81: Hyperhydrosis and Anhidrosis Flashcards
What is hyperhidrosis and how does it differ from anhidrosis?
Hyperhidrosis is excessive sweating beyond what is physiologically necessary to maintain normal body temperature, while anhidrosis is the inability to generate sweat when it is physiologically necessary to dissipate heat, which can lead to medical emergencies like hyperthermia or heat stroke.
What are the clinical features of primary focal hyperhidrosis?
The clinical features of primary focal hyperhidrosis include:
- Excessive sweating at baseline in various anatomical locations (palms, soles, axillae, craniofacial region, groin).
- Affects both males and females equally.
- Begins in childhood (palmar-plantar) or during puberty (axillary).
- Persists into adulthood and rarely improves spontaneously.
- Severity ranges from mild (moist skin) to severe (dripping wet).
What are the diagnostic criteria for hyperhidrosis?
The diagnostic criteria for hyperhidrosis include:
- Focal visible excessive sweating for ≥6 months without apparent cause.
- At least two of the following:
- Bilateral and relatively symmetric sweating.
- Age of onset typically before age 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.
What triggers hyperhidrosis?
Triggers for hyperhidrosis include:
- Increased temperature.
- Anxiety.
- Stress.
- Physical activity.
What are the first-line treatment options for hyperhidrosis?
First-line treatment options for hyperhidrosis include:
- Over-the-counter antiperspirants.
- Aluminum chloride hexahydrate (10% to 35%), which is best applied to dry skin at bedtime and washed off after 6 to 8 hours.
If moisture is present when applied, it can form a weak hydrochloric acid, causing burning, irritation, or desquamation.
What is the most likely diagnosis for a patient with excessive sweating on their palms and soles that worsens during stress?
The most likely diagnosis is Primary Focal Hyperhidrosis. Diagnostic criteria include focal visible excessive sweating for ≥6 months without apparent cause and at least two of the following: bilateral and symmetric sweating, onset before age 25, cessation during sleep, frequency of at least once per week, positive family history, and impairment of daily activities.
What is the next step in treatment for severe axillary sweating that has not responded to over-the-counter antiperspirants?
The next step is the application of aluminum chloride hexahydrate (10%-35%), which is best applied to dry skin at bedtime and washed off after 6-8 hours. It works by forming a weak hydrochloric acid that blocks sweat ducts.
What are the key diagnostic criteria for focal visible excessive sweating classified as hyperhidrosis?
The diagnostic criteria for hyperhidrosis include:
- Focal visible excessive sweating for ≥6 months without apparent cause
- At least two of the following:
- Bilateral and relatively symmetric sweating
- Age of onset typically before age 25
- Cessation of sweating from the focal areas during sleep
- Frequency of at least once per week
- Positive family history
- Sweating impairs daily activities.
What are the common triggers for primary hyperhidrosis?
Common triggers for primary hyperhidrosis include:
- Increased temperature
- Anxiety
- Stress
- Physical activity.
What are the clinical features of primary focal hyperhidrosis?
Clinical features of primary focal hyperhidrosis include:
- Excessive sweating at baseline in various anatomic locations (palms, soles, axillae, craniofacial region, groin)
- Affects both males and females equally
- Begins in childhood (palmar-plantar) or during puberty (axillary)
- Persists into adulthood
- Ranges from mild (moist skin) to severe (dripping wet) excessive sweating.
What is the first-line therapy for managing hyperhidrosis?
The first-line therapy for managing hyperhidrosis includes:
- Over-the-counter antiperspirants
- Aluminum chloride hexahydrate (10% to 35%)
Application Instructions:
- Best applied to dry skin at bedtime
- Washed off after 6 to 8 hours
- Caution: If moisture is present during application, it can lead to burning, irritation, or desquamation due to hydrochloric acid formation.
What are the potential medical complications associated with primary hyperhidrosis?
