Stress and Postural Hyperhidrosis

Introduction Stress and orthostatic sweating refers to the sweating reaction produced by the body's compression when the body position changes and the lateral position. It is a manifestation of hyperhidrosis. Hyperhidrosis is a disease caused by excessive secretion of sweat glands due to excessive sympathetic stimulation. 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 patients with hyperhidrosis completely lost normal control. Excessive sweating and facial flushing make the patient feel helpless, anxious or panic every day.

Cause

Causes of stress and orthostatic hyperhidrosis

Systemic hyperhidrosis can be an abnormal physiological reaction, or one of the symptoms of certain diseases such as hyperthyroidism and diabetes. Local hyperhidrosis may result in increased secretion of choline acetate due to sympathetic nerve damage or abnormal reaction, resulting in excessive sweat secretion by the small sweat glands.

(1) Causes of the disease

Hyperhidrosis can be roughly divided into three categories from the cause of the disease. First, due to systemic diseases, such as endocrine disorders (hyperthyroidism, diabetes, hypertrophic pituitary, etc.), nervous system diseases, some infectious diseases (malaria, tuberculosis, etc.) and long-term illness caused by physical weakness. As long as these systemic diseases are controlled, hyperhidrosis can be resolved. Second, mental sweating, due to high tension and emotional agitation, is caused by sympathetic disorders, oral administration of some sedatives (such as atropine, Prubensin, belladonna mixture, etc.) has a temporary effect, but there are mouths Dry and other side effects. The third is taste sweating, which belongs to another physiological phenomenon, such as sweating caused by eating some irritating foods (chili, garlic, ginger, cocoa, coffee). This kind of situation generally does not need treatment, only need to avoid .

(two) 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.

an examination

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Pressure and postural 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.

1. According to sweating

(1) Localized hyperhidrosis: It usually begins in children or adolescence. Both men and women can occur. Some have a family history and can last for several years. After 25 years of age, there is a tendency to naturally reduce. The most common sites of localized hyperhidrosis are palmar and friction surfaces, such as the underarms, groin, and perineum. Followed by the forehead, nose and chest. The excessive sweating of the palmar sputum can be sustained or transient, caused by mood fluctuations, and there is no seasonal difference. It often occurs when the hands and feet are cold or even sputum, and it can be accompanied by hand and foot keratosis. Sputum sweating can be induced by heat or mental activity. Excessive sweating under the armpits is caused by excessive activity of the small sweat glands, unlike the stinking odor mainly caused by the apocrine glands.

(2) Generalized hyperhidrosis: Mainly due to other diseases, widespread sweating, like infectious hyperthermia, due to regulation of the nervous system or oral antipyretic to sweat to dissipate heat. Other damages such as the central nervous system including the cortex and basal ganglia, 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, Irritated by heat, patients with excessive sweating may have abnormal ECG, may have tachycardia or sharp waves, which may be related to unstable vasomotor. Generally no limitation 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 nail disease, recessive hereditary bullous epidermolysis, congenital ichthyosis-like erythroderma Both cortical and hand-foot hyperhidrosis can occur in hyperthyroidism syndrome. Often appear after excitement or eating, but sometimes 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. Hyperhidrosis caused by sweating can be seen in the following diseases:

A. Hodgkin'disease: characterized by triad of fever, night sweats and weight loss, 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 paroxysmal localized sweat that is common in the face or upper limbs. Heat, spirit and taste stimuli can all be triggered, but the former is more common and 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. The 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-auricular area 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, and the parasympathetic fibers regenerated in the damaged parotid gland migrate to the distal end of the nerve, which governs the sweat glands in the sublingual region. The destruction of the tympanic plexus 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 patients with sympathectomy, lung cancer, spinal osteoma, subclavian aneurysm and thyroidectomy. Because the sympathetic chain in the superior mediastinum is adjacent to the vagus nerve, after the sympathetic trunk injury, the vagus nerve emits cholinergic fibers to the adjacent sympathetic trunk preganglionic fibers. Patients often have faces, neck, trunk and upper limbs after eating or swallowing. The sweating reaction.

(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, can occur Local sweating may be associated with hemangioma in the affected area. In addition, cold erythema (cold erythema) after the patient is cold-stimulated, the skin has localized erythema, severe pain and central sweating, vascular atrophy and muscle atrophy, 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 the other 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 less sweat, modern compensatory hyperhidrosis. Upper body (torso-based) heat-stimulated hyperhidrosis, common with night sweats. Facial and 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 Night sweats can occur in out-of-control conditions and other chronic infectious diseases.

Differential diagnosis

Differential diagnosis of symptoms of stress and orthostatic sweating

Hyperhidrosis is usually based on a history of hyperhidrosis, typical clinical manifestations, and combined with objective examinations, which are usually not difficult to diagnose. Mainly for the identification of the cause of secondary hyperhidrosis, based on different clinical manifestations, make a judgment. If diabetes has abnormalities in blood sugar and urine glucose tests, localized symptoms and signs should be present in organic brain lesions.

Secondary hyperhidrosis: A small number of people have an increase in sweating due to physical illnesses, such as secondary hyperhidrosis, such as hyperthyroidism, endocrine diseases, mental illness, and endocrine imbalances in menopause. .

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