Disorders Of Sweat Glands Flashcards
Eccrine sweat glands
Coil and duct are found in the dermis
Produce sweat which empties out directly onto skin
- approximately 0.5 L/hr
Function = thermoregulation
- *Distributed throughout, however highest density is the palms and soles**
- lowest in the chest, upper back and medial extremities
**Innervated by sympathetic nerve fibers that release ACh instead of NE
How does sweating differ based on stimulus
Thermosensative = upregulates in face, neck and upper chest the most but sweats everywhere
Mental or emotional stimuli = soles and palms and axilla the most but also kind of everywhere
Apocrine sweat glands
Also have coil and duct in dermis
Produce oily fluids that includes
- lipids/proteins/sex hormones
Empties into neck of hair follicle and mixes with adjacent sebaceous gland fluids
Found more in axilla, external auditory meatus and genital regions, anus regions
Generalized hyperhidrosis
Generalized sweating episodes with or without an objective fever
- NOT a problem with the sweat glands themselves
- DOES occur at night
Potential causes
- infections
- endocrine issues
- cancer
- medications(especially serotonergic drugs)
- autonomic dysreflexia
- alcohol intoxication
Treatment = treat cause of hyperhidrosis
Primary focal hyperhidrosis
Excessive sweating that is NOT present at night and has NO secondary cause
- gets worse with heat and emotional stimuli
Diagnostic clincial criteria
- focal visible excessive sweating of at least 6 months in length without an apparent cause with at least two of the following:
- bilateral and symmetric
- impairs daily activities
- at least one episodes per week
- onset before age 25
- family history of idiopathic hyperhidrosis
- focal sweating stops during sleep
Starch-iodine test
Laboratory diagnosis of primary focal hyperhidrosis or anhidrosis
- only used if history and physical exam cant confirm diagnosis
Apply iodine to skin and let it dry. Then apply corn starch to the areas.
- areas of sweating turns blue-black color
First line treatments for primary focal hyperhidrosis
OTC topical antiperspirant
- usually doesnt work by itself
Prescription dose topical antiperspirants
- most common = aluminum chloride hexahydrate which blocks sweat gland ducts directly
- applied nightly every day for 2 weeks then once weekly
Topical glycopyrronium
- blocks sweat gland ACh release
- applied daily and can cause anti-slud issues
2nd lines for primary focal hyperhidrosis
Botulinum toxin = blocks ACh
Microwave thermolysis = Nukes the eccrine glands
Surgical resection of minor tissue
Endoscopic thoracic sympathectomy = ABSOLUTE LAST RESORT
Gustatory hyperhidrosis
Excessive sweating with eating that often occurs with mild erythema
Physiologically normal = occurs often with spicy foods, alcohol or citrus
- typically stops after eating
Pathological abnormal = parotid gland issues of some sort
- nerves reconnect to the sweat pathways incidentally which now causes any salivation signal to trigger sweating also
- Frey syndrome = variant of gustatory hyperhidrosis that occurs within months of parotid gland surgery trauma and/or infection
(Significant sweating and erythema on the cheek when eating chewing or thinking about food)
Treatment = similar to primary focal hyperhidrosis
Compensatory hyperhidrosis
Increase in sweating due to decreased or absent sweating elsewhere
Common triggers:
- diabetic neuropathy = decreased leg/foot sweating
- post-sympathectomy
- miliaria
Treatment = try to reverse causes of anhidrosis or similar to focal hyperhidrosis
Anhidrosis/hypohidrosis
Decreased or absent sweating
- possible fatigue/sleepiness or cant concentrate in hot environments
can lead to life-threatening hyperthermia
Causes
- decreased neural signals from brain to sweat glands (tumors stroke, injury)
- intrinsic sweat gland issues (destruction, obstruction, genetic issues)
- medications (especially ACh blockers or any kind)
Diagnosis: clinical evaluation and the starch-iodine test again but look for opposite results, skin biopsy
Treat = treat underlying cause
Apocrine bromhidrosis
Excessively malodorous sweat
- diagnosed when noticeable body odor has a negative effect on an individuals self-view or quality of life
Bacterium degradation of apocrine secretions by corynebacterium, staph, etc. is the leading hypothesis for this
Treatment = reduce bacteria species with good hygiene and topical antibiotics (erythromycin) and then antiperspirants
- can also do hair removal or destroy apocrine glands (refractory only)
Eccrine bromhidrosis
Malodorous sweat from eccrine glands
- can be localized or generalized
- localized = looks kinda like apocrine bromhidrosis
- generalized = ingestion from order foods/medications or systemic illness
- *includes, garlic, onion, curry,alcohol consumption, use of penicillin, heavy metal toxcity, PKU, kidney or liver failure or gout
Diagnosis
- history of bad odor and known cause above
Treatment = address underlying cause
Apocrine chromhidrosis
Presents with colored sweat that stains clothes
- colors includes: blue, black, brown, yellow, green
- worsens with sweat stimuli
**caused by lipofuscin granules in apocrine glands which get oxidized and colored via intrinsic causes
Treatment = benign, if want to treat = topical capsaicin or botulinum toxin injection
Eccrine chromhidrosis
Colored sweat from eccrine glands
Caused by lipofusin granules which oxidize but does so via an extrinsic cause (as oppose to intrinsic for apocrine)
Causes
- meds, heavy metals, cranberry juice, etc.
Treatment = avoid causative agent and treat similar to apocrine chromhidrosis
