OF THE ECCRINE SWEAT GLANDS
in the function of sweat glands is either :
sweating: anhidrosis due to sweat retention or limitation of sweat
is an abnormal increase in the amount of sweat. These may be related
to different factors, which may be physiological or pathological.
Hyperhidrosis may be generalized or localized involving mainly
palms, soles and axilla.
factors can affect the eccrine sweat glands and increase their sweat
conditions: due to emotional, hot humid environment, work or
hyperhidrosis is associated with certain diseases such as malaria,
pneumonia, and febrile illnesses.
hyperthyroidism and diabetes.
the brain or
inflammatory conditions of the hypothalamus or its tracts. This is
due to derangement in the central control of heat regulation center.
certain drugs such as sympathomimetic drugs and others that can
affect the hypothalamus, leading to hyperhidrosis.
hyperhidrosis is a very common condition causing in certain
instances a psychological, occupational and social problem
especially when different lines of treatment fail to control this
Any age and
sex may have this problem. It may be very localized involving the
palms soles or extend more to involve the axilla, crural areas or
the waist where profuse sweating occurs when the patients are
exposed to certain stimuli.
the activity of the sympathetic nervous system such as in
hyperactive children, emotional imbalance, vasomotor instability all
may cause increase in sweating.
factors may trigger the condition such as pain, mental stress, fear,
and physical effort.
reassurance and psychotherapy may help some cases especially the
Benadryl or other types of mild sedatives improve hyperhidrosis.
analogues of atropine such as Banthin and Probanthin have temporary
inhibitory effect of sweat .The side effects as some patients may
not easily accept, are dryness of mouth, blurring of vision with
Cyproheptadine or Citrizine may be of value in treatment of
hyperhidrosis, especially the emotional type.
preparations: Many topical preparations are available in the market
but some may cause contact dermatitis besides plugging of the sweat
ducts orifices, causing anhidrosis, sweat retention and hidradenitis
suppurativa. Most antiperspirants contain aluminum salts in
different concentrations and combinations.
Palm and foot soaks with: Potassium permanganate 1: 2000 , 2 per
cent Burrows solution and tannic acid in alcohol for an hour may
have antiperspirant effect.
These are used for dusting of the feet and the interdigital spaces
to minimize sweating. The commonly used powders are:
preparation may have a good effect in decreasing localized
botulinum toxins proved to be effective, safe and long lasting
alternative therapeutic modality for treatment of severe palmer
is given 50 subcutaneous injections, 2 mouse units each in each palm
using regional nerve blocks of the median and ulnar nerves.
hexahydrate 25% in absolute ethanol can give effect in axillary
Iontophoresis is a recognized method of reducing sweat in various
parts of the body. Ionotophoresis, the process of increasing the
penetration of drugs into surface tissues by the application of an
device is a battery-operated method of inducing tap water
Ionotophoresis. This simple device may be used at home and is
effective in reducing hyperhidrosis for as long as 6 weeks.
sweat may occur in the axilla and feet.
cases it is associated with:
and fungal infections
decomposition producing distinctive odor.
foodstuffs such as garlic, onion and excessive protein ingestion.
the cause if possible.
cleaning of the body and frequent bathing.
socks and under wears repeatedly and using light clothes.
certain types of food such as excess proteins, garlic, and spices.
the area .
powders especially for the feet before dressing the socks.
the feet such as potassium permanganate 1: 2000 or formaldehyde
are available in different preparations. Care of local sensitization
due to certain products.
antiseptic soap (Cidal soap)
is colored sweat due to dysfunction of the apocrine glands.
commonest site is the face, where the color of sweat may be black,
green, blue or yellow. The crural areas may be involved where a
rusty stain may appear on the underwear.
suppurativa is infection of the apocrine sweat glands mainly that of
the axilla and the inguinal areas.
reddish nodule appears, firm that may cause an abscess with multiple
openings on the skin surface and discharging pus. The condition is
chronic and has the tendency of recurrence. Scarring may accompany
compresses with potassium permanganate for oozing cases and topical
of systemic antibiotics.
drainage of the abscess.
