20: Disorders of Sweat Glands - Feilmeier

Question 1

“body odor”

Answer 1

apocrine sweat glands

Question 2

thermal sweating depends on …

Answer 2

intact hypothalamus

Question 3

what serves as body’s thermoregulatory center?

Answer 3

hypothalamus

Question 4

What neurotransmitter innervates eccrine sweat glands?

Answer 4

acetylcholine

Question 5

the hypothalamus can be triggered by all these except:
Stress
Exercise
Obesity
Temperature change

Answer 5

obesity

Question 6

Inability of the body to produce and or deliver sweat to the skin surface

Answer 6

anhydrosis

Question 7

Increased eccrine sweating

Answer 7

hyperhidrosis

state of excessive sweating of the axilla, palms, soles, or face that interferes with daily activities

Question 8

Foot odor or sogginess

Answer 8

bromhidrosis

Propionibacterium is responsible for the cheesy odor – Bacterial decomposition of epidermal lipids &
fatty acids

Question 9

Excessive Sympathetic Activity

Answer 9

The eccrine sweat glands are excessively

stimulated by acetylcholine –> increased sweat production

Question 10

Hyperhidrosis involves which sweat gland type?

Answer 10

eccrine

not a problem with the gland itself

Question 11

first line therapy mild cases

Answer 11

Foot gear: Should be non-occlusive, leather or canvas, avoid synthetic materials like plastic
Open sandals
Socks: Should be absorbent wool/synthetic blend. Avoid nylon and all cotton. Change midday
Talc
Tolnaftate: zeasorb powder-45% microporous cellulose, twice the absorbancy of talc
Odor: Activated charcoal inserts

Question 12

Drysol

Answer 12

Aluminum chloride hexahydrate – astringent, antibacterial, and antifungal properties (effective for tinea pedis)

skin should be completely dry
applied at bedtime
more effective if occluded
initial tx: 3-5 nights until controlled then once every 4-5 days.

Question 13

how do topical treatments work?

Answer 13

The metal ions in the topical antiperspirant damage the lining of the sweat gland.
As damage continues, a PLUG is formed over the sweat gland.

Sweat production never ceases, the gland is simply plugged

Sweating will return as the skin undergoes regeneration or shedding

Question 14

how to use tropical treatment?

Answer 14

Best to apply before bedtime
Allow to remain on skin for 6 – 8 hours
Apply every 24 – 48 hours until sweating diminishes
Maintenance applications needed every 1-3 weeks

Question 15

iontophoresis

Answer 15

Sit with hands or feet in shallow tray of water
Allow 15 – 20 milli-amps of electrical current to pass through water
Use for 10 days, 30 minutes each day
Maintenance therapy needed

water + electricity = thickening of skin and blocked sweat flow

Question 16

most effective for cranio-facial hyperhidrosis

Answer 16

anticholinergics can be used in treating hyperhidrosis along with other anti-anxiety medicatiosn

Question 17

anticholinergics block transmission of

Answer 17

acetylcholine

Question 18

how does botox work?

Answer 18

Botox blocks the release of acetylcholine at the site of the neuromuscular junction.

Sweat glands are not stimulated, and sweat production ceases

Question 19

endoscopic thoracic sympathectomy

Answer 19

last treatment option- permanent

Last treatment option- PERMANENT
Uncommon for plantar hyperhidrossi
Surgery performed under general anesthesia
Goal of surgery is to excise or ablate the ganglion that innervate the sweat glands
Performed most frequently for palmar hyperhidrosis
Performed through
thorascope or video
Minimally invasive

Question 20

Small, circular “punched out pits” in stratum corneum

Answer 20

pitted keratolysis

Primary isolate corynebacterium with no odor
Primary isolate micrococcus sedentarius with odor

Question 21

treatment pitted keratolysis

Answer 21

Topical 2% erythromycin solution or gel x 2 wks ***

Topical 1% clindamycin solution or gel x 2 wks

Question 22

describe porokeratosis plantaris discreta

Answer 22

• Hyperkeratosis (of epidermal sweat duct)
• 1-3mm diameter punctate lesion
• White or yellow
• Caused by pressure on weight bearing aspect of plantar skin
• Tender with side to side pressure and direct
• Non-vascular on debridement

treat with debridement and topical keratolytics

Question 23

Eccrine Poromas

Answer 23

Benign Lesion- derived from cells of the terminal duct and connected to the epidermis

Slow growing, painless nodule

May present as superficial and smooth-surfaced or flat lesion

Resembles a pyogenic granuloma, dermatofibroma, or amelanotic melanoma

Rubbery and firm

Question 24

dyshidrosis

Answer 24

Dyshidrotic Eczema or Pompholyx
Small, fluid filled vesicles
Palms and soles sparing the interspaces
Last for 3-4 weeks
Intense pruritus
Blisters, then dry and crack to fissures
Painful
Mistaken for pustular tinea
assoc with allergies
tx with topical steroids, moisturizers