DISEASES OF THE SWEAT GLANDS
HYPERIDROSIS
=Derivation.= From the Greek _hyper_, in excess, and _hidros_, sweat.
=Synonyms.= Idrosis; ephidrosis; hydrosis; sudatoria; polyidrosis;
excessive sweating, sudorrhea.
=Definition.= Hyperidrosis is a functional disorder of the sweat
glands (usually of the hands and feet) characterized by the excessive
excretion of sweat. The condition may be limited to certain areas or it
may be distributed over the entire body.
=Etiology.= When hyperidrosis is general it is caused by faulty
innervation. The cause in localized forms is doubtless varied from
that of pure idiosyncrasy to grave systemic disturbances. In instances
there seems to be an inherited tendency to this disturbance. Excessive
drinking of water or tea will produce hyperidrosis pedum in some
people. Localized sweating may follow some debilitating diseases for a
period of time. Anything that causes a depression of the nervous tone,
may be an etiologic factor. Neurasthenics often display this symptom.
Physical or mental excitement will cause profuse sweating in many
individuals.
=Pathology.= The normal sweat excretion is closely related to the
nervous system, hence pathologic excretion must have some nervous
cause. It is most probable that any disease or injury that affects the
function of the sympathetic nervous system, is the direct cause of
excessive sweat excretion. Examination of sections of the glands fails
to show any increase in size or in the epithelium of the gland.
=Symptoms.= Hyperidrosis may occur as a result of a general disease
such as rheumatism, tuberculosis, malaria, etc., or it may be
idiopathic and persist for a long period. The latter phase is of most
interest to the podiatrist. The disease is quite common. The sweating
may be immediate or profuse, and is always more marked in regions where
excessive sweating is normal, such as the hands, feet, axillae, etc.
It is more pronounced in hot weather, but is excessive even in cold
weather, and is increased by the least exertion. In hot weather it is
frequently accompanied by miliaria, intertrigo, or acute eczema.
On the feet, hyperidrosis is often disgusting, and may become
exceedingly troublesome. The excretion is excessive and the feet are
constantly damp or wet and clammy. The stockings become moist and the
shoe may become water-soaked. Sweating is most profuse on the soles and
between the toes. The skin is soggy and macerated and, in severe cases,
the sole and surrounding areas are reddened, puffy and irritated,
with ill-defined vesicular or flattened bullous lesions. In ordinary
hyperidrosis of the feet, the sweat is not offensive immediately after
it is exuded, but rapidly becomes so, unless the footgear is changed
frequently. Bromidrosis is often associated with hyperidrosis.
=Prognosis.= As a rule, localized cases are obstinate, but with
continued treatment, good results will follow. It is often necessary to
change the treatment from time to time. Relapses are not uncommon.
=Treatment.= The treatment of hyperidrosis is divided into two groups,
local and general. Excessive general sweating following fevers and
debilitated conditions of the system should receive general treatment
at the hands of the physician. When nervous disorders produce sweating
in limited areas, they also require specially directed general
treatment. In localized sweating of indefinite cause, under the advice
of the physician, it is often advisable to administer general tonics,
and remedies such as ergot, belladonna, gallic acid, etc., may be
locally applied. Precipitated sulphur, taken internally, one dram
twice daily, is the resort of many physicians in such cases and the
treatment has given satisfactory results.
While constitutional treatment should be used in every case of
hyperidrosis pedum, the external treatment is more positive in result
and therefore is more essential. This external treatment consists of
the application of ointments and powders, with frequent washing and the
use of lotions. Astringent lotions, used for the purpose of hardening
the skin may be chosen from the following:
Alum powdered 1 ounce.
Water 1 pint.
or
Zinc sulphate 2 drams.
Water 1 pint.
or
Formalin 3 drams.
Alcohol 1 pint.
The feet should be thoroughly cleansed and dried. Lotions applied two
or three times daily, should be allowed to dry on the foot. This may
then be followed by a dusting powder of the following:
Acid salicylic 15 grains.
Boric acid 1 ounce.
The local application of belladonna in the form of the diluted
tincture, the liniment or the ointment, has given excellent results
in some cases, but great care should be exercised in their use, as
belladonna may produce toxic effects, through absorption.
