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Semin Neurol 2003; 23(4): 399-406
DOI: 10.1055/s-2004-817724
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Disorders of Sweating

William P. Cheshire1 , Roy Freeman2
  • 1Department of Neurology, Mayo Clinic, Jacksonville, Florida
  • 2Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Publikationsverlauf

Publikationsdatum:
15. April 2004 (online)

    Lizenzen und Reprints

ABSTRACT

The clinical spectrum of sweating disorders includes sudomotor excess and deficiency. Hyperhidrosis is characterized by sweating beyond that required to maintain a constant internal body temperature. Hypohidrosis and anhidrosis are distinguished by a reduced or absent ability to generate sweat for the purpose of evaporative heat dissipation. Whereas hyperhidrosis is usually benign, anhidrosis may predispose to hyperthermia. Either hyperhidrosis or anhidrosis may accompany a more serious underlying disorder. Correct diagnosis depends on determining the anatomical pattern of sweating and localizing the lesion within the autonomic nervous system. Sudomotor deficits may involve the frontal operculum, hypothalamus, brain stem, spinal cord, sympathetic chain ganglia, peripheral nerve, or eccrine sweat glands. Treatments for hyperhidrosis include topical aluminum chloride, oral anticholinergic agents, intradermal botulinum toxin for some localized syndromes, and thoracic ganglionic sympathotomy or sympathectomy for refractory palmar hyperhidrosis.

KEYWORDS

Hyperhidrosis - hypohidrosis - peripheral neuropathies - cholinergic antagonists - botulinum toxin - autoimmune diseases of the nervous system

REFERENCES

  • 1 Cabanac M. Temperature regulation.  Annu Rev Physiol . 1975;  37 415-439
    CrossrefPubMedGoogle Scholar
  • 2 Nathan P W, Smith M C. The location of descending fibres to sympathetic preganglionic vasomotor and sudomotor neurons in man.  J Neurol Neurosurg Psychiatry . 1987;  50 1253-1262
    PubMedGoogle Scholar
  • 3 Sato K, Kang W H, Saga K, Sato K T. Biology of sweat glands and their disorders. I. Normal sweat gland function.  J Am Acad Dermatol . 1989;  20 537-563
    CrossrefPubMedGoogle Scholar
  • 4 Quinton P M. Sweating and its disorders.  Annu Rev Med . 1983;  34 429-452
    CrossrefPubMedGoogle Scholar
  • 5 List C F, Peet M. Sweat secretion in man. I. Sweating responses in normal persons.  Arch Neurol Psychiatry . 1938;  39 1228-1237
    PubMedGoogle Scholar
  • 6 List C F, Peet M M. Sweat secretion in man. II. Anatomic distribution of disturbances in sweating associated with lesions of the sympathetic nervous system.  Arch Neurol Psychiatry . 1938;  40 27-43
    PubMedGoogle Scholar
  • 7 Fealey R D. Thermoregulatory failure. In: Appenzeller O, ed. Autonomic Nervous System Amsterdam: Elsevier Press 2000: 53-84
    Google Scholar
  • 8 Freeman R, Waldorf H A, Dover J S. Autonomic neurodermatology (Part II): Disorders of sweating and flushing.  Semin Neurol . 1992;  12 394-407
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Penfield W. Diencephalic epilepsy.  Arch Neurol Psychiatry . 1929;  22 358-374
    PubMedGoogle Scholar
  • 10 Bullard D E. Diencephalic seizures: responsiveness to bromocriptine and morphine.  Ann Neurol . 1987;  21 609-611