Potential medical complications associated with primary hyperhidrosis include:
- Maceration
- Secondary infections
- Pitted keratolysis
- Dermatophytosis
- Verruca vulgaris or plantaris.
What is the mechanism of action of Botulinum Toxin in treating hyperhidrosis?
Botulinum Toxin acts on the cholinergic synapses by inhibiting acetylcholine release, which helps reduce sweating in the treated areas.
What are the side effects associated with Glycopyrrolate when used for hyperhidrosis?
Side effects of Glycopyrrolate include:
- Erythema
- Mild pain or discomfort
- Paresthesia in the treatment zone.
What is the purpose of Endoscopic Thoracic Sympathectomy (ETS) in hyperhidrosis treatment?
ETS is used for severe cases of palmar hyperhidrosis that have failed conservative management. It can lead to complications such as compensatory sweating in other body segments and other serious risks.
What is the FDA-approved use of miraDry in hyperhidrosis treatment?
miraDry is an FDA-approved procedure for adults with primary axillary hyperhidrosis. It uses microwave energy to permanently destroy eccrine glands, reducing sweating in the treated area.
What is the recommended maintenance frequency for Tap Water Iontophoresis Therapy after initial treatments?
After initial treatments, Tap Water Iontophoresis Therapy typically requires maintenance treatments 1-2 times per week to sustain its effects.
What are the contraindications for using oral anticholinergic agents like Glycopyrrolate and Clonidine?
Oral anticholinergic agents are contraindicated in:
- Myasthenia gravis
- Paralytic ileus
- Pyloric stenosis
Caution is also advised in patients with closed-angle glaucoma, bladder outflow obstruction, gastroesophageal reflux disease, and cardiac insufficiency.
What is the mechanism of action of topical glycopyrrolate in treating craniofacial hyperhidrosis?
Topical glycopyrrolate is an anticholinergic agent that inhibits acetylcholine at muscarinic receptors, reducing sweat production.
What surgical option is available for a patient with severe palmar hyperhidrosis who has failed conservative management?
Endoscopic Thoracic Sympathectomy (ETS) is an option. Potential complications include compensatory sweating, Horner syndrome, bradycardia, pneumothorax, pleural effusion, acute bleeding, delayed hemothorax, chylothorax, and persistent intercostal neuralgia.
What is the duration of efficacy for botulinum toxin injections in axillary hyperhidrosis?
The median duration of efficacy is 4-5 months. Off-label areas include the face, scalp, palms, soles, inframammary folds, and inguinal folds.
What is the rationale for using propranolol in managing stress-induced hyperhidrosis?
Propranolol, a beta-blocker, is effective in managing stress-induced hyperhidrosis by reducing the physiological effects of stress on sweat production.
What are the clinical implications of using Botulinum Toxin for treating hyperhidrosis?
Botulinum Toxin acts on the cholinergic synapses by inhibiting acetylcholine release, which reduces sweating. It is effective for patients who do not respond to topical therapies and has a median duration of effect of 4 to 5 months. It is FDA-approved for severe primary axillary hyperhidrosis in adults 18 years and older, and can also be used off-label for other focal areas such as the face, scalp, and palms.
What are the potential complications associated with Endoscopic Thoracic Sympathectomy (ETS) for palmar hyperhidrosis?
Complications of ETS include:
1. Increased risk of compensatory sweating in body segments below the treated area.
2. Less common complications such as Horner syndrome, bradycardia, and pneumothorax requiring chest tube drainage.
3. Other risks include pleural effusion, acute bleeding, delayed hemothorax, chylothorax, and persistent intercostal neuralgia.
How does Glycopyrrolate function as an anticholinergic agent in the treatment of hyperhidrosis?
Glycopyrrolate is an anticholinergic that can be crushed and mixed with water to enhance sweat reduction. It works by limiting the passage across lipid membranes, which helps reduce sweating. Side effects include:
- Erythema
- Mild pain or discomfort
- Paresthesia in the treatment zone.
