Contents
Diseases of the eccrine sweat glands (excessive sweating) are generalized or local hyperfunction of the eccrine sweat glands. Hyperhidrosis is a condition in which more than 50 mg of sweat is released per minute. Generalized excessive sweating may be physiological (excessive sweating caused by, for example, exercise) or symptomatic (as a consequence of coexisting diseases).
Diseases of the eccrine sweat glands
It is excessive sweating caused by a generalized or local hyperfunction of the eccrine glands, which are a structural element of the endocrine glands. Excessive sweating is a condition in which a person secretes more than 50 mg of sweat per minute. People sweat when exposed to high temperature or exercise. On the other hand, diseases of the eccrine sweat glands can occur as a result of severe stress or mental problems. Very often the smell of sweat depends on what we eat, what is our mood, and even our hormonal balance. In a certain group of people excessive sweating occurs regardless of possible stimuli, then genes are blamed.
Generalized excessive sweating may be:
1) physiological (in the case of acclimatization processes in a tropical climate, when consuming certain spices or foods, caused by exercise or obesity);
2) symptomatic – affects the whole body, occurs rarely and is a consequence of coexisting diseases, regresses under the influence of treatment of the underlying disease. The symptomatic (secondary) form of generalized hyperhidrosis is accompanied by:
1.diseases of the nervous system:
a.Parkinson’s disease,
b. damage to peripheral nerves,
c. spinal cord injury.
2.acute febrile diseases:
a. tuberculosis,
b. malaria,
c. brucellosis.
3.endocrine diseases:
a. overactive thyroid gland,
b. an overactive pituitary gland,
c. pheochromocytoma.
4. neoplastic diseases:
a. lymphomas.
5.other diseases:
a.Raynaud’s disease,
b.diabetic neuropathy,
c. alcohol poisoning,
d. endocarditis,
e. gout,
f. systemic lupus erythematosus with CNS involvement.
Eccrine sweat glands and their function
The sweat glands are primarily responsible for thermoregulation of the body. It is an important element needed to maintain a constant body temperature (around 37 degrees Celsius). Eccrine sweat glands secrete a small amount of sweat (a small amount of sweat), which is quickly released. A number of factors affect the rise in body temperature, including exercise, stress or illness. This increase causes the eccrine sweat glands to automatically secrete more sweat, which cools the body surface and, indirectly, the blood, which in turn leads to a drop in temperature. In addition, the eccrine sweat glands are designed to release certain substances from the body. The sweat contains urea, cholesterol and sulfuric chloride. Another function of sweat is to protect against pathogenic microorganisms (sweat creates an acid protective mantle).
Primary focal eccrine hyperhidrosis
It is hyperhidrosis in an area smaller than 100 cm2. The prevalence of the disease is estimated at 0,6-1% of adults.
The pathophysiology of idiopathic hyperhidrosis remains unclear. Presumably, limited hyperhidrosis is associated with disturbances in the activity of the glands due to improper functioning of the autonomic part of the nervous system. At the root of hyperhydrosis are disorders of the sympathetic system, especially of the hypothalamic nuclei and their connections. Genetic factors also play an important role. It is supposed that primary hyperhidrosis is a hereditary disease (burdensome family history, it is found in 30-62% of the examined patients). Autosamal dominant mode of inheritance. The direct cause of excessive reduced sweating is very often excessive emotional stress, but many people sweat without an obvious provoking factor. The trigger of sweating can be:
- pain,
- fever,
- bow,
- stage fright and even joy,
- additional – caffeine, spicy spices or increased ambient temperature.
Primary focal eccrine hyperhidrosis concerns:
– palms of hands and soles of feet (60% of patients),
– armpits (30-40%),
– forehead and upper lip,
– buttocks and groin.
Characteristic clinical features: the duration of the disease exceeds 6 months, the cause of the disease cannot be established, at least two of the following symptoms occur:
- presence of bilateral and symmetrical lesions,
- at least one episode of excessive sweating a week
- the first symptoms of the disease appear before the age of 25,
- negative influence of phenomena on the patient’s activity,
- family history of the disease,
- no symptoms during sleep.
Figure 9.1. Minor’s test of hyperhidrosis of the armpits.
Diagnostics and treatment
Histopathological examination of the sweat glands does not reveal any changes. General recommendations for people with excessive sweating:
- wearing breathable clothes made of natural fibers,
- frequent washing of clothes and / or frequent changes of clothes and shoes,
- avoiding the consumption of coffee, alcohol and spicy spices.
Topical agents used in focal hyperhidrosis are deodorants (sprays, lotions and sticks): they contain substances that inhibit the multiplication of sweat-decomposing bacteria, do not affect the activity of the sweat glands, their effect is short-lived, they contain fragrances that mask the smell of sweat.