    CrossrefPubMedGoogle Scholar
  • 11 Boeve B F, Wijdicks E F, Benarroch E E, Schmidt K D. Paroxysmal sympathetic storms (“diencephalic seizures”) after severe diffuse axonal head injury.  Mayo Clin Proc . 1998;  73 148-152
    CrossrefPubMedGoogle Scholar
  • 12 Solomon G E. Diencephalic autonomic epilepsy caused by a neoplasm.  J Pediatr . 1973;  83 277-280
    PubMedGoogle Scholar
  • 13 Engel G L, Aring C D. Hypothalamic attacks with thalamic lesion. I. Physiologic and psychologic considerations.  Arch Neurol Psychiatry . 1945;  54 37-43
    PubMedGoogle Scholar
  • 14 Fox R H, Wilkins D C, Bell J A. et al . Spontaneous periodic hypothermia: diencephalic epilepsy.  BMJ . 1973;  2 693-695
    PubMedGoogle Scholar
  • 15 Shapiro W R, Williams G H, Plum F. Spontaneous recurrent hypothermia accompanying agenesis of the corpus callosum.  Brain . 1969;  92 423-436
    CrossrefPubMedGoogle Scholar
  • 16 Walker B R, Anderson J A, Edwards C R. Clonidine therapy for Shapiro's syndrome.  Q J Med . 1992;  82 235-245
    PubMedGoogle Scholar
  • 17 Klein C J, Silber M H, Halliwill J R, Schreiner S A, Suarez G A, Low P A. Basal forebrain malformation with hyperhidrosis and hypothermia: variant of Shapiro's syndrome.  Neurology . 2001;  56 254-256
    PubMedGoogle Scholar
  • 18 Gilman A G. The Pharmacological Basis of Therapeutics.  New York: Pergamon Press; 1990
    Google Scholar
  • 19 Sato K, Kang W H, Sato K T. Biology of sweat glands and their disorders. II. Disorders of sweat gland function.  J Am Acad Dermatol . 1989;  20 713-726
    CrossrefPubMedGoogle Scholar
  • 20 Chan P, Kao G F, Pierson D L, Rodman O G. Episodic hyperhidrosis on the dorsum of hands.  J Am Acad Dermatol . 1985;  12 937-942
    PubMedGoogle Scholar
  • 21 Stolman L P. Treatment of excess sweating of the palms by iontophoresis.  Arch Dermatol . 1987;  123 893-896
    CrossrefPubMedGoogle Scholar
  • 22 Saadia D, Voustianiouk A, Wang A K, Kaufmann H. Botulinum toxin type A in primary palmar hyperhidrosis: randomized, single-blind, two-dose study.  Neurology . 2001;  57 2095-2099
    CrossrefPubMedGoogle Scholar
  • 23 Schnider P, Binder M, Kittler H. et al . A randomized, double-blind, placebo-controlled trial of botulinum A toxin for severe axillary hyperhidrosis.  Br J Dermatol . 1999;  140 677-680
    CrossrefPubMedGoogle Scholar
  • 24 Schnider P, Moraru E, Kittler H. et al . Treatment of focal hyperhidrosis with botulinum toxin type A: long-term follow-up in 61 patients.  Br J Dermatol . 2001;  145 289-293
    CrossrefPubMedGoogle Scholar
  • 25 Wollina U, Karamfilov T, Konrad H. High-dose botulinum toxin type A therapy for axillary hyperhidrosis markedly prolongs the relapse-free interval.  J Am Acad Dermatol . 2002;  46 536-540
    CrossrefPubMedGoogle Scholar
  • 26 Gossot D, Galetta D, Pascal A. et al . Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis.  Ann Thorac Surg . 2003;  75 1075-1079
    CrossrefPubMedGoogle Scholar
  • 27 Lin T S, Kuo S J, Chou M C. Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: analysis of 2000 cases.  Neurosurgery . 2002;  51 84-87
    PubMedGoogle Scholar
  • 28 Atkinson J L, Fealey R D. Sympathotomy instead of sympathectomy for palmar hyperhidrosis: minimizing postoperative compensatory hyperhidrosis.  Mayo Clin Proc . 2003;  78 167-172