What is the mechanism of action and contraindications for using oral anticholinergic agents like oxybutynin and clonidine in hyperhidrosis treatment?
Oral anticholinergic agents like oxybutynin and clonidine work by blocking cholinergic receptors, thus reducing sweating. However, they are contraindicated in conditions such as:
- Myasthenia gravis
- Paralytic ileus
- Pyloric stenosis
Caution is advised in patients with closed-angle glaucoma, bladder outflow obstruction, and cardiac insufficiency due to potential side effects like xerostomia, constipation, and bradycardia.
What are the primary causes of secondary hyperhidrosis?
Secondary hyperhidrosis can occur due to:
1. Endocrine diseases (57% of cases) - including diabetes mellitus, hyperthyroidism, and hyperpituitarism.
2. Neurologic diseases (32% of cases) - presenting as asymmetric hyperhidrosis.
3. Malignancies - such as pheochromocytoma.
4. Respiratory diseases and psychiatric diseases.
5. Physiologic or pathologic gustatory sweating and other neurologic dysfunctions.
What is Frey syndrome and what are its causes?
Frey syndrome is characterized by localized sweating on the lips, forehead, scalp, and nose while eating hot and spicy foods. It can occur due to:
- Injury or surgery in the region of the parotid gland, leading to aberrant regeneration of autonomic fibers of the auriculotemporal nerve.
- Birth trauma in infants and children, particularly with forceps delivery.
- Upper thoracic and cervical sympathectomy, facial herpes zoster, or chorda tympani injury.
- It may also be associated with cluster headaches and diabetes mellitus.
What are the clinical features of generalized secondary hyperhidrosis?
The clinical features of generalized secondary hyperhidrosis include:
- Focal, regional, or generalized sweating that often persists during sleep.
- Onset typically occurs in adulthood.
- Can result from various underlying conditions such as metabolic disorders, infections, malignancies, or as a side effect of medications or toxins.
What is paroxysmal localized hyperhidrosis and its treatment options?
Paroxysmal localized hyperhidrosis is characterized by episodes of excessive sweating affecting the head, neck, and upper trunk. It is more common in older postmenopausal women and less commonly in men. Treatment options include:
- Clonidine
- Topical or oral glycopyrrolate
Hormonal replacement therapy is generally ineffective for this condition.
What is eccrine nevus and how is it treated?
Eccrine nevus is a rare skin hamartoma defined histologically as focal hyperplasia or hypertrophy of eccrine glands. It is characterized by:
- A hyperhidrotic isolated patch of skin with no epidermal changes.
- Frequently located on the forearm.
Treatment depends on the severity and may include:
- Botulinum toxin injections
- Topical glycopyrrolate.
What is the likely cause of asymmetric hyperhidrosis in a patient with a history of brainstem stroke?
The likely cause is secondary hyperhidrosis due to neurologic disease, such as a brainstem stroke, which can disrupt autonomic regulation.
What is gustatory sweating and what triggers it?
Gustatory sweating is a physiological response via the trigeminovascular reflex triggered by hot and spicy foods.
What is the diagnosis for localized sweating on the cheek after parotid gland surgery?
The diagnosis is Frey syndrome, caused by aberrant regeneration of autonomic fibers after trauma to the auriculotemporal nerve.
What is the likely cause of paroxysmal hyperhidrosis in a postmenopausal woman, and what treatment options are available?
The likely cause is alterations in the hypothalamic set point temperature range for sweating. Treatment options include clonidine or topical/oral glycopyrrolate.
What are the primary causes of secondary hyperhidrosis and how do they differ between localized and generalized forms?
Primary causes of secondary hyperhidrosis:
1. Endocrine diseases (57% of cases): Includes conditions like diabetes mellitus, hyperthyroidism, and hyperpituitarism.
2. Neurologic diseases (32% of cases): Can present as asymmetric hyperhidrosis.
3. Malignancies: Such as pheochromocytoma and respiratory diseases.
4. Infections and fever: Contribute to generalized secondary hyperhidrosis.
Localized secondary hyperhidrosis can be due to:
- Physiologic or pathologic gustatory sweating.
