Diseases of apocrine and eccrine glands Flashcards
Harlequin syndrome
Unilateral flushing
Hyperhidrosis in association with contralateral anhidrosis
May be due to peripneral or CNS abnormalities
What causes sweating in phaeochromocytoma
Episodic release of catecholamines
Overarching causes of hyperhidrosis
Primary Cortical Hypothalamus Medullary Spinal Local
Causes of hypothalamic hyperhidrosis
- Chronic infections
- Malignancy - lymphoma
- Neurological - CNS tumours, parkinsons, etc
- Vasomotor
- Toxins - ETOH, ETOH withdrawal
- Endocrine/metabolic - diabetes, hyperthyroidism, pregnancy, menopause, PKU, gout
- Miscellaneous: compensatory, localized unilateral hyperhidrosis, POEMs
What can cause hyperhidrosis in diabetes
- Low BSL
- Peripheral neuropathy
- Gustatory hyperhidrosis
- Poorly controlled –> scalp sweating
What temperature does sweating start?
When the fever is 39-40 there is no sweating, its only once the temperature goes down does the sweating start –> inhibitory mechanism
How does food induce sweating
Reflex arc:
Afferent impulses from taste bud receptors –> travel via the glossopharyngeal nerve to nuclei within the medulla oblongata –> provocation of sweating rather than the usual response of salivation
Sweating occurs to the upper cutaneous lips and cheeks a few minutes after eating
Associated vasodilation –> erythema
Food that induces sweating
Spicy or sharp-tasting foods and beverages
Citrus fruits, alcohol, condiments
Three main causes of compensatory hyperhidrosis
- Miliaria –> anhidrosis to the back results in hyperhidrosis to the face
- Diabetes –> peripheral neuropathy results in truncal hyperhidrosis
- Post sympathectomy –> cervicothoracic –> thermal hyperhidrosis to the trunk
What is cold erythema
Cold induces localized erythema, pain and central hyperhidrosis
How can you assess sweat for axillary and volar
Volar:
Mild : moist palm or sole
Moderate: sweating towards fingertips
Severe: Drip sweat
Axillary Normal: <5 cm Mild 5-10 cm Mod 10-20 cm Severe >20 cm
Starch iodine (3.5% iodine in alcohol, then starch powder brushed onto area) or quinizarin methods –> site that turns blue-black is where the sweating is happening
Gravimetric - weighing filter paper before and after application to the skin
Evaporative: assesses water vapour loss from the skin
Infrared thermography
When to use aluminium antiperspirants
At night, because the aluminium occludes sweat ducts, and so you don’t want to be too sweaty
Used 3-5 consecutive nights, then after that 1-2 times a week
Main a/e is irritant contact dermatitis and burning
Aluminium chloride hexahydrate 6.25-20%
Aluminium chloride 12-20%
Aluminium zircuonium may be effective in axillae but not volar surfaces
What can you give with aluminium antiperspirants to stop it being sweated away
Anticholinergic drug 1 hour before using
Can also use topical aldehydes - formaldehyde, glutaraldehyde
Who can you use topical towellete treatment with and what does it do
Glycopyrronium tosylate via a cloth towelette –> nine years or over
How does iontophoresis work
Don’t know, but thought to block the sweat ducts in the stratum corneum
Use 2-3 times a week
What are adverse effects from oral anticholinergics
Dry eyes and mouth Insomina Mental status changes - confusions, hallucinations Palpitations Seizures Blurred vision Bowel disturbances Urinary retension Hypertension
Risks for sympathectomy
Do T2-3 for palmar and lumbar for plantar
Risk: Horner syndrome, hypotension, pneumothorax, compensatory hyperhidrosis, and hyperhidrosis may jsut gradually recur
List all possible treatments for primary hyperhidrosis
Primary: - Topical aluminium anti-perspiratorys - Topical towellete Secondary: - Botox - Iontophoresis - Thermal ablation: Nd:Tag laser, microwave - Anti-cholinergics: oxybutinin, glycopyrrolate - Alpha 2 agonist: clonidine - Beta blocker: propanolol - Anxiolytic: clonazepam Third line: - Sympathectomy - Excision - Liposuction
What is the diagnostic criteria for primary hyperhidrosis
- Present for at least 6 months
- No secondary cause
At least 2 of the following: - Bilateral and symmetric
- Impairs ADL
- Once a week
- Age of onset <25 years
- FHx
- Stops during sleep
How do you test for anhidrosis
- Hot environment or exercise, but try not to overheat
- Colorimetric or gravimetric diminished or absent sweating
- Local intradermal injection of cholinergic drug to stimulate sweat, but risk of side effects precludes a large area
- If suspicious of peripheral nueropahy: text for axon reflex sweating with intradermal nicotine sulfate or picrate
- Biopsy: sweat gland abnormalities
What is the diagnostic test for CF and what is the rationale for it
Sweat test
Have a CFTR gene mutation –> decreased electrolyte reabsorption by the eccrine duct –> loss of sodium, chloride and potassium in sweat. Increased Cl concentration in the sweat is seen - >60 mEq/L on 2 separate occasions
What is the difference between eccrine and apocrine bromhidrosis
Eccrine: maceration of SC with bacterial degradation of keratin
Apocrine: bacterial degradation of apocrine sweat into ammonia and short-chain fatty acids
Causes of chromhidrosis
Eccrine: exogenous contamination - paint,. dye, microorganisms such as Cornyebacteria, copper salts (blue-grey)
Sunless tanning products - brown sweat
Red sweat - clofazimine and rifampin
Apocrine: intrinsic - lipofuscin in large amounts, alkaptonuria (can be first sign)
Complications of miliaria
Crystallina - none
Rubra –> can develop miliaria pustulosa, can get secondary infection, and rubra can cause hyperpyrexia
Profundus: when a large number get occluded, can result in compensatory hyperhidrosis, thermoregulatory problems, axillary and inguinal lymphadenopathy
