Chapter 40 - Diseases of the Eccrine and Apocrine Sweat Glands

Question 1

When the temperature rises, what are the two main mechanisms that the skin uses to cool the body?

Answer 1

Radiative cooling due to cutaneous vasodilation and evaporative cooling due to sweat

Question 2

Which anatomic locations don’t have any eccrine sweat glands?

Answer 2

Clitoris, labia minora, glands penis, external auditory canal, and lips

Question 3

True or false: patients with primary hyperhidrosis often have a positive family history for the condition.

Answer 3

True; 80% give a positive family history

Question 4

True or false: the right axilla usually produces more sweat than the left.

Answer 4

True!

Question 5

Can epidermolysis bullosa simplex be associated with palmoplantar hyperhidrosis? What about familial dysautonomia (Riley-Day syndrome)?

Answer 5

Yes to both

Question 6

True or false: Sweating is absent when a patient has a fever over 39 degrees Celsius.

Answer 6

True! Due to apparent inhibition of the hypothalamic centre for sweating

Question 7

True or false: foods and drinks an induce sweating in normal individuals.

Answer 7

True, especially spicy foods, citrus, and alcohol

Question 8

What is the principle terminal neurotransmitter in eccrine sweating?

Answer 8

Acetylcholine, via sympathetic nervous system

Question 9

What is the diagnostic criteria for primary hyperhidrosis?

Answer 9

1) Focal, visible excess sweating, 2) Present for at least 6 months, 3) No apparent secondary causes, 4) 2 of the following: a) Bilateral and symmetric, b) Impairs activities of daily life, c) At least 1 episode per week, d) Age of onset <25 years, e) Positive family history, f) Stops during sleep

Question 10

What are the 2 major forms of primary hyperhidrosis?

Answer 10

Volar (palmoplantar) (50-60%) and axillary (30-50%)

Question 11

What are the 5 types of secondary hyperhidrosis?

Answer 11

Cortical, hypothalamic, medullary, spinal or local.

Question 12

What are some causes of hypothalamic (thermal) hyperhidrosis? Hint: think of broad categories

Answer 12

Infection, tumors, endocrine/metabolic causes, vasomotor dysfunction, neurologic causes, drugs/toxins, and miscellaneous causes such as POEMS syndrome

Question 13

What happens in spinal (cord transection) sweating?

Answer 13

Lack of sweating belwo the level of injury, bouts of mass refex sweating (except belwo T8-T10)

Question 14

What is the main mediator in axon reflex (local inflammatory) sweating?

Answer 14

Substance P

Question 15

What 3 situations/disorders leads to compensatory hyperhidrosis?

Answer 15

1) miliaria, 2) diabetes mellitus, 3) post-sympathectomy

Question 16

What is the treatment for hyperhidrosis?

Answer 16

Topical (aluminum chloride hexahydrate, aluminum tetrachloride), iontophoresis, oral anticholinergics, alpha adrenergic blockers, biofeedback therapy, botulinum toxin, surgery

Question 17

What are the 3 types of causes for anhidrosis? Hint: think broad categories

Answer 17

1) central and neuropathic diseases/medication disrupting the neural pathway, 2) non-neural alterations in gland itself, 3) idiopathic origin

Question 18

What is the treatment for anhidrosis?

Answer 18

Limited. Discontinue/avoid trigger, keep in cool environment