- Central or peripheral neurologic dysfunctions.
- Cold-induced sweating syndrome.
- Paroxysmal localized hyperhidrosis.
Generalized secondary hyperhidrosis results from metabolic disorders, infections, malignancies, or autonomic nervous system derangements.
What is Frey syndrome and what are its clinical implications and treatment options?
Frey syndrome is characterized by:
- Localized sweating on the lips, forehead, scalp, and nose when eating hot or spicy foods due to a trigeminovascular reflex.
- It can occur after injury or surgery in the region of the parotid gland, often due to aberrant regeneration of autonomic fibers from the auriculotemporal nerve.
Clinical implications:
- Can present in infants and children after birth trauma or in cases of familial bilateral Frey syndrome without trauma.
- Associated with conditions like cluster headaches and diabetes mellitus.
Treatment options include:
- Topical glycopyrrolate.
- Aluminum chloride.
- Botulinum toxin injections.
- Rarely, intracranial section of the glossopharyngeal nerve or tympanic neurectomy may be considered.
What is the cause of Frey syndrome?
Frey syndrome is caused by injury or surgery in the region of the parotid gland, often due to aberrant regeneration of autonomic fibers from the auriculotemporal nerve.
What are the clinical implications of Frey syndrome?
Frey syndrome can present in infants and children after birth trauma or in cases of familial bilateral Frey syndrome without trauma. It is associated with conditions like cluster headaches and diabetes mellitus.
What are the treatment options for Frey syndrome?
Treatment options include topical glycopyrrolate, aluminum chloride, botulinum toxin injections, and rarely, intracranial section of the glossopharyngeal nerve or tympanic neurectomy.
How does paroxysmal localized hyperhidrosis manifest?
Paroxysmal localized hyperhidrosis is characterized by episodes of excessive sweating affecting the head, neck, and upper trunk.
Who is more commonly affected by paroxysmal localized hyperhidrosis?
It is more common in older postmenopausal women, but can also occur in men.
What are the contributing factors for paroxysmal localized hyperhidrosis?
Contributing factors include alterations in the hypothalamic set point temperature range for sweating.
What are the treatment options for paroxysmal localized hyperhidrosis?
Treatment options include clonidine and topical or oral glycopyrrolate.
What is eccrine nevus?
Eccrine nevus is a rare skin hamartoma characterized by focal hyperplasia or hypertrophy of eccrine glands.
What are the clinical features of eccrine nevus?
Eccrine nevus presents as a hyperhidrotic isolated patch of skin without epidermal changes, frequently located on the forearm.
What are the treatment options for eccrine nevus?
Treatment options depend on severity and may include botulinum toxin injections and topical glycopyrrolate.
What are some metabolic disorders associated with generalized secondary hyperhidrosis?
Metabolic disorders include diabetes mellitus, hypoglycemia, thyrotoxicosis, carcinoid syndrome, hyperpituitarism (acromegaly), congestive heart failure, dumping syndrome, menopause, malignancy, and drug withdrawal.
What are some infectious disorders associated with generalized secondary hyperhidrosis?
Infectious etiologies include tuberculosis, malaria, brucellosis, subacute bacterial endocarditis, and Hodgkin lymphoma (excessive IL-6).
What is Riley-Day Syndrome?
Riley-Day Syndrome, also known as Familial dysautonomia (FD), is an autosomal recessive disorder affecting 1 in 3600 live births in the Ashkenazi Jewish population.
What genetic mutation is associated with Riley-Day Syndrome?
Riley-Day Syndrome is associated with mutations in the IKAP gene on chromosome 9.
What are the clinical features of Riley-Day Syndrome?
Clinical features include 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.
