Hyperhidrosis

HYPER IDROSIS, poly(h)idrosis, hyperhidrosis, sweating, functional disorder of the sweat glands characterized by increased sweat secretion. This anomaly can be symptomatic or idiopathic, acute or chronic; it can be general and spread over the surface of the entire body (H. universalis) or local and limited to certain areas of it (H. localis, ep(h)idrosis, partial sweating). In general hyperhidrosis, those areas of the skin that are naturally supplied with a significant number of sweat glands (face, armpits, groin folds, palms, soles) sweat particularly heavily. Abundant profuse sweats, generalized or partial, permanent or critical, occur in functional and organic neuroses, in neurasthenia, hysteria, tabes dorsalis, hemiplegia, multiple degenerative neuritis, sometimes in paralysis agitans, diseases of the brain and medulla oblongata (gumma, glioma), in injuries of nerve trunks, Basedow's disease, tetanus, in dysmenorrhea, amenorrhea and in the climacteric period, in uric acid diathesis and in anemic and obese subjects. Within physiological limits, hyperhidrosis accompanies sharp fluctuations in temperature. Symptomatic hyperhidrosis is observed in infectious diseases, playing the role of a thermoregulating factor (critical sweats in croupous pneumonia, typhoid fever, intermittent fever, influenza, septicemia, malaria, acute articular rheumatism, during a drop in temperature, hectic sweats in pulmonary tuberculosis). Slight psychological agitation, physical exertion, or a slight increase in external temperature can already cause excessive sweating. Individual subjects exhibit significant differences. It often leads to the development of erythema, intertrigo, eczema, and skin pruritus due to maceration and irritation of the stratum corneum of two contacting skin folds. Local hyperhidrosis is more frequently observed, especially in joint folds, in the armpits, on the palms and soles, constituting a distressing phenomenon for patients. Sweat sometimes appears on one half of the body and trunk (H. unilateralis) - rarely in healthy individuals, more often as a pathological phenomenon in paralytic migraine, facial nerve disease, neuralgia of the trigeminal, intercostal, sciatic, and lumbar nerves, after injuries to the cervical sympathetic nerve. Unilateral hyperhidrosis often arises reflexively under the influence of certain taste sensations (mustard, vinegar, cheese). Increased sweating of the scalp is very characteristic in rachitic children. Hyperhidrosis of the extremities (so-called acrohyperhidrosis) is often combined with acroasphyxia (moist, cold, and mostly cyanotic hands and feet). In H. superior, only the upper limbs and the upper part of the trunk sweat, which apparently depends on irritations of the sweat centers of the spinal cord at the corresponding level. Crossed hyperhidrosis, according to Schlesinger, is a consequence of a lesion of the spinal cord near its posterior surface. Under the name H. nudorum, or so-called paradoxical sweating, is meant the abundant secretion of sweat in large drops in the armpit area. Under the influence of irritation (cold or emotion), the smooth muscle fibers of the large sweat glands (see Apocrine glands) contract, emptying their contents. Apparently, this anomaly is an excretory reflex. The causes of hyperhidrosis are diverse. In local hyperhidrosis, along with increased excitability of the sweat centers, the sensitivity of the glandular epithelium and the endings of peripheral nerves is of no small importance. Treatment: elimination of the underlying condition, hygienic measures, daily hot baths, frequent changes of stockings, abstinence from alcoholic beverages, change of climate, tonic remedies (arsenic and iron), sedatives and vasoconstrictors (bromine, quinine, ergotin), antiperspirants (atropine and agaricin), external remedies (astringent, drying, and disinfecting): alum, salicylic acid, tannin, formalin, talc, starch; in local hyperhidrosis, X-ray therapy (1/2 and 3/4 dose) gives a favorable effect.