skINsight

SECTION EDITOR: JAMES M. GRICHNIK, MD, PhD

A Unique Pattern of Hyperhidrosis

Victoria J. Lewis, MBBS, MRCP; P. J. A. Holt, MB, FRCP;
Welsh Institute of Dermatology, University Hospital of Wales, Cardiff

A
69- YEAR - OLD MAN PRESENTED WITH A
5-year history of drenching sweating lo-
calized to the left side of the trunk and
right thigh (Figure 1) that was exacer-
bated only by heat. Sweating, as mea-
sured by starch and iodine, was absent elsewhere.
Examination findings included delayed direct and in-
direct pupillary constriction to light and accommodation
on the left eye, and some of the limb reflexes were reduced
in a nonrelated distribution. Findings from serologic testing
for syphilis (VDRL slide test) were negative; chest x-ray film
findings were normal; and a magnetic resonance image of
the spine showed spondylotic changes at cervical verte-
brae C3-C6, but no canal stenosis or spinal cord abnor-
malities were observed.
A diagnosis of Ross syndrome was made, which is a dis-
order characterized by the triad of segmental anhidrosis
(with compensatory hyperhidrosis), hyporeflexia, and tonic
pupil, thought to be caused by degenerative loss of post-
ganglionic unmyelinated autonomic fibers.
Oral glycopyrronium bromide (1 mg, 3 times per day)
has helped dramatically (Figure 2), enabling the patient
to remain dry on most days, although higher doses caused
heat fatigue.
Submissions
The skINsight section is a forum to present visually
compelling images (clinical, dermoscopic, micro-
scopic, confocal, ultrasound, UV/IR, etc) with striking
reproducible patterns whose recognition enhances our
diagnostic and therapeutic abilities. Text is limited to
200 words. The skINsight section is not intended for
single case reports. Preliminary inquiries regarding
submissions for this feature may be submitted by
e-mail to James M. Grichnik, MD, PhD (grich001@mc
.duke.edu). Manuscripts should be submitted electroni-
cally to archdermatol@jama-archives.org.

Figure 1. Figure 2.

(REPRINTED) ARCH DERMATOL/ VOL 142, FEB 2006 WWW.ARCHDERMATOL.COM

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