Sweating disorder

Sweating disorders are one of the most common and at the same time poorly studied symptoms of dysfunction of the autonomic nervous system. The sweating system, along with the cardiovascular, respiratory systems and skin, ensures high adaptability of a person to hot climate conditions, physical work at normal and elevated ambient temperatures.

The existence of a relationship between temperature, humidity of the environment, physical activity, level of mental stress and the nature of sweating reactions allows all cases of daily sweating in humans to be divided into two types:

1. thermoregulatory sweating, which occurs over the entire surface of the body for adequate thermoregulation in response to changes in ambient temperature and during physical exertion;
2. psychogenic sweating that occurs in various areas as a result of mental stress - on the palms, in the armpits, the soles of the feet and certain areas of the face or on the entire surface of the body.

There is still no single understanding of the mechanisms of "thermoregulatory" sweating: does it always depend on an increase in blood temperature and subsequent activation of the central structures responsible for thermoregulation, or does the activation of these structures occur as a result of the reflex influence of peripheral thermoreceptors. At the same time, the excitability of the central thermoregulatory apparatus is apparently greatly influenced by the physical properties of the blood: sweating occurs faster and is more abundant when the viscosity of the blood decreases.

There are two types of sweat glands - eccrine and apocrine. Eccrine glands are distributed over the entire surface of the body and secrete a solution of sodium chloride. Their main function is thermoregulation, maintaining a constant body temperature. Less common apocrine glands develop from hair follicles and are located mainly under the arms and in the genital area: it is believed that only these glands determine body odor. On the palms and soles, the process of water secretion is different than on the entire surface of the body: the intensity of imperceptible perspiration in these areas is 5-20 times higher than on the general surface of the body, sweat glands are located very densely on them and sweat secretion occurs continuously.

The sweat glands located in the armpit, as well as on the palms and soles, show much more pronounced individual differences in morphological development and secretory activity than glands scattered over the surface of the body. Perspiration on the palms and soles differs sharply in nature from perspiration on the general surface of the body: it does not increase under the influence of ordinary thermal stimuli, but is easily intensified by the action of mental or sensory agents.

Psychogenic sweating, which occurs as a result of mental stress, differs fundamentally from thermoregulatory sweating in that it reaches an intensity corresponding to the degree of irritation without a latent period, lasts as long as the stimulus is present, and immediately ceases as soon as the stimulus is removed. The purpose of this sweating has been little studied. However, it is obvious that it primarily reacts to stimuli that cause stress and does not play any role in regulating body temperature. There are a number of interesting suggestions that apocrine sweating is an ancient mechanism that plays some role in sexual behavior.

A distinction is made between qualitative and quantitative sweating disorders, with the latter being encountered in the clinic much more frequently.

Absolute loss of sweating - anhidrosis - is an extremely rare clinical symptom; more often there is a decrease in its intensity - hypohidrosis (hypohidrosis) or an increase - hyperhidrosis (hyperhidrosis). Qualitative sweating disorders are associated with a change in the composition and color of the secreted sweat (chromhidrosis). A change in the color of sweat is noted when iron, cobalt, copper salts, potassium iodide enter the human body. In chronic nephritis, uremia, uridrosis is sometimes noted - the release of urea and uric acid on the hair and in the armpit in the form of tiny crystals. Steathidrosis is observed with a significant admixture of sebaceous gland secretion, as a result of which the sweat becomes greasy. Depending on the prevalence of the clinical phenomenon, sweating disorders can be generalized and local.

Classification of sweating disorders

All types of sweating disorders can be divided into two groups - primary (essential) and secondary, when they serve as a manifestation of some disease. Hyperhidrosis, depending on prevalence, is divided into two large groups:

Generalized hyperhidrosis:

• essential;
• in hereditary diseases: Riley-Day syndrome (familial dysautonomia), Buck syndrome, Gamstorp-Wohlfarth syndrome;
• in acquired diseases: obesity, hyperthyroidism, acromegaly, pheochromocytoma, alcoholism, chronic infections (tuberculosis, brucellosis, malaria), neuroses, neurogenic tetany, drug reactions due to taking anticholinesterase agents.

