Case Report Dermatology 1992; 184:298-299
Th. Rufli P. Itin L. Gilli
Localized Unilateral Hyperhidrosis
Department of Dermatology, University Hospital, Basel. Switzerland
Key Words Localized unilateral hyperhidrosis Disorders of sweat glands
Abstract We describe a case of localized unilateral hyperhidrosis on the forehead in a 52-ycar-old woman. The pathophysiology of this unique clinical picture and its treatment are described.
Case Report
Fig. 1. Localized hyperhidrosis, 2 min after wiping off sweat.
Minor Sweat Test Strong blue coloration in the sharply demarkated area of the left forehead (fig. 2). Histology Orthokeratosis with no epidermal or dermal abnormality. No alteration in the sweat glands could be seen.
Fig. 2. Minor sweat test shows circumscribed hyperhidrotic area.
Th. Rufli Department of Dermatology University Hospital CH-4031 Basel (Switzerland)
© I992 Karger AG, Basel 1» 18-8665/92/1844-029S $ 2.75A)
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 10:38:16 PM
A 52-year-old patient presented with a 5-year history of localized hyperhidrosis on the left side of the forehead beneath the eyebrows. The family and personal history of the patient was unremarkable for any disorders of the skin. Physical examination revealed a localized sharply demarkated area of severe hyperhidrosis just beneath the eye brow (fig. 1). The underlying skin was normal. Two minutes after wiping off the sweat, new sweat drops developed. The localized hyperhidrosis was continuing all day and was not dependent on external influences. However, no hyperhidrosis existed during the night.
Discussion The first description of unilateral frontal hyperhidrosis dates back to 1947. Since this first description by Tarlov and Hertz [1] only scattered case reports appeared in the medical literature [2^1]. Most patients with unilateral circumscribed idiopathic hyperhidrosis show a sharply demarkated area which is mostly less than 10 x 10 cm: . As a rule the hyperhidrotic area is present mainly on the face and arms of otherwise healthy persons. The onset of the hyperhidrosis dates between 7 and 67 years. Some patients reported that men tal or gustatory stimulations may trigger sweating. The pathogenesis of unilateral circumscribed hyperhidrosis remains unknown. In 1957 Lapiere [5] hypothesized that
this entity may be a functional eccrine nevus. However, Greaves et al. [6], in 1970, showed the normal anatomy of the hyperhidrotic area. Van dc Kerkoff et al. ¡7] investi gated a patient with unilateral hyperhidrosis of the face. Measurements of evaporative water loss in other body areas revealed a marked left/right difference in the sweat ing rate. However, the patient did not realize his hyper hidrosis of the ipsilateral body side. Although no long-time studies exist, it is documented that spontaneous regression in the natural course of the disease may occur. Topical treatment modalities include aluminium hydroxide and anticholinergics [8]. Systemic clonidine treatment in parox ysmal localized hyperhidrosis is a documented therapy [6]. Surgical treatment should be performed with great caution [9]-
References
2
3 4
Tarlov IM. Hertz E: Unilateral frontal hyper hidrosis relieved by supraorbital nerve section. J Am Med Ass 1947:133:476. Cunliffe WJ. Johnson CE. Williamson DM: Localized unilateral hyperhidrosis - A clinical and laboratory study. Br J Dermatol 1972:86: 374-378. Bedi TR. Bhutani LK: Unilateral facial hyper hidrosis. Dermatológica 1974:149:374-378. Fernandez G . Armijo M: Unilateral facial cir cumscribed hyperhidrosis. Acta Derm Venereol (Stockh)’ 1985:65:445-447.
5
6
7
I.apière SA: A propos d'une observation de ntevus sudoriparc avec hyperhidrose. Derma tológica 1957:115:293. Greaves MW. Birkett DA. Johnson CE: Nevus anemicus: A unique catecholaminedependent nevus. Arch Dermatol 1970:102: 172. Van de Kerkhof PCM. den Arend JAJC. Bousema MT. Stolz E: Localized unilateral hyperhidrosis. Br J Dermatol 1987:117: 779-782.
8
9
Kuritzky A. Hering R. Goldhammer G. Bcchar M: Clonidine treatment in paroxysmal localized hyperhidrosis. Arch Neurol 1984:41: 1210- 1211. Sato K. Kang WH. Saga K. Sato KT: Continu ing medical education. Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol 1989:20: 713-726.