Many cases have responded readily to the alternate foot bath (See
Chapter, _The Care of the Foot_). After the alternate foot bath,
the feet are thoroughly dried, and in severe cases, the lotion of
formalin and alcohol may be used, or in ordinary cases, grain alcohol
is applied. When the lotion has dried, the feet are dusted with the
following powder:
℞ Acid salicylic 15 grains
Alum powdered
Lycopodium aa 1 ounce
M. Sig. Dust on feet morning and night.
Diachylon ointment, freshly prepared, is the best remedy among the
unguents. It is prepared as follows:
℞ Lead plaster 1 ounce
Oil of lavender flowers 15 grains
Olive oil, q.s. ad. 3 ounces
M. Sig. Apply on gauze and bandage.
Another ointment which has astringent properties and which has been
used with some success is:
℞ Tannic acid 2 drams
Petrolatum 1 ounce
M. Sig. Spread on gauze and bandage.
Before these ointments are applied, the parts should be thoroughly
washed with soap and water, dried, and the ointment spread on gauze
and held in place with a bandage. The application should be removed
after twelve hours, the parts rubbed dry with a towel, and the ointment
reapplied. This should be continued for a week or two, when, if results
have not followed, other forms of treatment should be used.
The X-rays have a drying influence upon the skin, but if this treatment
is used, great caution should be exercised, as the rays are likely to
have a very harmful influence upon the tissues generally.
At the suggestion of a prominent chemist and physician, a series of
experiments were performed with oxygen gas and vanadium chloride
solution for the treatment of hyperidrosis, which proved more or less
successful. The solution of vanadium chloride (1-20,000) was applied
to the foot, and the oxygen gas was slowly sprayed on the foot, from
a large gas container. This treatment lasted for ten minutes and was
applied twice a week. In one particular case, which had resisted the
ordinary methods of treatment, the use of this remedy was of great
benefit to the patient. After several weeks, the case showed marked
improvement, but the inability of the patient to continue treatment
prevented further trials. In many other ordinary cases of hyperidrosis,
the results were excellent, while in others there was no marked
improvement[6]. The use of formalin and alcohol solution in conjunction
with the oxygen treatment, has proven very effective. The lotion is
used at night, immediately before retiring.
Stillians, in the Journal of the American Medical Association, states
that a 25% solution of aluminum chloride in distilled water, dabbed
gently on the part every second or third day and allowed to dry, will
cause a rapid amelioration of the excessive sweating; three such
applications are usually sufficient. If the condition recurs, the
treatment may be repeated.
Potassium permanganate solution, 5 parts to 1,000, has been found
efficient as a wash for the feet. More active, and therefore to be used
with more care, are “chromic acid” solutions, as:
Chromium trioxide 2.5
Water 50.0
Sig. Use as a paint once a week.
Less active, but more pleasant than the foregoing, is:
Tannic acid 5.
Alcohol 100.
Water, q. s. ad. 200.
Sig. Use as a wash twice a day.
The lotions and washes should be used in conjunction with drying
powders, such as have been already mentioned.
The use of the various solutions of aluminum chloride, or of chromium
trioxide, may, in some cases, cause a mild dermatitis, perhaps
with itching. This may be relieved by the application of protective
dressings to prevent scratching, and the application of ointments, such
as cold cream containing 12 per cent. boric acid, or a calamine lotion.
Itching may be relieved by adding 0.5 per cent. phenol to the calamine
lotion.
BROMIDROSIS.
=Derivation.= “_Bromos_,” a stench; and “_hidros_,” sweat.
=Synonym.= Osmidrosis.
=Definition.= Bromidrosis is a functional disorder of the sweat glands,
characterized by a sweat excretion which has an offensive odor.
=Etiology.= The etiology of bromidrosis is much the same as that of
hyperidrosis, occurring in those who are anemic, chlorotic and nervous
and in those who are compelled to stand for long periods. Eating
certain foods and drugs will give peculiar odors to the perspiration,
among which are garlic, onions, assafetida, and sulphur. The cause of
the odor of the sweat in bromidrosis pedum is the decomposition of the
fatty acids of the sweat, as well as the presence of the bacterium
fetidum, which is found on the feet, especially between the toes.
=Pathology.= Immediately after the sweat is excreted, it is not
offensive, but soon becomes so, due to the presence of microorganisms
and the decomposition of the fatty acids.
