Pathologic causes of hyperhidrosis

What are the pathologic causes of hyperhidrosis?

Spinal cord damage or lesions of the peripheral sympathetic nerves may cause localized hyperhidrosis.

Generalized and episodic hyperhidrosis may occur in patients with infectious diseases (night sweats), malignancies, hypoglycemia, thyrotoxicosis, pheochromocytomas, carcinoid syndrome, acromegaly, or diencephalic epilepsy and in patients receiving cholinergic agents. 

Primary or essential hyperhidrosis usually involves limited areas of the body, particularly the axilla, palms, and plantar regions.

Essential hyperhidrosis is, however, usually self-limiting by the fourth or fifth decade of life.

Up to one-half of patients have a family history of a similar condition.

The cause of this condition seems to be centrally initiated excessive sympathetic output to the sweat glands. 

How is this treated? 

The treatment of essential generalized hyperhidrosis is difficult and requires systemic pharmacotherapy (anticholinergics, clonidine), topical agents (aluminum chloride), excision of axillary sweat glands, botulinum toxin injections, and sympathectomy as the last resort.

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