacute bacterial endocarditis Hodgkin lymphoma
Also known as Riley-Day syndrome
Familial dysautonomia
Secondary hyperhidrosis has been previously reported in association with
Diabetes mellitus Hypoglycemia Thyrotoxicosis Carcinoid syndrome Hyperpituitarism (acromegaly) Congestive heart failure Dumping syndrome Menopause Malignancy Drug withdrawal Exogenous bacterial pyrogens (tuberculosis, malaria, brucellosis, subacute bacterial endocarditis) Hodgkin lymphoma
Riley-Day syndrome is also known
Familial dysautonomia
Most intensively studied of the hereditary sensory-autonomic neuropathies
Riley-Day syndrome
Riley-Day syndrome is caused by mutations in the
IKAP gene
Characterized by pronounced autonomic dysregulation with profuse sweating and salivation, diminished production of tears, red blotching of the skin, absence of fungiform papillae of the tongue, episodic orthostatic hypotension, arterial hypertension, reduced deep tendon reflexes, and behavioral abnormalities
Riley-Day syndrome
Hyperhidrosis can be associated with the following medications
Serotonin (5-hydroxytryptamine) reuptake inhibitors
Opioids
Prostaglandin inhibitors (naproxen)
Tricyclic antidepressants
Cholinergic agonists (pilocarpine, bethanechol, pyridostigmine)
Most common form of the ectodermal dysplasias
X-linked hypohidrotic ectodermal dysplasia
Mutations in the _____ gene encoding for _____ result in X-linked hypohidrotic ectodermal dysplasia
ED-1
Ectodysplasin
Rare autosomal recessive disorder characterized by the congenital insensitivity to noxious stimuli, anhidrosis, recurrent hyperpyrexia, mental retardation, and self-mutilating behavior
Congenital insensitivity to pain with anhidrosis or
HSAN type IV
CIPA is reported to occur because of loss-of-function variants in _____ gene
Neurotrophic tyrosinase repector kinase 1 (NTRK1)
Inherited X-linked lysosomal storage disorder caused by deficient activity of alpha-galactosidase A
Early manifestations include hypohidrosis, telangiectasia, angiokeratoma, acroparestheisa, and gastrointestinal symptoms
Fabry disease
Second most common symptom of Fabry disease
Hypohidrosis
Rare cause of anhidrosis that can result from idiopathic pure sudomotor failure, sudomotor neuropathy, or eccrine gland failure
Acquired idiopathic generalized anhidrosis
Three types of clinically distinctive miliaria based on the level of obstruction
Miliaria crystallina
Miliaria rubra
Miliaria profunda
To identify possible sweat gland abnormalities, a _____ should be obtained in patients with anhidrosis
Biopsy specimen from the affected area