Topical anti-sweat secretions include:
— Antyperspiranty: currently, the use of metal salts gives the best results. These include the buffered form of aluminum chloride. It has the property of temporarily closing the sweat ducts at the level of the lower and middle layers of the epidermis (active aluminum salt combines with the components of sweat and produces an amorphous hydroxyl gel which obstructs the openings of the sweat glands). It is used at night in concentrations of 10-15% on the armpits area and up to 30% on the hands and feet for 7 days, then once every 2-3 weeks as a maintenance therapy. The therapy is applied daily at night when the glands are inactive, thus allowing the active ingredients to penetrate deep into the skin.
– Water iontophoresis: the procedure used in physical therapy is based on the complex process of transporting ions through the skin under the influence of galvanic current. How this method works has not been explained so far. It is assumed that reversible disruption of ion channels occurs in the secretory glomeruli of the sweat glands. The sodium-potassium pump in the area of the sweat gland ducts is disturbed and water reabsorption is reduced. These treatments also induce hyperkeratosis in the gland orifices, which inhibits the secretion of sweat.
Hands and / or feet are immersed in shallow plastic dishes with warm water. The source of direct current is a galvanotherapeutic device (current 8-20 mA). The current intensity is increased to a tingling sensation. The session lasts 10-20 minutes, on average 3-4 times a week. The improvement usually takes place after 5-10 sessions, while the total effect occurs after 10-15 sessions. Maintenance therapy 1-2 sessions per week.
This method can be carried out for many years without complications. There are now devices for home therapy.
– Iontophoresis with the addition of anticholinergic drugs: after adding glycopyrronium bromide or polydin methyl sulfate or hexopyrronium bromide to the water at the anode, a faster and longer-lasting effect is obtained.
-This method can cause systemic side effects such as dry mucous membranes, accommodation problems, urinary retention and abdominal pain.
– Treatment of excessive sweating with botulinum toxin injections: Botulinum toxin inhibits the secretion of acetylcholine from the presynaptic end of the neuromuscular synapse, but also at other synapses, e.g. in the autonomic system. In the treatment of hyperfocal sweating, injections of botulinum toxin lead to “denervation” of the eccrine glands by blocking the secretion of acetylcholine of post-ganglionic cholinergic neurons. The treatment consists in intradermal injection of botulinum toxin in the areas affected by excessive sweating. Before the procedure, it is carried out the so-called Minor’s trial (iodine-starch test), which consists in applying a solution of potassium iodide, followed by starch to the area with symptoms of hyperhidrosis. If there is high humidity, a color reaction occurs, which indicates the surface on which the injection should be made. Injections are made every 1-1,5 cm to cover the entire surface Minor stained. The first favorable results are visible after 3-4 days, and the full therapeutic effect after 2-4 weeks. The elimination of hyperhidrosis usually lasts 5-9 months after the procedure (Fig. 9.1).
-General treatment with anticholinergics and sedatives: in severe cases, we use general anticholinergic agents. They block the action of eccrine sweat glands, stimulated by cholinergic sympathetic fibers (e.g. bornaprine hydrochloride – Sormodren).
Sedative medications can be used only in cases of excessive sweating, directly related to emotional arousal, behavioral disorders and other neurological diseases.
Surgical methods should only be considered when other methods have failed.
-Liposuction – a method that is safe and effective in treating excessive sweating of the armpits.
-Extirpation of sweat glands – invasive method of treating the armpits. It consists in the complete removal of the skin of the armpit along with the sweat glands, subcutaneous curettage of the skin of the armpits.
-Sympathectomy – the method consists in denervating sweat glands by removing sympathetic nerve trunks: from Th 2 to Th 3 in case of hyperhidrosis of the hands, from Th 3 to Th 6 in case of hyperhidrosis of the armpits and L3 ganglion in case of hyperhidrosis of the feet. Currently, transthoracic sympathectomy is performed. It is a last resort treatment.
Other diseases of the eccrine sweat glands
1. Potówki – a condition manifested by the presence of millet-sized vesicles that form in the orifices of the sweat glands.
2. Inflammation – sweat glands can become inflamed due to the action of bacteria; in adults it manifests itself with inflammation of the apolgin glands, while in children it is inflammation of the eccrine glands.
3. Hypohydrosis – is a disease whose essence is reduced sweat secretion caused by damage to the sweat glands or nervous disorders. This condition is often associated with ailments such as kidney failure, hypothyroidism, inflammation of the nerves or various dermatological diseases.
4. Anllydrosis – is a condition characterized by reduced or no sweat production. The etiological factor is damage to the eccrine sweat glands or its complete absence.
In order to counteract the formation of inflammation and abscesses, it is recommended to use antibiotics and antiseptic preparations. Every person with sweat gland disorders should consult a dermatologist who will make an appropriate diagnosis of the primary disease.
LITERATURE:
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