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Hypohidrosis is diminished sweating in response to appropriate stimuli. While hyperhidrosis is a socially troubling but benign condition, hypohidrosis can lead to hyperthermia, heat exhaustion, heat stroke and potentially death.^[1] An extreme case of hypohydrosis in which there is a complete absence of sweating and the skin is dry is termed anhidrosis.

Causes

Medications

Anticholinergic agents
Opioids
Botulinum toxin
Alpha-2 receptor antagonists
Clonidine
Barbiturates
Zonisamide

Physical agents

Tumors
Burns
Radiation
Surgery
Scars
Sores

Dermatological

X-linked hypohidrotic ectodermal dysplasia
Incontinentia pigmenti
Bazex disease
Fabry disease
Miliaria
Sjogren syndrome
Systemic sclerosis
Graft-versus-host disease

Neuropathic

Multiple system atrophy
Dementia with Lewy bodies
Multiple sclerosis
Cerebrovascular accident
Tumour
Encephalitis
Cervical myelopathy
Diabetes mellitus
Guillain–Barré syndrome
Hereditary sensory and autonomic neuropathy
Alcoholism
Amyloidosis
Ross syndrome
Pure autonomic failure
Horner's syndrome

Diagnosis

Sweat is readily visualized by a topical indicator such as iodinated starch (Minor test) or sodium alizarin sulphonate, both of which undergo a dramatic colour change when moistened by sweat. A thermoregulatory sweat test can evaluate the body’s response to a thermal stimulus by inducing sweating through a hot box ⁄ room, thermal blanket or exercise. Failure of the topical indicator to undergo a colour change during thermoregulatory sweat testing indicates hypohidrosis, and further tests may be required to localize the lesion.

Magnetic resonance imaging of the brain and ⁄ or spinal cord is the best modality for evaluation when the lesion is suspected to be localized to the central nervous system.

Skin biopsies are useful when anhidrosis occurs as part of a dermatological disorder. Biopsy results may reveal the sweat gland destruction, necrosis or fibrosis, in addition to the findings of the primary dermatological disorder.

Management

The treatment options for hypohidrosis and anhidrosis is limited. Those with hypohidrosis should avoid drugs that can aggravate the condition (see medication-causes). They should limit activities that raise the core body temperature and if exercises are to be performed, they should be supervised and be performed in a cool, sheltered and well-ventilated environment. In instances where the cause is known, treatment should be directed at the primary pathology. In autoimmune diseases, such as Sjogren syndrome and systemic sclerosis, treatment of the underlying disease using immunosuppressive drugs may lead to improvement in hypohidrosis. In neurological diseases, the primary pathology is often irreversible. In these instances, prevention of further neurological damage, such as good glycaemic control in diabetes, is the cornerstone of management. In acquired generalized anhidrosis, spontaneous remission may be observed in some cases. Numerous cases have been reported to respond effectively to systemic corticosteroids. Although an optimum dose and regime has not been established, pulse methylprednisolone (up to 1000 mg ⁄ day) has been reported to have good effect.

References

^ Chia, K. Y.; Tey, H. L. (2012). "Approach to hypohidrosis". Journal of the European Academy of Dermatology and Venereology. 27 (7): 799–804. doi:10.1111/jdv.12014. PMID 23094789.

Notes

http://www.mayoclinic.com/health/anhidrosis/DS01050^{[full citation needed]}
MedlinePlus Encyclopedia Sweating - absent

UpToDate Contents

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1. 遺伝性感覚自律神経ニューロパチー hereditary sensory and autonomic neuropathies
2. ホルネル症候群 horner syndrome
3. フォックス・フォアダイス病（アポクリン汗疹） fox fordyce disease apocrine miliaria
4. ファブリー病の臨床的特徴および診断 clinical features and diagnosis of fabry disease
5. シェーグレン症候群の臨床症状：腺外型疾患 clinical manifestations of sjogrens syndrome extraglandular disease

English Journal

Thoracolumbar Arachnoid Cyst with Horner Syndrome: A Case Report and Review of the Literature.

Gao Y1, Zhang H, Yang J, Fu Q, Zheng J, Shuai M, Hu Z, Tan W, Cao W, Yang X, Jin A, Zhou R, Lu H.
Cell biochemistry and biophysics.Cell Biochem Biophys.2014 Dec 9. [Epub ahead of print]
Horner syndrome (HS) results from the interruption of sympathic pathway, and the patients have a group of signs including miosis, ptosis, enophthalmos, and anhydrosis. While HS is mainly caused by cervical sympathetic nerve injury such as sympathetic chain tumor, we report here a HS case caused by a
PMID 25486904

A heterozygous female with Fabry disease due to a novel alpha-galactosidase A mutation exhibits a unique synaptopodin distribution in vacuolated podocytes.

Takahashi N, Yokoi S, Kasuno K, Kogami A, Tsukimura T, Togawa T, Saito S, Ohno K, Hara M, Kurosawa H, Hirayama Y, Kurose T, Yokoyama Y, Mikami D, Kimura H, Naiki H, Sakuraba H, Iwano M.
Clinical nephrology.Clin Nephrol.2014 Oct 8. [Epub ahead of print]
We report the case of a 42-yearold woman diagnosed with heterozygous Fabry disease (FD) due to a novel alpha-galactosidase A Pro210Ser mutation and exhibiting a unique distribution of synaptopodin within podocytes. The patient was referred to our hospital with moderate proteinuria, and a renal biops
PMID 25295576

Atopic Diathesis in Hypohidrotic/Anhidrotic Ectodermal Dysplasia.

Koguchi-Yoshioka H1, Wataya-Kaneda M, Yutani M, Murota H, Nakano H, Sawamura D, Katayama I.
Acta dermato-venereologica.Acta Derm Venereol.2014 Oct 1. doi: 10.2340/00015555-1978. [Epub ahead of print]
Recently, patients with hypohidrotic/anhidrotic ectodermal dysplasia (H/AED) have been reported to have a higher prevalence of symptoms suggestive of atopic disorders than the general population. To better understand atopic diathesis in H/AED, 6 cases of clinically or genetically diagnosed H/AED wer
PMID 25270765

Japanese Journal

脳神経障害を合併しMRI にて三叉神経の腫大・造影効果を呈した急性自律性感覚性運動性ニューロパチーの1例

臨床神経学 53(2), 125-130, 2013
NAID 130004505500

コリン性蕁麻疹 (特集特異なアレルギーの発症機序 : 最近の知見)

臨床免疫・アレルギー科 58(6), 671-675, 2012-12
NAID 40019542066

大腿骨骨折に対して観血的治療を要した先天性無痛無汗症の1例

関東整形災害外科学会雑誌 35(3), 182-184, 2004-06-01
NAID 10013117029

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