Two patients with localised hyperhidrosis of the hand based on functional and structural abnormalities of sweat glands

Abstract

A 14-year-old girl and a 30-year-old woman presented with localised hyperhidrosis on the dorsal hand and wrist, respectively, provoked by different stimuli such as physical activity and minor trauma to the skin. The skin was seemingly normal in both patients where an iodine-starch test revealed a well-demarcated area of hyperhidrosis. Following histopathological examination, the diagnosis was unilateral localised hyperhidrosis in both cases; one with normal histology and one with a nevus sudoriferous. Both patients were successfully treated with botulinum toxin type A. The 30-year-old woman additionally used low-dose propantheline bromide periodically and experienced long-term remission on this therapy. Hyperhidrosis may embarrass and interfere with patients' school and careers, and it is therefore important to tailor an effective individual treatment.

Keywords: dermatology; pathology; skin.

Figure 1

Nevus sudoriferous (of patient 1). Sweat can be seen on the dorsum of the patient’s left hand (A), and the hyperhidrotic area is further visualised by iodine–starch test (B).

Figure 2

(A) Skin biopsy (of patient 1) with an increased amount of eccrine sweat glands with normal appearance, equivalent to a nevus sudoriferous. (B) Skin biopsy (of patient 2) with an estimated normal amount of eccrine sweat glands. (H&E stain, original magnification ×25).

Figure 3

Unilateral localised hyperhidrosis (of patient 2) visualised by performing an iodine–starch test.