Hyperhidrosis
Introduction
Introduction to hyperhidrosis It is a disease caused by excessive sympathetic over-excited sweat glands, and the sympathetic nerves dominate the body's sweating. Under normal circumstances, the sympathetic nerve regulates the body temperature by controlling sweating and cooling. However, sweating and facial flushing in hyperhidrosis patients completely lose normal control, and hyperhidrosis and facial flushing make the patient feel helpless, anxious or panic every day. basic knowledge The proportion of illness: 0.02% - 0.05%, more common in small or obese people Susceptible people: no specific population Mode of infection: non-infectious Complications: folliculitis
Cause
Cause of hyperhidrosis
Disease factor (30%):
More common in endocrine disorders and hormonal disorders, such as hyperthyroidism, hypercoagulability, pregnancy, diabetes, nervous system diseases, febrile diseases, and some hereditary syndromes.
Mental factors (25%):
Mental sweating, caused by high tension and emotional agitation, is caused by sympathetic disorders. Oral administration of some sedatives (such as atropine, probensin, belladonna mixture, etc.) has a temporary effect, but has dry mouth, etc. side effect.
Taste factor (20%):
Tasteful sweating is another physiological phenomenon, such as sweating caused by eating some irritating foods (chili, garlic, ginger, cocoa, coffee). This kind of situation generally does not require treatment, just avoid taboo.
Pathogenesis
Hyperhidrosis mainly refers to excessive sweat production in many parts of the small sweat gland, often involving the armpits, palmar and groin, the reasons can be divided into neurological and non-neurological, neurological refers to the control of nerve reflex; in addition to local thermal stimulation In addition, non-neurological refers to the role of peripheral non-neurological factors - the excitatory response at the level of the gland.
Prevention
Hyperhidrosis prevention
1. Simple taste and sweat should avoid eating spicy and irritating foods and drinks.
2. Hyperhidrosis caused by mental factors should actively adjust their mentality to avoid mental stress, emotional agitation, anger, terror and anxiety.
Complication
Hyperhidrosis complications Complications folliculitis
Secondary and congenital hyperhidrosis, there may be clinical manifestations of primary disease or hereditary disease, the skin of the systemic hyperhidrosis is often moist, and there is paroxysmal sweating, local hyperhidrosis is common in Palms, athlete's foot, armpits, followed by the tip of the nose, forehead, genitals, etc., mostly in the onset of adolescents, patients often accompanied by peripheral blood circulation dysfunction, such as wet skin of hands and feet, cyanosis or pale, prone to frostbite, etc. Khan due to poor evaporation of sweat, causing the skin of the soles of the skin to be immersed and whitened, often accompanied by foot odor, when the armpits and genitals are sweaty, because the skin is thin and tender, often wet and rub, prone to rubbing erythema, accompanied by folliculitis, Hey.
Symptom
Hyperhidrosis Symptoms Common symptoms Slap, sweating, carcinoid syndrome, sympathetic nerves, high tension, muscle atrophy, night sweats, head sweating, hyperhidrosis, baby sleeping, sweating, high fever
1. According to sweating
(1) Localized hyperhidrosis: often begins in children or adolescence, both men and women can occur, some have a family history, can last for several years, there is a natural tendency to reduce after 25 years of age, localized hyperhidrosis most Common parts are palmar and rubbing surfaces, such as underarms, groin, perineum, followed by forehead, nose and chest, palmar sweating can be sustained or transient, caused by mood swings, no seasonal differences, often hand and foot It is chilly or even cyanotic. It can be accompanied by keratosis of the hands and feet. The sweating of the ankle can be induced by heat or mental activity. The excessive sweating of the underarm is caused by the excessive activity of the small sweat glands, and the odor is mainly caused by the apocrine glands.
(2) generalized hyperhidrosis: mainly due to other diseases caused by widespread sweating, like infectious hyperthermia, due to regulation of the nervous system or oral antipyretic to sweat to dissipate heat, others like the central nervous system Including the cortex and basal ganglia, damage to the spinal cord or peripheral nerves can cause excessive sweating throughout the body.