Chronic persisting localized cases may improve with steroid
Fig. 384. Hidradenitis Suppurativa
disease is a rare disease occurs mainly in young girls not before
puberty and not after menopause.
pruritic, small, flesh colored papules occur mainly on the axilla,
mamma, umbilicus, perineum, labia and rarely in males on the
may increase in size forming nodules with an empty follicular
histopathological feature is characteristic:
of the apocrine duct at the entrance into the follicular wall.
glands in the dermis.
Fig. 385. Fox Fordyce disease
the disease is not always successful.
and contraceptive pills have been used. These may give improvement
to itching and involution to the lesions.
a vesicular eruption of the palms and soles .The vesicles are deep
and appear as sago grains filled with clear fluid mainly bilateral
around the fingers and toes. The symptoms are minimal where there
may be mild itching or burning of the sites involved. The lesions
may be grouped.
was discussed in previous chapters in dyshidrotic eczema.
allergy: spicy foods or the additives in food.
and fungal infection else where in the body as an allergic or id
the cause such as hyperhidrosis or infections.
permanganate 1: 8000 soaks are effective for the hands and feet.
corticosteroids cream alone or in combination with antibacterial
preparation (Decoderm compound).
SWEAT GLAND ABSCESSES
affects mainly young infants .The causative organisms are usually
dome -shape, non-tender and non-pointing abscesses affecting mainly
the scalp, trunk and buttocks. The lesion may form boggy;
fluctuating dome shaped swelling that ruptures spontaneously.
antibacterial cream such as muperacin (Bactroban cream)
KG, Hey EN, Katz G. Eccrine sweat gland function in the newborn
baby. J Physiol 1968; 198: 36P-7P.
Shelly, MD,PhD, N.Y. Talanin , MD, PhD, MD Toledo, Ohio
Botulinum toxin therapy for palmar hyperhidrosis , J Am Acad
Dermatol 1998 ; 38:227-9 .
Akins-DL; Meisenheimer-JL; Dobson-RL J-Am-Acad-Dermatol. 1987 Apr;
16(4): 828-32 .Tapwater iontophoresis in the treatment of
Elgart-ML; :Fuchs-G Use of the Drionic device..Int-J-Dermatol.
1987 Apr; 26(3): 1947.
Glent-Madsen-L; Dahl-JC 68(1): 87-9 :Treatment of excess sweating
of the palms by iontophoresis. Department of Dermatology, Odense
University Hospital, Denmark. Acta-Derm-Venereol. 1988;
Stolman-LP : Efficacy of the Drionic unit in the treatment of
hyperhidrosis , Arch-Dermatol. 1987 Jul; 123(7): 893-6 .
Iontophoresis-instrumentation; Sweating- A
review.J-Am-Acad-Dermatol. 1986 Oct; 15(4 Pt 1): 671-84
care should be taken in infants and children when using
antiperspirants especially boric acid powder, which may cause
serious toxic and even fatal . Other measures for severe and
reluctant hyperhidrosis include sympathectomy and local radiation
K, Kang WH, Saga K et al. Biology of sweat glands and their
disorders. J Am Acad Dermatol 1989; 20: 537-63, 713-26.
Shelley WB, Hurley HJ. Studies on topical antiperspirant control
of axillary hyperhidrosis. Acta Der Venereol 1975; 95: 241-60.
Stolman LP. Treatment of excessive sweating of the palms by
iontophoresis. Arch Dermatol 1987; 123: 895-6.
Botulinum toxin-a possible new treatment for axillary
hyperhidrosis.: Bushara-KO; Park-DM; Jones-JC; Schutta-HS
.Department of Neurology, University of Wisconsin Hospital and
Clinics, Madison 53792-5132, USA Clin-Exp-Dermatol. 1996 Jul;
E, Alberta N. Long term efficacy and side-effects of tap water
iontophoresis of palmo-plantar hyperhidrosis - the usefulness of
home therapy. Dermatologica 1987; 175: 126-35.
