Sweating Disorders

Elizabeth A. Coon, MD; William P. Cheshire, Jr, MD, FAAN Autonomic Disorders p. 116-137 February 2020, Vol.26, No.1 doi: 10.1212/CON.0000000000000813
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PURPOSE OF REVIEW This article reviews disorders of sweating, including hyperhidrosis and anhidrosis due to central or peripheral autonomic nervous system causes.

RECENT FINDINGS Disorders of thermoregulation and sweating may manifest with hyperhidrosis or hypohidrosis/anhidrosis. Primary disorders of hyperhidrosis may significantly impact quality of life yet tend to be benign. Many sweating disorders present with compensatory hyperhidrosis due to areas of anhidrosis. Anhidrosis may occur due to either central or peripheral damage to the autonomic nervous system. The thermoregulatory control of sweating involves central pathways from the hypothalamus to the brainstem and then spinal cord as well as projections to peripheral structures, including the sympathetic chain ganglia, peripheral nerves, and eccrine sweat glands. Disruption at any point of this pathway may lead to impaired sweating. Characterization of sweating dysfunction helps localize different autonomic disorders to guide diagnosis and may allow for evaluation of treatment effect.

SUMMARY Sweating dysfunction manifests in myriad ways, including essential hyperhidrosis, complete anhidrosis with heat intolerance, and compensatory hyperhidrosis due to anhidrosis, and often indicates involvement of underlying central or peripheral autonomic dysfunction.

Address correspondence to Dr William P. Cheshire, Department of Neurology, Mayo Clinic, 4500 Mellish Dr, Jacksonville, FL 32224, cheshire@mayo.edu.

RELATIONSHIP DISCLOSURE: Dr Coon reports no disclosure. Dr Cheshire serves as an associate editor for Clinical Autonomic Research and on the editorial boards of Autonomic Neuroscience: Basic & Clinical and Parkinsonism & Related Disorders. Dr Cheshire has received personal compensation for travel from Biohaven and for speaking engagements for Trinity Graduate School.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Coon and Cheshire discuss the unlabeled/investigational use of amitriptyline, clonidine, endoscopic transthoracic sympathotomy, gabapentin, glycopyrrolate, morphine, and steroids for the treatment of sweating disorders.

© 2020 American Academy of Neurology.