Localized hyperhidrosis:

• facial: Lucy Frey auriculotemporal syndrome, chorda tympani syndrome, syringomyelia, red granulosis nasi, blue spongiform nevus;
• palmar and plantar: Brunauer syndrome, pachyonychia, peripheral venous pathology, polyneopathies, erythromelalgia, Cassirer's acroasphyxia, primary (essential);
• axillary hereditary hyperhidrosis.

Sweating disorders that occur as hypohidrosis are usually secondary to a variety of diseases: diabetes mellitus, hypothyroidism, Sjögren's syndrome, hereditary diseases (Gilford-Tendlau syndrome, Naegeli syndrome, Christ-Siemens-Touraine syndrome), age-related hypohidrosis in the elderly, ichthyosis, drug-induced hypohidrosis with long-term use of ganglion blockers, and also as a manifestation of peripheral autonomic dysfunction.

Pathogenesis of sweating disorders

The study of sweating disorders in terms of their topical affiliation is of fundamental importance for specifying the localization of the pathological process, which is important for differential diagnostics. Central and peripheral sweating disorders are distinguished. In cerebral sweating disorders, which often occur as a result of cerebral strokes accompanied by hemiplegia, hyperhidrosis on the hemiplegic side is primarily noted - hemihyperhidrosis. Less often in such cases there is hemihypohidrosis. In predominantly cortical lesions (in the area of the pre- or postcentral gyri) of small extent, contralateral hyperhidrosis of a monotype may occur, for example, with the involvement of one arm or leg, half of the face. However, the area of the cortex capable of influencing the intensity of sweating is much larger (only the occipital lobe and the anterior poles of the frontal lobes do not affect sweating). Unilateral sweating disorders are noted with damage to the brainstem at the level of the pons and especially the medulla oblongata, as well as subcortical formations.

Sweating Disorders - Pathogenesis

Symptoms of sweating disorders

Essential hyperhidrosis is an idiopathic form of excessive sweat production and occurs mainly in two forms: generalized hyperhidrosis, i.e., manifested over the entire surface of the body, and localized hyperhidrosis - on the hands, feet, and armpits, which is much more common.

The etiology of this disease is unknown. There are suggestions that patients with idiopathic hyperhidrosis have either an increased number of regional eccrine sweat glands or an increased reaction to common stimuli, while the number of glands is unchanged. To explain the pathophysiological mechanisms of local hyperhidrosis development, the theory of dual autonomic innervation of the eccrine glands of the palms, feet, and armpits is used, as well as the theory of increased sensitivity of the eccrine system to high concentrations of adrenaline and noradrenaline circulating in the blood during emotional stress.

Patients with essential hyperhidrosis, as a rule, note excessive sweating since childhood. The earliest age of onset of the disease is described as 3 months. However, during puberty, hyperhidrosis increases sharply, and, as a rule, patients consult a doctor at the age of 15-20 years. The intensity of sweating disorders in this phenomenon can vary: from the mildest degree, when it is difficult to draw the line with normal sweating, to the extreme degree of hyperhidrosis, leading to a violation of the patient's social adaptation. The phenomenon of hyperhidrosis in some patients causes great difficulties and restrictions in professional activities (draftsmen, stenographers, dentists, salespeople, drivers, electricians, pianists and representatives of many other professions).

Sweating Disorders - Symptoms

Treatment of sweating disorders

Treatment of patients with sweating disorders is an extremely difficult task. Since sweating disorders are often secondary, the tactics of managing such patients should be aimed primarily at treating the primary disease.

Conservative treatment of patients with hyperhidrosis includes general and local measures. General therapy consists of tranquilizers to control emotional disorders closely associated with hyperhidrotic reactions. Biofeedback, hypnosis and psychotherapy have a beneficial effect on the condition of patients, especially with the essential form of hyperhidrosis. Traditionally, such patients are treated with anticholinergic drugs (atropine, etc.), which cause side effects such as dry mouth, blurred vision or constipation.

X-ray irradiation of the skin is an outdated method, the purpose of which is to cause atrophy of the sweat glands. In addition to the harmful effects of the irradiation itself, its use is associated with the risk of various dermatitis. A significant result can be obtained by alcoholization of the stellate ganglion.

Sweating Disorders - Treatment