WD, Schoomaker EB, Rodman OG. Emotional eccrine sweating. A
heritable disorder. Arch Dermatol 1987; 123: 925-9.
L, Hansson H. Topical glutaraldehyde for plantar hyperhidrosis. Arch
Dermatol 1968; 97: 327-30.
McWilliams SA, Montgomery I, Jenkinson DM et al. Effects of
topically applied antiperspirant on sweat gland function. Br J
Dermatol 1987; 117: 617-26.
FJG. Hidradenitis suppurativa: an androgen-dependent disorder. Br J
Dermatol 1986; 115: 259-62.
Clemmensen OJ. Topical treatment of hidradenitis suppurativa with
clindamycin. Int J Dermatol 1983: 22: 325-8.
WP, Hughes LE. The distribution, size and density of the apocrine
glands in hidradenitis suppurativa. Br J Surg 1979; 66: 853-6.
WP, Leicester G. The role of depilation and deodorants in
hidradenitis suppurativa. Arch Dermatol 1982; 118: 101-2.
EB, Ali SD, Kurtz LH. Hidradenitis suppurativa: review of the
literature and management of the axillary lesion. J Nat Med Assoc
1980; 72: 237-43.
Meneghini CL, Angelini G. Contact and microbial allergy in
pompholyx. Contact Derm 1974; 5: 46.
L, Temime P. Dyshidrosis and atopy. Bull Soc Fr Dermatol Syphiligr
1968; 75: 378.
Hjorth N. Pompholyx-dyshidrotic eczema. Semin Dermatol 1983; 2:
HL, Pomeranz JR, Sitomer G. Fox-Fordyce disease. Arch Dermatol 1965;
J, Greenspan J, Daniels T et al. Anhidrosis (hypohidrosis) in
Sj“gren‘s syndrome. J Am Acad Dermatol 1987; 16: 233-
means absence of sweating.
is the absence of sweat due to defect in production or conduction of
sweat to the skin surface in the presence of an appropriate
stimulus. The condition may be localized or generalized.
type of anhidrosis
New born and
premature infants commonly show temporary anhidrosis for several
weeks probably due to immaturity of neural supply.
causes: Head injuries, heat stroke, hysteria, and neurosurgical
tumors in the region of the third ventricle leading to loss of
control of the thermoregulatory centers in the hypothalamus.
the sweat ducts or their pores lead to sweat retention anhidrosis as
in miliaria, contact dermatitis, atopic dermatitis, icthyosis and
antiperspirants containing aluminum sulfate. This type of anhidrosis
is the most common seen in general practice.
ganglion sympathectomy lead to anhidrosis in the areas supplied by
of the peripheral sympathetic fibers as in peripheral neuritis and
cholenergic drugs, atropine and its analogues and local anesthetics.
absence of the sweat glands, either in localized areas or
generalized as in congenital ectodermal defect, which is hereditary,
transmitted as sex - linked recessive trait.
sweat glands as in burns, radiodermatitis and accompanying
diseases such as scleroderma and exfoliative dermatitis.
anhidrosis is usually not successful without the control of the
the complications due to sweat retention such as miliaria.
exposure to hot environment.
and humidifiers may help the patients.
retention in children and older age groups may have different
predisposing factors and some variations in the clinical features.
condition is due to interference in free delivery of sweat to the
the sweat ducts pores by keratin in response to epidermal injury may
lead to rupture of the sweat glands. The condition is called
miliaria or sweat retention.
retention anhidrosis: due to poral occlusion only causes minimal
symptoms apart from anhidrosis.
