10th July 2023

Sebaceous and Sweat Gland Disorders

Please refer to the Dermatology topic ‘Inflammatory Disorders’, where the topics acne vulgaris and acne rosacea are covered.

Hyperhidrosis 

Hyperhidrosis is excessive sweating. Sweat is produced by the eccrine glands of the skin. There are two types of sweat glands – apocrine (open into hair follicles) and eccrine (widely distributed, more serous fluid expulsion). A dysfunction in the eccrine glands often leads to hyperhidrosis Causes include climate changes, anxiety, spicy food, stroke, malignancy, diabetes, menopause, hyperthyroidism, alcohol, caffeine and many more.

Treatment options:

First line: topical aluminium chloride

Iontophoresis

Botulinum toxin – axilla

Endoscopic transthoracic sympathectomy

Anhidrosis 

Anhidrosis or lack of sweating can be associated with systemic diseases such as Sjogren’s syndrome, Fabry’s disease, burns, psoriasis and disorders of the central nervous system.

Hidradenitis Suppurativa (HS)

A skin condition that primarily affects the apocrine glands of the groin and axillae. It is characterised by persistent or recurrent boil-like nodules and abscesses that culminate in a purulent discharge, sinuses, and scarring. Risk factors include obesity, cigarette smoking, family history (30%), African ethnicity, Crohn’s disease, and medications such as lithium and sirolimus. The lesions often present as comedones and painful papules that eventually progress into draining sinuses and scarring. Complications include pyogenic granulomas, secondary infections, lymphoedema and squamous cell carcinomas. Management involves lifestyle measures. Medical options include topical benzoyl peroxide, topical clindamycin, anti-androgen therapies, systemic steroids, ciclosporins and surgical drainage. The treatment of HS can often be challenging for clinicians and a multidisciplinary team approach is often needed.