Hydration Disorders

Question 1

What are the roles of the sweat glands

Answer 1

They play a key role in thermoregulation.

3 types of sweat glands

Innervated by sympathetic (cholinergic) nerve fibres (fight or flight) - acetylcholine

induced by cholinergic drug & blocked by anticholinergic drugs
eg/ Botox , botulinum toxin injections - reduces uncontrollable sweating

Question 2

Function of sweat

Answer 2

cools the skin as it evaporates

excretes waste products

provides a protective anti-microbial substance

provides epidermis with water to hydrate the skin

Question 3

Hyperhidrosis

Answer 3

excessive production of the sweat from the eccirne sweat glands

Question 4

Aeitiology of hyperhidrosis

Answer 4

*Adolescence
*Stress
*Menopause
*Diabetes
*Endocrine Disorder
-hyperthyroidism
-diabetes
*CNS disorder
-effect on sympathetic (cholinergic nerve fibres
-Alcoholism

Question 5

Pathology of hyperthyroidism

Answer 5

Secondary to a central cortical phenomenon rather than eccrine pathology

• excess production of sweat and lack of evaporation results in maceration of the skin

*effects epidermal barrier function

*Skin unable to withstand stresses

Question 6

Clinical observations of hyperhydrosis

Answer 6

Increase in stresses and forces across the foot which leads to:
*blistering
*Peeling of the skin
*Bubbly soft callus
*Fissuees , fungal/bacterial infections
*Burning pain/discomfort

Question 7

Treatment of hyperhidrosis

Answer 7

*debridement of callus and fissures if necessary
*skin care advice
- Footwear (leather,charcoal lined insoles)
-Socks (cotton, change regularly)
-Infection prevention (bathing)

*Topical therapy
*referral to dermatologist

Question 8

Topical therapy for hyperhidrosis

Answer 8

Astringents
-Surgical spirits
-Silver nitrate >20% solution
-Salicylic acid 3%

Aluminium chloride solution

Iontophoresis

Question 9

Pitted Keratolysis

Answer 9

Superficial bacteral infection that affects soles of the feet

Question 10

Characteristics of pitted keratolysis

Answer 10

*whitish skin and clusters of punched-out pits
*Coalesce- crater-like lesions
*hyperhidrosis
*punctate erosions
*Tender on weight bearing

Question 11

Aeitiology of Pitted Keratolysis

Answer 11

*Ass with hyperhidrosis
*Corynebacteria, Dermatophilus congolensis, Kytococcus sedentarius, actinomyces and streptomyces

Pitting is due to destruction of the stratum corneum by protease enzymes produced by the bacteria

Malodour due to sulfur compounds produced

Question 12

Treatment/management of Pitted Keratolysis

Answer 12

Removal of causative organism & hyperhidrosis treatment

HH self-care advice

Topical antibiotics: erythromycin, clindamycin, fusidic acid, benzoyl peroxide

Question 13

Bromhidrosis

Answer 13

A chronic condition that presents clincally with an abnormal and excessively unpleasant body odour

Question 14

Aetiology & pathology of Bromhidrosis

Answer 14

breakdown of sweat by bacteria causes malodour

Ass with HH

Poor hygiene,

Occlusive conditions

Inestion of cerain foods

Underlying disorders eg Diabetes, Oesity, Erythrasma can promote bacteria growth

Question 15

Treatment Management of Bromhidrosis

Answer 15

Self care advice
Anticholinergic or beta-blcoking drugs
Iontophoresis
Botox injection (Botulinum toxin)
Chemical or surgical sympathectomy

Question 16

Chromhidrosis

Answer 16

coloured sweat

Question 17

Apocrine Chromhidrosis

Answer 17

face, axillae and breast areola

Lipfuscin pigment

Sweat coloured yello, green, blue or black

Cause unknown

Question 18

Eccrine Chromhidrosis

Answer 18

Rare

Mainly occurs due to etrinsic dyes and certain drugs

Question 19

Anhidrosis is?

Answer 19

Deficiency or absence of sweat secretion

Question 20

Pathology of Anhidrosis

Answer 20

*Skin not effectively hydrated / moistened
- Diminishes skins elasticity and less able to tolerate stress
- Compression, tensile, torsion, shear

*Integrity of skin is weakened

• Dry Fissues may allow secondary infection to occur

Question 21

Aetiology of anhidrosis is?

Answer 21

*Neurological defect of sympathetic system
- Diabetes
- Alcohol neuropathy
-peripheral neuropathy
-Tumour
-MS

*Hypothyroidism

*Diminished peripheral circulation
- Aging
- Ischaemia

*Heat exhaustion

Question 22

Observations of `anhidrosis

Answer 22

Scaly
Dry fissures
Inelastic
Skin may feel rough
Extravasation may be evident

Question 23

Treatment /Management of Anhidrosis

Answer 23

Rehydration through the use of emollient

Debride callus

Fissues management

Patient Advice