Fig. 386. Miliaria Rubra
Fig. 387. Miliaria Crystallina
Fig. 388 Miliaria Rubra
group: Different types of miliaria have different clinical symptoms
This is due
to escape of sweat in the stratum corneum leading to numerous
discrete vesicles with clear fluid, which ruptures easily.
usually negligible where some cases have little burning or stinging
sensation when exposed to strenuous effort or in hot humid
environment. Miliaria crystallina may be found in association of
contact dermatitis especially in young children due to occlusion of
the crural area for long time or using powders, which may occlude
the sweat orifices.
rubra or prickly heat:
This is the most common, especially in hot humid climates appearing
on the back, chest, side of the abdomen, antecubital, popliteal
fossa and in areas exposed to friction.
manifests as erythematous papulovesicular rash causing itching and
burning sensation due to leakage of sweat into the epidermis, where
the severity depends on the heat load.
lesions appear as pruritic, discrete, superficial erythematous
pustules with a dark punctum at the center corresponding to the
hyperkeratotic plug occluding the sweat orifice. The common site of
miliaria pustulosa is the intertriginous areas and the flexural
surfaces of the extremities.
This type is
also common in young children using diapers and associated with
certain diseases as intertrigo, atopic dermatitis and contact
dermatitis. The contents of the pustules are sterile and it is
formed due to intraepidermal sweat retention.
profunda: This type
is due to deep poral occlusion and rupture of sweat ducts and escape
of sweat into the epidermis at the dermo-epidermal junction.
eruption is in the form of non-inflammatory, non-pruritic and flesh
colored papules where the severity of the lesion depends on the
degree of sweating. Miliaria profunda may be accompanied by systemic
manifestations such as irritability, easily fatigue ; headache, anorexia,
drowsiness and inability to concentrate due to heat intolerance.
improves by cooling of the skin and the symptoms may disappear after a
occurs when the flow of eccrine sweat is impeded by obstruction of
the intraepidermal portion of the sweat duct.
immaturity of the sweat ducts may be an important predisposing
factor in early infancy.
pants provide favorable conditions for the development of miliaria
in the napkin area.
KG, Hey EN, Katz G. Eccrine sweat gland function in the newborn
baby. J Physiol 1968; 198: 36P-7P.
WH. Generalized anhidrosis associated with Fabry‘s disease. J Am
Acad Dermatol 1987; 17: 883-7.
Loewenthal LJA. The pathogenesis of miliaria. Arch Dermatol 1961;
E, Kligman AM. The pathogenesis of miliaria rubra. Role of the
resident flora. Br J Dermatol 1978; 99: 117-37.
F, Slutsky HL. The natural history of the eccrine miliarias. New
Engl J Med 1957; 256: 401-8, 451.
B. Transient neonatal pustular melanosis. Cutis 1978; 22: 327-8.
G. The role of bacteria in anhidrosis. Dermatologica 1973; 146:
N, Kawagachi H, Miyakawa K et al. Congenital sensory neuropathy
with anhidrosis. Arch Dermatol 1988; 124: 964-6.
THE APOCRINE GLANDS
glands are not active in childhood and smaller in size. Their
activity is related to sex hormones and has no heat regulatory role
as that of the eccrine sweat glands.
glands are present in special areas of the body such as the axilla,
nipple, face, pubic area and genitalia. Secretion of apocrine glands
is small in amount odorless but give distinct odor under certain
conditions due to action of bacteria liberating unsaturated fatty
acids, which give the characteristic aromatic odor. The odor varies
according to the age, sex, race and emotional status of individuals.
the apocrine glands is mainly in the axilla and called hidradenitis
suppurativa. Occlusion of their pores leads to cyst formation or
papular, itchy and intensely pruritic eruption called Fox -Fordyce
effective treatment includes decrease the secretion by aluminum
salts and inhibits bacteria in the area by shaving the hair in
adults which invites debris, bacteria besides keratin and repeated
cleaning the areas with water and soap.
FJG. Apocrine glands in health and disease. Int J Dermatol 1989;
Montagna W, Parakkal PF. The Structure and Function of Skin 3rd
edn. New York, London: Academic Press, 1974.
TE. Diagnosis and treatment: some diseases, syndromes and
conditions associated with an unusual odor. Pediatrics 1968; 41:
PJH. Body odor - the role of skin bacteria. Semin Dermatol 1982:
HJ, Shelley WB. The Human Apocrine Sweat Gland in Health and
Disease. Springfield: Thomas, 1960.