    PubMedGoogle Scholar
  • 29 Low P A. Autonomic neuropathies.  Curr Opin Neurol . 2002;  15 605-609
    CrossrefPubMedGoogle Scholar
  • 30 Slaugenhaupt S A, Blumenfeld A, Gill S P. et al . Tissue-specific expression of a splicing mutation in the IKBKAP gene causes familial dysautonomia.  Am J Hum Genet . 2001;  68 598-605
    CrossrefPubMedGoogle Scholar
  • 31 Van De Kerkhof C M P, Den Arend J J C A, Bousema M T, Stolz E. Localized unilateral hyperhidrosis.  Br J Dermatol . 1987;  117 779-782
    PubMedGoogle Scholar
  • 32 White J W. Treatment of primary hyperhidrosis.  Mayo Clin Proc . 1986;  61 951-956
    PubMedGoogle Scholar
  • 33 Weaver L C. What causes autonomic dysreflexia after spinal cord injury?.  Clin Auton Res . 2002;  12 424-426
    CrossrefPubMedGoogle Scholar
  • 34 Sudo K, Fujiki N, Tsuji S. et al . Focal (segmental) dyshidrosis in syringomyelia.  J Neurol Neurosurg Psychiatry . 1999;  67 106-108
    PubMedGoogle Scholar
  • 35 Stanworth P A. The significance of hyperhidrosis in patients with post-traumatic syringomyelia.  Paraplegia . 1982;  20 282-287
    PubMedGoogle Scholar
  • 36 Walsh J C, Low P A, Allsop J L. Localized sympathetic overactivity: an uncommon complication of lung cancer.  J Neurol Neurosurg Psychiatry . 1976;  39 93-95
    PubMedGoogle Scholar
  • 37 McEvoy M, Ryan E, Neale G, Prichard J. Unilateral hyperhydrosis-an unusual presentation of bronchial carcinoma.  Ir J Med Sci . 1982;  151 51-52
    PubMedGoogle Scholar
  • 38 Lindsay D C, Freeman J G, Record C O. Unilateral hyperhidrosis associated with underlying intrathoracic neoplasia.  Thorax . 1986;  41 814-815
    PubMedGoogle Scholar
  • 39 Slabbynck H, Bedert L, De Deyn P P, Galdermans D, Coolen D. Unilateral segmental hyperhidrosis associated with pulmonary adenocarcinoma.  Chest . 1998;  114 1215-1217
    PubMedGoogle Scholar
  • 40 Pleet D L, Mandel S, Neilan B. Paroxysmal unilateral hyperhidrosis and malignant mesothelioma.  Arch Neurol . 1983;  40 256
    PubMedGoogle Scholar
  • 41 Lambert M, Kanyinda J M, Richard F, Sindic C. Unilateral hyperhidrosis associated with intrathoracic IgD lambda myelomatous tumour.  Clin Oncol (R Coll Radiol) . 1993;  5 65-66
    CrossrefPubMedGoogle Scholar
  • 42 Seline P C, Jaskierny D J. Cutaneous metastases from a chondroblastoma initially presenting as unilateral palmar hyperhidrosis.  J Am Acad Dermatol . 1999;  40 325-327
    CrossrefPubMedGoogle Scholar
  • 43 Telford E D. Cervical rib and hyperhidrosis.  BMJ . 1942;  2 96
    PubMedGoogle Scholar
  • 44 Korpelainen J T, Sotaniemi K A, Myllyla V V. Hyperhidrosis as a reflection of autonomic failure in patients with acute hemispheral brain infarction. An evaporimetric study.  Stroke . 1992;  23 1271-1275
    PubMedGoogle Scholar
  • 45 Labar D R, Mohr J P, Nichols F T, Tatemichi T K. Unilateral hyperhidrosis after cerebral infarction.  Neurology . 1988;  38 1679-1682
    PubMedGoogle Scholar
  • 46 Rousseaux M, Hurtevent J F, Benaim C, Cassim F. Late contralateral hyperhidrosis in lateral medullary infarcts.  Stroke . 1996;  27 991-995
    PubMedGoogle Scholar
