Localized unilateral hyperhidrosis

We describe a case of localized unilateral hyperhidrosis on the forehead in a 52-year-old woman. The pathophysiology of this unique clinical picture and its treatment are described.

A case report of EMO syndrome showing localized hyperhidrosis in pretibial myxedema

We describe here a case of EMO syndrome, which is defined as a combination of exophthalmos, pretibial or localized myxedema, and hypertrophic osteoarthropathy. A 34-year-old Japanese man with Graves' disease developed the characteristic eye changes. He showed 22 mm protrusion of both eyes and hypertrophy of the right lateral rectus muscle as well as both superior rectus muscles by computerized tomography. He subsequently developed lightly erythematous, indurated, nonpitting, peau d'orange plaques and nodules on his lower legs. Finally, he developed Graves' acropathy with hypertrophic osteoarthropathy in the metacarpal bones. Histological examination of myxedematous skin showed typical deposition of mucin accompanied by changes in the amount and distribution of elastic fibers. In addition, the lesional skin showed localized hyperhidrosis, a rarely reported complication of pretibial myxedema. We speculate that this hyperhidrosis of the lesional skin was brought about by stimulation of peripheral sympathetic nerves by surrounding mucin deposition, in the setting of poorly controlled hyperthyroidism.

The innermost cell layer of the outer root sheath is positive with Ki-67

The expression of a cell proliferation-associated human nuclear antigen was immunohistochemically studied in human anagen hair and hair follicles using the monoclonal antibody Ki-67. The reaction of Ki-67 in mature anagen hair follicles was observed in the hair matrix cells and outer root sheath (ORS) cells. Nuclear staining was seen in a small number of matrix cells and in some ORS cells; this finding corresponded to the thymidine or bromodeoxyuridine labeling studies previously reported. In addition, there were two different patterns of cytoplasmic staining in the ORS: strong staining of the innermost cells (IMC) and weaker staining of the other ORS cells in the isthmus. Ki-67 reactivity of the IMC layer was observed at each stage of anagen and was regularly seen from the upper bulb to the isthmus. Ki-67 is a commercially available antibody that detects cycling cells. However, the IMCs in anagen hair follicles showed cytoplasmic labeling by Ki-67 from the matrix cells in the upper bulb to the distal portion of the isthmus.

[A case of myokymia-hyperhidrosis syndrome with muscle involvement]

The present report deals with an unique case of myokymia-hyperhidrosis syndrome. A 46-year-old man developed generalized relatively slow, undulating movement of the muscles, excessive sweating, muscle cramps and easy fatigability since three years ago. On admission, he had generalized myokymia, abnormal movements consisting of slow, undulating and worm-like muscular contractions. There was no muscle atrophy or weakness, or sensory deficits. Deep tendon reflexes were diminished and no Babinski sign or other pathological reflexes were present. Muscle tone was in normal range. Neither fasciculation nor myotonia was found. Laboratory examinations revealed elevation of BMR with normal thyroid function. The value of anti-Ach receptor antibody was below 0.6nmol/l. EMG recordings showed (1) continuous spontaneous repetitive discharges of NMU at a frequency of 30-50Hz, with duration of 1-2 seconds and amplitude of about 1 mV, were demonstrated at rest and the findings were consistent with myokymia, (2) waxing phenomenon was observed on repetitive peripheral nerve stimuli, which didn't improve by the tension test, and (3) high amplitude, long duration and polyphasic NMU, a sign of denervation, were observed on voluntary contraction. Muscle biopsy specimens from the left quadriceps showed a number of internal nuclei. On electron microscopy, clustered mitochondria and filamentous bodies were very often found in subsarcolemma. From these observations, damage to peripheral nerves, neuromuscular junctions and muscles may be responsible for the generalized myokymia in our patient.

Localized unilateral hyperhidrosis

A case of unilateral hyperhidrosis of the face is described. Measurements of the rate of evaporative water loss from other areas of the body, showed a marked left-right difference in the sweating rate on the arms and on the legs which had not been suspected clinically. Unilateral hyperhidrosis is a rare and puzzling disorder. Possible neurological causes are discussed.