What medications are known to cause hyperhidrosis as a side effect?
Medications include serotonin (5-hydroxytryptamine) reuptake inhibitors, opioids, and prostaglandin inhibitors (e.g., naproxen).
What is the mechanism by which opioids cause hyperhidrosis?
Opioids can cause mast cell degranulation and histamine release, leading to hyperhidrosis.
What are the diagnostic steps for secondary hyperhidrosis?
Diagnostic steps include a thorough clinical history and physical examination, obtaining baseline vital signs, and conducting laboratory studies as warranted.
What are the causes of anhidrosis?
Causes include congenital absence of sweat glands (e.g., hypohidrotic ectodermal dysplasia), connective tissue diseases (e.g., Sjögren syndrome), eccrine duct obstruction, underlying neurologic disorders, peripheral neuropathies, and medications or toxins.
What is the pathophysiological mechanism behind generalized hyperhidrosis in diabetes mellitus?
Generalized hyperhidrosis in diabetes mellitus may result from autonomic neuropathy, which disrupts normal sweat regulation.
What cytokine is implicated in night sweats in Hodgkin lymphoma?
Interleukin-6 (IL-6) is implicated, as it induces fever and night sweats by elevating the thermal set point.
What is the genetic mutation associated with familial dysautonomia?
Familial dysautonomia is associated with mutations in the IKAP gene on chromosome 9.
What is the mechanism behind hyperhidrosis in patients taking serotonin reuptake inhibitors?
The likely mechanism is 5-hydroxytryptamine (2A) receptor antagonism, which can stimulate sweat production.
What are the potential infectious etiologies that could present with generalized hyperhidrosis?
Potential infectious etiologies include tuberculosis, malaria, brucellosis, subacute bacterial endocarditis, and Hodgkin lymphoma.
How does Familial Dysautonomia manifest in patients?
Familial Dysautonomia is characterized by 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.
What role do medications play in causing hyperhidrosis?
Medications that can cause hyperhidrosis include serotonin reuptake inhibitors, opioids, and prostaglandin inhibitors.
What are the clinical features of acquired idiopathic generalized anhidrosis (AIGA)?
AIGA is characterized by acute onset, cholinergic urticaria, elevated serum immunoglobulin E levels, absence of other autonomic dysfunction, and marked response to glucocorticoids.
What are the types of miliaria and their distinguishing features?
Miliaria is classified into three types: Miliaria Crystallina (ductal obstruction at the stratum corneum), Miliaria Rubra (deeper obstruction within the epidermis), and Miliaria Profunda.
What is the primary cause of Miliaria Profunda?
The primary cause of Miliaria Profunda is obstruction of eccrine sweat ducts, leading to symptoms in hot and humid conditions.
What are the treatment options for Miliaria Profunda?
Treatment options include topical application of anhydrous lanolin and prevention strategies such as controlling exposure to heat and humidity.
What is hypohidrotic ectodermal dysplasia?
Hypohidrotic ectodermal dysplasia is characterized by abnormal development of eccrine sweat glands, hair, and teeth, and is associated with life-threatening hyperpyrexia.
What defines congenital insensitivity to pain with anhidrosis (CIPA)?
CIPA is a rare autosomal recessive disorder characterized by congenital insensitivity to noxious stimuli, anhidrosis, recurrent hyperpyrexia, and mental retardation.
What are the early and later manifestations of Fabry disease?
Early manifestations include hypohidrosis, telangiectasia, angiokeratoma, acroparesthesia, and gastrointestinal symptoms. Later manifestations involve renal, cardiac, and central nervous system dysfunction.
What are the clinical features of acquired idiopathic generalized anhidrosis (AIGA)?
Clinical features include acute onset, cholinergic urticaria, elevated serum immunoglobulin E levels, and absence of other autonomic dysfunction.
What are the management strategies for Miliaria Profunda?
- Identify and address the primary cause of Miliaria Profunda.