  • 47 Awada A, Ammar A, Al-Rajeh S, Borollosi M. Excessive sweating: an uncommon sign of basilar artery occlusion.  J Neurol Neurosurg Psychiatry . 1991;  54 277-278
    PubMedGoogle Scholar
  • 48 Smith C D. A hypothalamic stroke producing recurrent hemihyperhidrosis.  Neurology . 2001;  56 1394-1396
    PubMedGoogle Scholar
  • 49 Kim B S, Kim Y I, Lee K S. Contralateral hyperhidrosis after cerebral infarction. Clinicoanatomic correlations in five cases.  Stroke . 1995;  26 896-899
    PubMedGoogle Scholar
  • 50 Lee T S. Physiological gustation sweating in a warm climate.  J Physiol . 1954;  124 528-542
    PubMedGoogle Scholar
  • 51 Drummond P D. Mechanism of gustatory flushing in Frey's syndrome.  Clin Auton Res . 2002;  12 144-146
    CrossrefPubMedGoogle Scholar
  • 52 Kurchin A, Adar R, Zweig A, Mozes M. Gustatory phenomena after upper dorsal sympathectomy.  Arch Neurol . 1977;  34 619-623
    PubMedGoogle Scholar
  • 53 Bloor K. Gustatory sweating and other responses after cervico-thoracic sympathectomy.  Brain . 1969;  92 137-146
    PubMedGoogle Scholar
  • 54 Restivo D A, Lanza S, Patti F. et al . Improvement of diabetic autonomic gustatory sweating by botulinum toxin type A.  Neurology . 2002;  59 1971-1973
    PubMedGoogle Scholar
  • 55 Sjaastad O. Cluster headache: on the inadequacy of existing hypotheses concerning the origin of the autonomic phenomena.  Cephalalgia . 1988;  8 133-137
    CrossrefPubMedGoogle Scholar
  • 56 Drummond P D. Autonomic disturbances in cluster headache.  Brain . 1988;  111 1199-1209
    CrossrefPubMedGoogle Scholar
  • 57 Young A G. Unilateral sweating of the submental region after eating (chorda tympani syndrome).  Br Med J . 1956;  12 976-979
    PubMedGoogle Scholar
  • 58 Drummond P D, Boyce G M, Lance J W. Postherpetic gustatory flushing and sweating.  Ann Neurol . 1987;  21 559-563
    CrossrefPubMedGoogle Scholar
  • 59 Laskawi R, Rohrbach S. Frey's syndrome. Treatment with botulinum toxin.  Curr Probl Dermatol . 2002;  30 170-177
    PubMedGoogle Scholar
  • 60 Sohar E, Shoenfeld Y, Udassin R, Magazanik A, Revach M. Cold-induced profuse sweating on back and chest.  Lancet . 1978;  2 1073-1074
    PubMedGoogle Scholar
  • 61 Lisker R, Garcia-Ramos G, de la Rosa-Laris C, Diaz-Mitoma F. Peripheral motor neuropathy associated with autonomic dysfunction in two sisters: new hereditary syndrome?.  Am J Med Genet . 1981;  9 255-259
    CrossrefPubMedGoogle Scholar
  • 62 Kihara M, Sugenoya J, Takahashi A. The assessment of sudomotor dysfunction in multiple system atrophy.  Clin Auton Res . 1991;  1 297-302
    CrossrefPubMedGoogle Scholar
  • 63 Sandroni P, Ahlskog J E, Fealey R D, Low P A. Autonomic involvement in extrapyramidal and cerebellar disorders.  Clin Auton Res . 1991;  1 147-155
    CrossrefPubMedGoogle Scholar
  • 64 Appenzeller O, Goss J E. Autonomic deficits in Parkinson's syndrome.  Arch Neurol . 1971;  24 50-57
    CrossrefPubMedGoogle Scholar
  • 65 Micieli G, Tosi P, Marcheselli S, Cavallini A. Autonomic dysfunction in Parkinson's disease.  Neurol Sci . 2003;  24(Suppl 1) S32-S34
    CrossrefPubMedGoogle Scholar
  • 66 Cheshire W P, Tsuboi Y, Wszolek Z K. Physiologic assessment of autonomic dysfunction in pallidopontonigral degeneration with N279K mutation in the tau gene on chromosome 17.  Auton Neurosci . 2002;  102 71-77