=Symptoms.= The sweat has a disagreeable odor and is usually associated
with hyperidrosis, but not necessarily so, as it may occur in persons
having a normal sweat excretion. When the excretion is excessive, there
are the usual symptoms of hyperidrosis, viz., puffiness, tenderness,
sogginess and possibly blebs or vesicles. The odor is offensive, stale,
penetrating and peculiar and often is sufficient to make the sufferer
unfit for society.
=Treatment.= The treatment is essentially the same as for hyperidrosis,
coupled with absolute cleanliness and frequent change of footgear.
Shoes should be allowed to stand in the air for at least twenty-four
hours after having been worn, so that several pairs are required.
Constitutional treatment is the same as for hyperidrosis as is also the
external treatment. The feet should be washed in boric acid solution,
and the powder used freely in the socks and on the feet.
The feet may be painted once every three weeks with a 5 to 10 per cent.
solution of chromic acid, or they may be washed every other day in one
per cent. solution of potassium permanganate, and in the interval the
following powder proves efficacious:
℞ Acid salicylic 10 grains
Tannoform 2 drams
Zinc oxide
Talc aa 3 drams
M. Sig. Dust on feet morning and night.
ANIDROSIS
=Derivation.= _a_, without; and _hidros_, sweat.
=Synonym.= Decrease or absence of sweating.
=Definition.= Anidrosis is a functional disorder of the sweat glands
characterized by a diminution or suppression of sweat.
=Etiology.= Anidrosis is rare as an idiopathic condition, occurring
generally in diabetes and fever, also in some skin diseases such as
ichthyosis and pityriasis rubra pilaris; also in the parts affected
by anesthetic leprosy, scleroderma and keloids. Localized sweat
suppression follows injury to the nerves.
=Symptoms.= The skin seems to be abnormally dry, and this dry skin may
be a form of ichthyosis or may predispose to eczema. When the sole
of the foot is dry and the skin shows clefts, which contain helomata
miliare, and has a yellowish color, diabetes may be suspected. There
may be but slight diminution of sweat excretion, or total absence.
=Treatment.= In congenital cases, nothing is of much avail. In the
acquired cases, applications of hot water or vapor baths externally,
and general tonics, the free drinking of water and the use of warm
clothing, are indicated. Pilocarpin or jaborandi may be given
internally, but this must be on the prescription of a physician.
Massage with oil or the application of galvanic or faradic electricity
have proven of benefit. Hot alkaline baths, preceding the massage with
oil, are also at times beneficial.
In addition to the above there are a number of rare granular
perversions which occasionally are seen by the podiatrist and of which
but brief mention need here be made:
_Chromidrosis._ A condition in which the sweat is colored, usually
black. When this condition arises from accident, the sweat may be
colored green. Red sweat, which occasionally occurs in the axillae, is
due to the action of bacterium prodigiosum.
_Sudamen._ A collection of sweat in the upper layers of the epidermis,
due to obstruction of the sweat ducts, which gives rise to an eruption
of numerous pinhead, transparent vesicles. Occurs during the course of
fevers and is usually of but short duration.
_Uridrosis._ Characterized by the excretion of urine constituents
through the sweat glands. Usually the result of suppression of urine by
reason of impaired kidney function, whereupon the sweat glands assist
in the elimination of the urinary deposits. There is a urinous odor to
the skin.
_Hematidrosis._ Characterized by hemorrhage from the sweat glands. A
very rare condition.
_Phosphoridrosis._ In this very unusual disease the sweat glands exude
a phosphorescent sweat, said to be due to a species of photobacterium
following the ingestion of phosphorus or of food stuffs containing
phosphorus.
_Miliaria._ A mild inflammatory affection caused by obstruction of
the sweat ducts, characterized by the occurrence of small papules and
vesicles at their mouths.
_Hydrocystoma._ A condition characterized by the formation upon the
face of firm, pinhead sized vesicles, due to sweat gland obstructions.
_Hydradenitis Suppuration._ An inflammatory disease of the sweat glands
followed by deep-seated, shot-like nodules, which suppurate and leave
scars.
_Seborrhea._ A lesion of the fat-producing glands characterized by an
increased and altered secretion of sebum resulting in an oily or scaly
condition of the skin.