- Discontinue any contributing medications.
- Keep the patient cool to prevent life-threatening overheating.
- Advise wearing wet clothing during physical activity.
What are the diagnostic steps for Miliaria Profunda?
- Careful medical history, focusing on medications, underlying medical conditions, and family history.
- Biopsy to identify possible sweat gland abnormalities.
What are the treatment options for Miliaria Profunda?
- Topical application of anhydrous lanolin.
- Prevention strategies such as controlling exposure to heat and humidity, treating any underlying febrile illnesses, and removing occlusive clothing.
What is the likely mechanism of generalized anhidrosis in systemic sclerosis?
Generalized anhidrosis in systemic sclerosis may result from eccrine duct obstruction due to skin fibrosis.
What are the primary types of focal hyperhidrosis?
- Palmoplantar hyperhidrosis
- Axillary hyperhidrosis
- Craniofacial hyperhidrosis
- Generalized hyperhidrosis
What are some secondary causes of focal hyperhidrosis associated with central nervous system disorders?
- Cerebral infarction
- Frontal opercular infarct
- Brainstem stroke
- Chiari type I and II malformation
- Myelopathies caused by infarction, syringomyelia, or tumor
- Cold-induced sweating syndrome
- Olfactory hyperhidrosis
What are the primary autonomic disorders associated with acquired anhidrosis?
- Progressive isolated segmental anhidrosis
- Idiopathic pure sudomotor failure
- Chronic idiopathic anhidrosis
- Isolated sudomotor disorders (e.g., Ross syndrome, pure autonomic failure, autoimmune autonomic neuropathy)
What are some secondary autonomic disorders associated with anhidrosis?
- Central nervous system lesions (e.g., stroke, tumor, infection)
- Degenerative disorders (e.g., multiple system atrophy, Parkinson disease)
- Peripheral nerve lesions (e.g., hereditary sensory and autonomic neuropathy, Guillain-Barré syndrome)
What are some conditions associated with generalized hyperhidrosis?
- Hyperthyroidism
- Diabetes mellitus
- Hypoglycemia
- Hypercortisolism
- Acromegaly
- Malignancies (e.g., leukemia, lymphoma)
What is the likely mechanism of miliaria in atopic dermatitis?
Miliaria in atopic dermatitis may result from obstruction of eccrine sweat ducts due to inflammation and skin barrier dysfunction.
What is the underlying cause of generalized anhidrosis in Sjögren syndrome?
Generalized anhidrosis in Sjögren syndrome may result from autoimmune destruction of eccrine sweat glands.
What is the pathophysiological mechanism of hypohidrosis in Fabry disease?
Hypohidrosis in Fabry disease results from glycosphingolipid accumulation in eccrine sweat glands and autonomic neuropathy.
What is the pathophysiological mechanism of anhidrosis in diabetic autonomic neuropathy?
Anhidrosis in diabetic autonomic neuropathy results from damage to autonomic nerves that regulate sweat glands.
What is the likely mechanism of anhidrosis in amyloidosis?
Anhidrosis in amyloidosis may result from deposition of amyloid in autonomic nerves, impairing sweat gland function.
What is the underlying cause of compensatory hyperhidrosis after sympathectomy?
Compensatory hyperhidrosis occurs due to disruption of normal autonomic pathways, leading to excessive sweating in untreated areas.
What is the pathophysiology of unilateral facial anhidrosis in Harlequin syndrome?
Harlequin syndrome is caused by disruption of sympathetic innervation to one side of the face, leading to anhidrosis and flushing.
What is the likely cause of localized hyperhidrosis in burning feet syndrome?
Localized hyperhidrosis in burning feet syndrome is likely due to autonomic dysregulation affecting eccrine sweat glands.
What is the likely mechanism of generalized anhidrosis in Parkinson disease?
Generalized anhidrosis in Parkinson disease may result from autonomic failure due to neurodegeneration.