    PubMedGoogle Scholar
  • 67 Noronha M J, Vas C J, Aziz H. Autonomic dysfunction (sweating responses) in multiple sclerosis.  J Neurol Neurosurg Psychiatry . 1968;  31 19-22
    CrossrefPubMedGoogle Scholar
  • 68 Ueno M, Tokunaga Y, Terachi S, Gondo K, Hara T. Asymmetric sweating in a child with multiple sclerosis.  Pediatr Neurol . 2000;  23 74-76
    CrossrefPubMedGoogle Scholar
  • 69 Korpelainen J P, Sotaniemi K A, Myllyä V V. Ipsilateral hypohidrosis in brainstem infarction.  Stroke . 1993;  24 100-104
    PubMedGoogle Scholar
  • 70 Carmel P W. Sympathetic deficits following thalamotomy.  Arch Neurol . 1968;  18 378-387
    PubMedGoogle Scholar
  • 71 Kruszewski P, Antonaci F, Bordini C, Wester K, Sjaastad O. Sympathetic functions in parkinsonism treated with stereotactic surgery: observations in ten patients.  Funct Neurol . 1991;  6 263-268
    PubMedGoogle Scholar
  • 72 Kneisley L W. Hyperhidrosis in paraplegia.  Arch Neurol . 1977;  34 536-539
    PubMedGoogle Scholar
  • 73 Seckendorf R, Randall W C. Thermal reflex sweating in normal and paraplegic man.  J Appl Physiol . 1961;  16 796-800
    PubMedGoogle Scholar
  • 74 Huckaba C E, Frewin D B, Downey J A, Tam H S, Darling R C, Cheh H Y. Sweating responses of normal, paraplegic and anhidrotic subjects.  Arch Phys Med Rehabil . 1976;  57 268-274
    PubMedGoogle Scholar
  • 75 Downey J A, Huckaba C E, Kelley P S, Tam H S, Darling R C, Cheh H Y. Sweating responses to central and peripheral heating in spinal man.  J Appl Physiol . 1976;  40 701-706
    CrossrefPubMedGoogle Scholar
  • 76 Fealey R D, Low P A, Thomas J E. Thermoregulatory sweating abnormalities in diabetes mellitus.  Mayo Clin Proc . 1989;  64 617-628
    CrossrefPubMedGoogle Scholar
  • 77 Low P A, Caskey P E, Tuck R R, Fealey R D, Dyck P J. Quantitative sudomotor axon reflex test in normal and neuropathic subjects.  Ann Neurol . 1983;  14 573-580
    CrossrefPubMedGoogle Scholar
  • 78 Vinik A I, Maser R E, Mitchell B D, Freeman R. Diabetic autonomic neuropathy.  Diabetes Care . 2003;  26 1553-1579
    CrossrefPubMedGoogle Scholar
  • 79 Vernino S, Low P A, Fealey R D, Stewart J D, Farrugia G, Lennon V A. Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies.  N Engl J Med . 2000;  343 847-855
    CrossrefPubMedGoogle Scholar
  • 80 Klein C M, Vernino S, Lennon V A. et al . The spectrum of autoimmune autonomic neuropathies.  Ann Neurol . 2003;  53 752-758
    CrossrefPubMedGoogle Scholar
  • 81 Waterman S A. Autonomic dysfunction in Lambert-Eaton myasthenic syndrome.  Clin Auton Res . 2001;  11 145-154
    CrossrefPubMedGoogle Scholar
  • 82 Khurana R K, Koski C L, Mayer R F. Autonomic dysfunction in Lambert-Eaton myasthenic syndrome.  J Neurol Sci . 1988;  85 77-86
    CrossrefPubMedGoogle Scholar
  • 83 Wright R A, Grant I A, Low P A. Autonomic neuropathy associated with sicca complex.  J Auton Nerv Syst . 1999;  75 70-76
    CrossrefPubMedGoogle Scholar
  • 84 Katayama I, Yokozeki H, Nishioka K. Impaired sweating as an exocrine manifestation in Sjogren's syndrome.  Br J Dermatol . 1995;  133 716-720
    PubMedGoogle Scholar
  • 85 McLeod J G. Invited review: autonomic dysfunction in peripheral nerve disease.  Muscle Nerve . 1992;  15 3-13