2. Divided into different causes of excessive sweat production
(1) Neuropathic hyperhidrosis:
1 cortical hyperhidrosis:
A. Emotional hyperhidrosis: due to emotional stimulation, increased secretion of acetylcholine and hyperhidrosis, and cortical or emotional sweating after sexual stimulation is a special type.
B. palmar hyperhidrosis: can be seen in a variety of ethnic groups, no significant gender differences, most patients have a positive family history, often in infancy or childhood begins to occur, palmar hyperhidrosis does not occur in sleep and quiet, Irrespective of heat source, patients with excessive sweating may have abnormal ECG, may have tachycardia or sharp waves, which may be related to unstable vasomotor, generally no local or systemic associated disease.
C. Axillary hyperhidrosis: Axillary hyperhidrosis: In addition to heat source stimulation, there is also emotional stimulation and hyperhidrosis, and more sweating with palm sputum, but the sweat is odorless, males are more likely than females. The amount of sweat is large.
D. Other diseases with cortical hyperhidrosis: palmoplantar keratosis, congenital thick nails, recessive hereditary bullous epidermolysis, congenital ichthyosis-like erythroderma Both the hyperthyroidism syndrome and the hyperthyroidism syndrome can occur in the superficial hand and foot hyperhidrosis, often after excitement or eating, but sometimes the heat source stimulation can occur, indicating that the subcortical center is particularly hot (the hypothalamus also plays a role).
2 hypothalamic hyperhidrosis (hypothalamic hyperhidrosis): the hypothalamus is the main autonomic nervous system in the central nervous system, controlling the regulation of sweating, hypothalamic hyperhidrosis can be seen in the following diseases:
A. Hodgkin'disease: characterized by fever, night sweats and weight loss triads, night sweats in the early stages of the disease, sudden drop in body temperature during sleep, and a lot of night sweats.
B. Diabetes mellitus: There are 3 types; excessive sweating in the onset of severe hypoglycemia; compensatory hyperhidrosis in the upper body when the peripheral neuropathy occurs, no sweat in the lower body; mainly occurs in the face and neck The taste of the department is sweaty.
C. Pressure and postural hyperhidrosis: refers to the sweating reaction caused by body position changes and lateral compression of one side of the body.
D. Idiopathic unilateral circumscribed hyperhidrosis: is a genital local sweat that is common in the face or upper limbs. Heat, spirit and taste stimulation can all trigger, but the former is more See, the sweating mechanism is unknown.
3 myeloid hyperhidrosis: medullary hyperhidrosis is often involved in taste receptors due to efferent stimuli, so myeloid hyperhidrosis, also known as gustatory sweating, can be divided into physiological and pathological Two types of myeloid hyperhidrosis.
A. Physiological medullary hyperhidrosis: Many people suffer from limited sweating after eating spicy and fragrant foods and beverages. They are more common on the face, especially on the upper lip or cheek. As well as the scalp and knees, usually appear within a few minutes, the site often accompanied by vasodilation, occurs in young people, hot climate, and has a family genetic predisposition.
B. pathologic medullary hyperhidrosis: often involving one side of the ear or under the ear, varying degrees, there are three clinical types: local trauma or disease caused by parotid gland; caused by central nervous disease Such as syringomyelia or encephalitis; caused by thoracic sympathetic trunk injury, nucleus pulposus plays a role in all three types, but there are certain variations in the incoming and outgoing arcs, resulting in different clinical manifestations:
a. auriculotemporal syndrome: also known as Krey's syndrome (Krey's syndrome) in the parotid or pre-ear region surgery, trauma and cysts and other lesions after the injury of the ear nerves within 1 month to 5 years, diet, chewing stimulation When saliva is secreted, localized pain, vasodilation and sweating occur in the area of the deafness. The reason is that the auricular nerve and the parotid gland are involved at the same time. The parasympathetic fibers regenerated in the damaged parotid gland migrate to the distal end of the nerve, which governs the area under the ear. The sweat gland and tympanic plexus are destroyed by surgery, which can eliminate the taste sweating of patients with this disease.