What is the underlying defect in increased chloride concentration in sweat in cystic fibrosis?
Increased chloride concentration in sweat in cystic fibrosis is due to defective CFTR protein, which impairs chloride reabsorption in sweat glands.
What is the pathophysiology of segmental anhidrosis in Ross syndrome?
Ross syndrome is characterized by segmental anhidrosis due to autonomic dysfunction affecting sweat glands.
What is the likely mechanism of anhidrosis in Guillain-Barré syndrome?
Anhidrosis in Guillain-Barré syndrome may result from autonomic nerve damage due to demyelination.
What is the likely mechanism of generalized anhidrosis in hypothalamic lesions?
Generalized anhidrosis in hypothalamic lesions may result from disruption of central autonomic pathways that regulate sweating.
What is the underlying cause of generalized anhidrosis in multiple system atrophy?
Generalized anhidrosis in multiple system atrophy results from widespread autonomic failure due to neurodegeneration.
What is the likely mechanism of anhidrosis in Lambert-Eaton myasthenic syndrome?
Anhidrosis in Lambert-Eaton myasthenic syndrome may result from impaired autonomic nerve function due to autoantibodies against voltage-gated calcium channels.
What is the likely cause of localized hyperhidrosis in erythromelalgia?
Localized hyperhidrosis in erythromelalgia may result from autonomic dysregulation affecting sweat glands.
What is the likely mechanism of anhidrosis in systemic sclerosis?
Anhidrosis in systemic sclerosis may result from fibrosis and obstruction of eccrine sweat ducts.
What are the primary causes of focal hyperhidrosis?
Primary causes of focal hyperhidrosis include:
- Palmoplantar, axillary, craniofacial, and generalized hyperhidrosis.
What are the secondary causes of focal hyperhidrosis?
Secondary causes of focal hyperhidrosis can be due to:
- Cerebral infarction (e.g., frontal opercular infarct, brainstem stroke).
- Spinal cord injury (e.g., autonomic dysreflexia, posttraumatic syringomyelia).
- Other central nervous system disorders (e.g., Chiari malformation).
- Peripheral nervous system disorders (e.g., peripheral motor neuropathy).
How do secondary autonomic disorders associated with anhidrosis differ from primary autonomic disorders?
Secondary autonomic disorders associated with anhidrosis include:
- Central nervous system lesions (e.g., hypothalamic lesions, brainstem lesions).
- Degenerative disorders (e.g., multiple system atrophy, Parkinson disease).
Primary autonomic disorders with acquired anhidrosis include:
- Progressive isolated segmental anhidrosis.
- Idiopathic pure sudomotor failure.
- Chronic idiopathic anhidrosis.
What are some common causes of generalized hyperhidrosis associated with central nervous system disorders?
Common causes of generalized hyperhidrosis associated with central nervous system disorders include:
- Episodic hypothermia with hyperhidrosis (Hines-Bannick or Shapiro syndrome).
- Posttraumatic or posthemorrhagic diencephalic epilepsy.
- Fatal familial insomnia and Parkinson disease.
- Infections such as tuberculosis, malaria, brucellosis, and endocarditis.
- Metabolic disorders like hyperthyroidism and diabetes mellitus.
What are the clinical implications of peripheral nerve lesions causing anhidrosis?
Peripheral nerve lesions causing anhidrosis can lead to:
- Loss of sweat production in affected areas, impacting thermoregulation.
- Conditions such as hereditary sensory and autonomic neuropathy, Guillain-Barré syndrome, and diabetic autonomic neuropathy.
- Symptoms like heat intolerance and increased risk of heat-related illnesses.
What are the potential effects of medications on sweating and anhidrosis?
Medications can cause anhidrosis through various mechanisms, including:
- Anticholinergics and ganglionic blockers, which inhibit sweat gland activity.
- Opioids and other narcotics, which can alter autonomic function.
- Heat exposure and pharmacologic agents leading to heat-related illnesses.
