‫ﻧﺖ‬

‫َ‬ ‫ﻤ َﺘﻨَ ﺎ اﻧ َ‬
‫ﻚ‬ ‫ﻋﻠ ْ‬
‫ﻣﺎ َ‬ ‫ﻋ ْﻠ َ‬
‫ﻢ ﻟَﻨَ ﺎ اﻻ َ‬ ‫ﺤﺎ َﻧ َ‬
‫ﻚ ﻻَ ِ‬ ‫ﻮا ُ‬
‫ﺳ ْﺒ َ‬ ‫ﻗ ُ‬
‫ﺎﻟ ْ‬ ‫َ‬
‫ﻴﻢ‬
‫ﻜ ُ‬‫ﺤ ِ‬ ‫ﻴﻢ ْ‬
‫اﻟ َ‬ ‫ﻌ ِﻠ ُ‬ ‫ْ‬
‫اﻟ َ‬
Disorders of sweat
glands
Hyperhidrosis
Definition:
Hyperhidrosis is increased eccrine
sweating.
Types:
 Generalized hyperhidrosis
o Hot humid environment.
o Vigorous exercise.
o Fevers (e.g. tuberculosis, malaria, brucellosis,
endocarditis),
o Metabolic diseases (diabetes, hypoglycemia,
hyperthyroidism),
o Menopause,
o Drugs (e.g. fluoxetine, NSAIDs)
Types:
 Palmoplanter (Emotional) hyperhidrosis:
o This type is usually localized to the
palms, soles or axillae
o Worse during warm temperature.
o It may be triggered by anxiety, stress or
fear.
Types:
 Gustatory hyperhidrosis:
o Sweating on the lips, forehead and nose
after eating certain foods occur
physiologically in many people.
o Hot spicy foods are the most likely
cause.
Treatment :
 In many patients, all that is necessary is simple
reassurance and explanation that the disorder
is likely to improve spontaneously.

 Topical and systemic treatments are only

temporarily suppressive.
Treatment :
Topical therapy

 Eccrine duct blocking agents: as 20% solution

of aluminium chloride in absolute ethyl alcohol
at night.

 Iontophoresis:

 Botulinum toxin A injection

Treatment :
Systemic therapy

 Atropine-like drugs but their side effects

(dryness of mouth, constipation, glaucoma,
hyperthermia and convulsions) are often more
troublesome than the hyperhidrosis itself.
Treatment :
Surgical treatment

 Only those patients in whom a severe disability

is arising from the hands or axillae warrant
surgical intervention as sympathectomy.
 Miliaria (Sweat rash, Prickly rash)

Definition
Erythematous papules associated with
sweat duct occlusion following heat
exposure.
 Miliaria (Sweat rash, Prickly rash)

Epidemiology
Miliaria are most common in first week of
life as infant adjusts to environment; also,
occur in any age with excessive heat and
sweating.
 Miliaria (Sweat rash, Prickly rash)

Pathogenesis
The eccrine sweat pore become macerated and then
occludes the duct.
This leads to superficial clear vesicles (miliaria crystallina)
or deep, more painful red papules or nodules (miliaria
rubra).
Most common sites trunk, neck and in occluded areas.
 Miliaria (Sweat rash, Prickly rash)

Clinical picture:
In miliaria rubra, he typical lesions develop in areas of
friction with clothing and flexures.
The lesions are uniformly minute erythematous papules or
papulovesicles which may be present in very large numbers.
 Miliaria (Sweat rash, Prickly rash)

Clinical picture:
Characteristically, they lead to intense discomfort and
unbearable pricking sensation.
Secondary bacterial infection is a common complication.
Miliaria (Sweat rash, Prickly rash)
Miliaria (Sweat rash, Prickly rash)
Miliaria (Sweat rash, Prickly rash)
 Miliaria (Sweat rash, Prickly rash)

Treatment:
• The most effective treatment for miliaria is to place the
patient in a cool environment.
• Avoidance of excessive clothing and excessive use of soap
and contact of skin with irritants.
 Miliaria (Sweat rash, Prickly rash)
Treatment:
• Soothing local applications e.g. Calamine lotion.

• Oral antihistamines for itching and antibiotics if there is

secondary infection.
• Oral ascorbic acid 500 mg twice daily may diminish the
severity of miliaria.