b. Chorda tympanic syndrome: The clinical manifestations are similar to deafness syndrome due to injury of the surrounding autonomic nerve fibers near the submandibular gland, occurring at the temporal and mandibular margin.
c. Crocodile tear syndrome: is a lesion similar to gustatory hyperhidrosis, often occurs after facial nerve injury, the difference is that the patient has gustatory tearing; originated from the regulation of tears and runny Misleading or short circuit of the autonomic nervous pathway.
d. Sperm sweating caused by syringomyelia or encephalitis: may be caused by vagus and glossopharyngeal nerve stimulation, which may cause damage to the nucleus pulpus that controls sweating and salivation; clinical manifestations vary widely and there is widespread sweating reaction.
e. Thoracic sympathetic trunk injury after nucleosis hyperhidrosis: can be seen in sympathectomy, lung cancer, spinal osteoma, subclavian aneurysm and thyroidectomy, because the sympathetic chain in the upper mediastinum is adjacent to the vagus nerve, in the sympathetic trunk After injury, the vagus nerve emits cholinergic fibers to the adjacent sympathetic trunk preganglionic fibers. Patients often experience sweating on the face, neck, trunk and upper limbs after eating or swallowing.
(2) Non-neural hyperhidrosis: not subject to the sympathetic nervous system, but the dominant sweating of the gland to heat; and cholinergic, adrenergic and other drugs directly stimulate the sweat gland Causes dominant sweating, as well as some organoid nevus and sputum-like hemangioma damage, Maffucci syndrome, arteriovenous tumor, Hippld-Trenaunay syndrome, glomus tumor, blue rubber blisters syndrome, may appear Local sweating may be associated with hemangioma in the affected area. In addition, cold erythema causes localized erythema, severe pain and central sweating, vascular atrophy and muscle atrophy after cold stimulation. The disease may be caused by the release of serotonin from platelets.
(3) Compensatory hyperhidrosis: Since the sweat glands of a certain part are not treated by certain factors, the sweat glands of another part are compensated to maintain body temperature. The common diseases are as follows.
1 Diabetes: secondary to the lower limbs of diabetic peripheral neuropathy, no sweat or sweating, modern compensatory hyperhidrosis, upper body (torso-based), heat-irritating hyperhidrosis, common to night sweats, facial, neck taste Hyperhidrosis.
2 After sympathectomy, pathological and gustatory hyperhidrosis occurred after cervical and thoracic sympathectomy.
3 night sweat, in addition to the above reasons can cause excessive sweat, but also due to cardiovascular endocarditis, lymphoma, hyperthyroidism, systemic vasculitis, pheochromocytoma, carcinoid syndrome, withdrawal response, autonomic function Out of control, other chronic infectious diseases can have night sweats.
Examine
Hyperhidrosis check
Blood, urine, stool and cerebrospinal fluid routine examination and blood biochemical examination are mostly non-specific, and secondary hyperhidrosis laboratory examination is related to the primary disease.
1. The skull, the majority of the limb imaging examination is a normal result, and the secondary hyperhidrosis has a performance related to the primary disease.
2. Autonomic nerve function test, which has auxiliary diagnosis and differential significance for hyperhidrosis.
Diagnosis
Diagnosis of hyperhidrosis
Hyperhidrosis is usually based on a history of hyperhidrosis, typical clinical manifestations, and combined with objective examinations, which are usually not difficult to diagnose.
The characteristics of this disease are outstanding, very good diagnosis, difficult to confuse with other diseases, mainly the identification of the cause of secondary hyperhidrosis, should be based on different clinical manifestations, such as diabetes, abnormal blood sugar and urine glucose test, Localized symptoms and signs should be present in organic brain lesions.