Surgical treatment of axillary hyperhidrosis

In the human axilla, the proportion of eccrine and apocrine sweat glands is 1:1. The former are in the dermis, while most of the latter are in the subcutaneous cellular tissue. After studying the difficult methods that have been described for the surgical treatment of axillary hyperhidrosis, we concluded that the treatment should be as radical as possible and deal with both types of glands. The technique described here is a combined method which removes en bloc the skin and subcutaneous cellular tissue of more than half the area of sweating and the subcutaneous cellular tissue of the rest, leaving an S-shaped scar that follows the main axis of the axilla. Problems with this method have been minimal. Follow-up studies carried out up to 3 years after the operation have indicated excellent results.

Episodic hyperhidrosis on the dorsum of hands

A 21-year-old man presented with a 6-year history of episodic localized hyperhidrosis on the back of his hands. Results of the neurologic examination were normal. Profuse sweating of the affected skin was elicited by exercise, raising core temperature, direct heat, and intradermal injections of cholinergic drugs. Examination of the affected skin by electron microscopy and light microscopy with special stains and enzyme methods revealed prominent hyperplasia of otherwise normal eccrine sweat glands and ducts and increased surrounding stromal hyaluronic acid.

Structural changes in axillary eccrine glands following long-term treatment with aluminium chloride hexahydrate solution

Axillary skin biopsies from fifteen patients with axillary hyperhidrosis who had received long-term treatment with aqueous aluminium chloride solution were examined histologically. The apocrine glands were normal, but the eccrine glands showed conspicuous morphological changes of varying severity. These included vacuolization of the secretory epithelium, dilatation of eccrine acini with atrophy of secretory cells, and accumulation of PAS-positive, diastase-resistant material in the dilated lumen of the secretory coils. The histological changes correlated in most patients with decreased secretion of sweat. We conclude that long-term blockage of the distal acrosyringium due to aluminium salts may lead to functional and structural degeneration of the eccrine acini.

Mechanism of action of iontophoresis in the treatment of palmar hyperhidrosis

Sweat glands from the palm of a patient with hyperhidrosis were examined by light and electron microscopy before and after treatment with tap water iontophoresis. No changes in structure were noted after treatment, disclaiming the currently accepted theory that mechanical ductal obstruction is the mechanism of action of this method. Furthermore, we believe the safety and effectiveness of this treatment are supported by our experience.

The distribution, size and density of the apocrine glands in hidradenitis suppuritiva

The distribution, size and density of the apocrine glands in hidradenitis suppuritiva as compared with those in axillary hyperhidrosis and normal controls have been studied. There are no significant differences in the size or density of the apocrine glands in hidradenitis suppuritiva as compared with normal controls. The apocrine glands in axillary hyperhidrosis are significantly larger than those in axillary hidradenitis and in normal controls. A simple method that can be used to demonstrate the distribution of the apocrine glands preoperatively is described. This has proved useful in delineating the area which it is necessary to excise to obtain complete apocrine gland excision in the diseased area. The apocrine gland-containing skin in the diseased region does not always correspond exactly to the hair-bearing area in that region.

Hidrotic ectodermal dysplasia

Description of a patient presenting an hidrotic ectodermal dysplasia. Clinical signs were hypotrichosis, dystrophic nails, palmoplantar keratoderma, absence of teeth and hyperhidrosis.

Innervation of human axillary sweat glands. Histochemical and electron microscopic study of hyperhidrotic and normal subjects

Adrenergic nerves were demonstrated by formaldehyde-induced fluorescence and cholinergic nerves using thiocholine techniques to demonstrate acetylcholinesterase activities at the light and electron microscopic levels. The specimens were taken during surgery from the axillae of hyperhidrotic patients and normal voluntary controls. No fluorescent nerves were found around eccrine or apocrine sweat glands in hyperhidrotic or normally sweating axillae. Both eccrine and apocrine sweat glands exhibited a nerve network showing acetylcholinesterase activity. There was no marked difference in the innervation patterns or in the intensity of the acetylcholinesterase reaction of the nerves in the hyperhidrotic patients or normal subjects. Ultrastructurally the acetylcholinesterase-positive nerves were seen in the vicinity of both eccrine and apocrine glands, but these nerves were outside the basement membrane.