299
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1
Th. Rufli P. Itin L. Gilli
Localized Unilateral Hyperhidrosis
Department of Dermatology, University Hospital, Basel. Switzerland
Key Words Localized unilateral hyperhidrosis Disorders of sweat glands
Abstract We describe a case of localized unilateral hyperhidrosis on the forehead in a 52-ycar-old woman. The pathophysiology of this unique clinical picture and its treatment are described.
Case Report
Fig. 1. Localized hyperhidrosis, 2 min after wiping off sweat.
Minor Sweat Test Strong blue coloration in the sharply demarkated area of the left forehead (fig. 2). Histology Orthokeratosis with no epidermal or dermal abnormality. No alteration in the sweat glands could be seen.
Fig. 2. Minor sweat test shows circumscribed hyperhidrotic area.
Th. Rufli Department of Dermatology University Hospital CH-4031 Basel (Switzerland)
© I992 Karger AG, Basel 1» 18-8665/92/1844-029S $ 2.75A)
Downloaded by: King's College London 137.73.144.138 - 3/7/2018 10:38:16 PM
A 52-year-old patient presented with a 5-year history of localized hyperhidrosis on the left side of the forehead beneath the eyebrows. The family and personal history of the patient was unremarkable for any disorders of the skin. Physical examination revealed a localized sharply demarkated area of severe hyperhidrosis just beneath the eye brow (fig. 1). The underlying skin was normal. Two minutes after wiping off the sweat, new sweat drops developed. The localized hyperhidrosis was continuing all day and was not dependent on external influences. However, no hyperhidrosis existed during the night.
Discussion The first description of unilateral frontal hyperhidrosis dates back to 1947. Since this first description by Tarlov and Hertz [1] only scattered case reports appeared in the medical literature [2^1]. Most patients with unilateral circumscribed idiopathic hyperhidrosis show a sharply demarkated area which is mostly less than 10 x 10 cm: . As a rule the hyperhidrotic area is present mainly on the face and arms of otherwise healthy persons. The onset of the hyperhidrosis dates between 7 and 67 years. Some patients reported that men tal or gustatory stimulations may trigger sweating. The pathogenesis of unilateral circumscribed hyperhidrosis remains unknown. In 1957 Lapiere [5] hypothesized that
this entity may be a functional eccrine nevus. However, Greaves et al. [6], in 1970, showed the normal anatomy of the hyperhidrotic area. Van dc Kerkoff et al. ¡7] investi gated a patient with unilateral hyperhidrosis of the face. Measurements of evaporative water loss in other body areas revealed a marked left/right difference in the sweat ing rate. However, the patient did not realize his hyper hidrosis of the ipsilateral body side. Although no long-time studies exist, it is documented that spontaneous regression in the natural course of the disease may occur. Topical treatment modalities include aluminium hydroxide and anticholinergics [8]. Systemic clonidine treatment in parox ysmal localized hyperhidrosis is a documented therapy [6]. Surgical treatment should be performed with great caution [9]-
References
2
3 4
Tarlov IM. Hertz E: Unilateral frontal hyper hidrosis relieved by supraorbital nerve section. J Am Med Ass 1947:133:476. Cunliffe WJ. Johnson CE. Williamson DM: Localized unilateral hyperhidrosis - A clinical and laboratory study. Br J Dermatol 1972:86: 374-378. Bedi TR. Bhutani LK: Unilateral facial hyper hidrosis. Dermatológica 1974:149:374-378. Fernandez G . Armijo M: Unilateral facial cir cumscribed hyperhidrosis. Acta Derm Venereol (Stockh)’ 1985:65:445-447.
5
6
7
I.apière SA: A propos d'une observation de ntevus sudoriparc avec hyperhidrose. Derma tológica 1957:115:293. Greaves MW. Birkett DA. Johnson CE: Nevus anemicus: A unique catecholaminedependent nevus. Arch Dermatol 1970:102: 172. Van de Kerkhof PCM. den Arend JAJC. Bousema MT. Stolz E: Localized unilateral hyperhidrosis. Br J Dermatol 1987:117: 779-782.
8
9
Kuritzky A. Hering R. Goldhammer G. Bcchar M: Clonidine treatment in paroxysmal localized hyperhidrosis. Arch Neurol 1984:41: 1210- 1211. Sato K. Kang WH. Saga K. Sato KT: Continu ing medical education. Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol 1989:20: 713-726.
299
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