DR BENISH MEHMOOD

PGR DERMATOLOGY UNIT I

objectives
o Understand the pathophysiology of sweating

o Identify the causes of Hypherhidrosis

o suitable treatment options for Hyperhidrosis

Sweat glands
The human body has 2-5 million sweat
gland

There are two main types

Eccrine
apocrine
Eccrine Sweat
Glands
Approximately 3
million eccrine
sweat glands
Secrete a clear,
odorless fluid
Aid in
regulating body
temperature
Areas of
concentration:
Facial, plantar,
Apocrine Sweat
Glands

Inactive until
puberty
Produce thick
fluid
Secretions
produce“ body
odor”
Found in
axillary and
genital areas
MECNANISM OF SWEAT
PRODUCTION

Dorsal root
hypothalamus spinalcord
ganglion

Sympathetic
Sweat gland
chain
Triggering factors
The hypothalamus can be triggered by:
Exercise
Temperture
Stress
hormones
What is
hyperhidrosis
It is production
of excess sweat
of whole body
or part of body
that interferes
with activities
of life.
Clinical groups
generalized

regional

focal
GENERALIZED HYPERHIDROSIS
Febrile infective illness
Infective endocarditis
Endocrinopathy
acromegaly
menopause
 Malignancy and lymphoma

 .>10%weight loss, lymph

nodes,hepatosplenomegaly,anorexia
parkinsonism
Congestive cardiac failure
 Cold induced sweating
syndrome
 Sweating on
exposure to cold;
 inability to sweat
in heat
 Clinodactyly
 Syndactyly
 Lumber lordosis
 Abnormaly
positioned ears
 High arched
palatte
 Familial dysautonomia/ riley day
syndrome
Absence of overflow
of tears during
emotions
Corneal abrasions
Delay in speech and
walking
Lumber lordosis
Increase heart rate
Loss of fungiform
papillae over tongue
Decrease sensory
and temperature
sensation
Congenital autonomic dysfunction with
universal pain loss
Universal pain
loss
Profound
hypotonia
Self mutilation
Lack of
overflow of tears
Loss of deep
tendon reflexes
Loss of
fungiform
 Episodic
hypothermia
with
hyperhidrosis

Pale cool skin

dysthermia
Peripheral
neuropathy
Autonomic
neuropathy
DRUGS
 Focal
hyperhidrosis
Family history positive
Doesnot occur in sleep
Related to mental
activity,physical
exertion,emotional
disturbances
Raynauds +ve
Continuous or phasic
Contact dermatitis
Palmoplantar
keratoderma
Localized and asymmetrical
Autonomic dysreflexia
Orthostatic hypotension
Intrathoracic neoplasia
Ipsilateral Atrophy of Pleural effusion
horner small muscles and pleuritic
syndrome of hand chest pain

dyspnoea Sensory loss

Guatatory hyperhidrosis
Sweating of
lips,forhead,scalp,nose
while eating spicy food
 post traumatic
Post surgical
Post herpetic
Freys syndrome
Congenital/acqu
ired
Redness and
sweating of face
on eating,thinking
and talking about
food
Eating a piece of
lemon that
provokes sweating
is diagnostic
Granulosa rubra nasi
Diffuse
erythema over tip
of nose,upper
lip,chin,
Papules,macule
s,vesicles
Marked
sweating at tip of
nose
telangectesias
Sweating associated with local skin
disorders
Glomus
tumor/paraganglio
ma
Small bluish
Commanly on
nails
Often raises the
nail bed
Pain is produced
when placed in cold
water common in
females
Blue rubber bleb
nevus

Asymtpmatic
multiple
protuberat,dark
blue,compressi
ble
look and feel
like rubber
nipple
Extracutaneo
us lesions may
bleed
poems syndrome

polyneuropathy organomegaly endocrinopathy

M protein
Skin changes
changes
Burning feet syndrome
Gierson-
gopalan
syndrome
Erythema
Sweating and
burning of feet
Congenital or
acquired
Compensatory hyperhidrosis
 generalized

fever No fever Drug history

Low grade
High grade
LN WT CHANGES NO WT CHANGES
LN,nausea etc
ORGANOMEGALY

TREMORS,FESTIN
ATING Neurologic
Infective illness MALIGNANCY Weight gain weight loss GAIT,STOOPING signs
POSTURE

Menopause
CCF hyperthroidism PARKINSONISM
acromegaly
 LOCALIZED
ASYMMETRICAL

WT LOSS,PLEURITIC
CHEST
PAIN,IPSILLATERAL
H/O SPIINAL TRAUMA HORNER H/O SURGERY SKIN LESIONS
SYNDROME,ATROPHY
OF SMALL MUSCLES OF
OF HAND

ORTHOSTATIC
HYPOTENSION,HYPER
INTRATHORACIC
TENSION,LOSS OF FACIAL SURGERY SYMPATHECTOMY
NEOPLASM
BLADDER AND BOWEL
CONTROL

SWEATING EVEN
AUTONOMIC RELATION TO SPICY
AFTER TALKING OR
DYSREFLEXIA FOOD
THINKING ABT FOOD

FREYS
GUSTATORY
SYNDROME
TESTS FOR HYPERHIDROSIS
 Iodinted starch
 Sodium alizarin sulphate
 Filter paper collection
 Quantitative sudomotor axon reflex test
 Skin sympathetic potential
 Iodine impregnted paper imprint after pilocarpine
stimulation
CONT…
 Microcannulation of ducts or coil
 Collection into wescor macroduct coil
 Cutaneous microdialysis
 Confocal electron microscope
 Immunohistochemical analysis
treatment

local

conservative

systemic
treatment

surgical sympathectomy
Palmar and plantar hyperhidrosis

Aluminium
glycopyrrolate Botulinum toxin A
chloride

IONTOPHORESIS sympathectomy
 Aluminium
chloride

glycopyrrolate
conservative
Botulinum
toxinA

Axillary IONTOPHOR
hyperhidrosis ESIS

LOCAL
EXCISION
surgical
SYMPATHEC
TOMY
CRANIOFACIAL
AND GUSTATORY
GUSTATORY

GLYCOPYRR
GLYCOPYRR OLATE
OLATE

BOTULINUM
CLONIDINE
A TOXIN

BELLAMINE

TOPIRAMATE
MECHANISM OF ACTION OF BOTOX
MECHANISM OF ACTION OF
IONTOPHORESIS
Treatment Option Review Systemic – blocks
acetylcholine

Photo used with permission: The Whiteley Clinic, 2007