    PubMedGoogle Scholar
  • 86 Facer P, Mathur R, Pandya S S, Ladiwala U, Singhal B S, Anand P. Correlation of quantitative tests of nerve and target organ dysfunction with skin immunohistology in leprosy.  Brain . 1998;  121(Pt 12) 2239-2247
    CrossrefPubMedGoogle Scholar
  • 87 Ross A T. Progressive selective sudomotor denervation: a case with coexisting Adie's syndrome.  Neurology . 1958;  8 809-817
    CrossrefPubMedGoogle Scholar
  • 88 Weller M, Wilhelm H, Sommer N, Dichgans J, Wietholter H. Tonic pupil, areflexia, and segmental anhidrosis: two additional cases of Ross syndrome and review of the literature.  J Neurol . 1992;  239 231-234
    CrossrefPubMedGoogle Scholar
  • 89 Cheshire W P. Peripheral autonomic function and dysfunction. In: Appenzeller O, ed. Autonomic Nervous System Vol. 75. Amsterdam: Elsevier Press; 2000: 105-142
    Google Scholar
  • 90 Wolfe G I, Galetta S L, Teener J W, Katz J S, Bird S J. Site of autonomic dysfunction in a patient with Ross' syndrome and postganglionic Horner's syndrome.  Neurology . 1995;  45 2094-2096
    CrossrefPubMedGoogle Scholar
  • 91 Sommer C, Lindenlaub T, Zillikens D, Toyka K V, Naumann M. Selective loss of cholinergic sudomotor fibers causes anhidrosis in Ross syndrome.  Ann Neurol . 2002;  52 247-250
    CrossrefPubMedGoogle Scholar
  • 92 Perretti A, Nolano M, De Joanna G. et al . Is Ross syndrome a dysautonomic disorder only?.  <~>An electrophysiologic and histologic study. Clin Neurophysiol . 2003;  114 7-16
    PubMedGoogle Scholar
  • 93 Faden A I, Chan P, Mendoza E. Progressive isolated segmental anhidrosis.  Arch Neurol . 1982;  39 172-175
    CrossrefPubMedGoogle Scholar
  • 94 Low P A, Fealey R D, Sheps S G, Su W P, Trautmann J C, Kuntz N L. Chronic idiopathic anhidrosis.  Ann Neurol . 1985;  18 344-348
    CrossrefPubMedGoogle Scholar
  • 95 Varma A J, Fisher B K, Sarin M K. Diazepam-induced coma with bullae and eccrine sweat gland necrosis.  Arch Intern Med . 1977;  137 1207-1210
    CrossrefPubMedGoogle Scholar
  • 96 Itakura E, Urabe K, Yasumoto S, Nakayama J, Furue M. Cholinergic urticaria associated with acquired generalized hypohidrosis: report of a case and review of the literature.  Br J Dermatol . 2000;  143 1064-1066
    CrossrefPubMedGoogle Scholar
  • 97 Vincent M C, Biancalana V, Ginisty D, Mandel J L, Calvas P. Mutational spectrum of the ED1 gene in X-linked hypohidrotic ectodermal dysplasia.  Eur J Hum Genet . 2001;  9 355-363
    PubMedGoogle Scholar
  • 98 Clarke A, Phillips D IM, Brown R, Harper P S. Clinical aspects of X-linked hypohidrotic ectodermal dysplasia.  Arch Dis Child . 1987;  62 989-996
    CrossrefPubMedGoogle Scholar
  • 99 Priolo M, Lagana C. Ectodermal dysplasias: a new clinical-genetic classification.  J Med Genet . 2001;  38 579-585
    CrossrefPubMedGoogle Scholar
  • 100 de Carolis P, Magnifico F, Pierangeli G. et al . Transient hypohidrosis induced by topiramate.  Epilepsia . 2003;  44 974-976
    CrossrefPubMedGoogle Scholar
  • 101 Arcas J, Ferrer T, Roche M C, Martinez-Bermejo A, Lopez-Martin V. Hypohidrosis related to the administration of topiramate to children.  Epilepsia . 2001;  42 1363-1365
    CrossrefPubMedGoogle Scholar
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