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Causes of Secondary Hyperhidrosis: Focal hyperhidrosis
A variety of diseases can cause localized hyperhidrosis.
Neurologic injury and dermatologic syndromes make up the majority
of secondary causes of excessive focal sweat production.
Acute spinal cord injury would be expected to lead to loss
of sweating below the site of injury, but such injuries can
also lead to localized areas of hyperhidrosis seen months
to years after the injury.[119]
Patients with spinal cord injury at or above T6 can have autonomic
dysreflexia, presenting with exaggerated responses to triggers
such as bowel and bladder distention, or skin irritation.
In addition to excessive sweating on the face and upper part
of the trunk, patients also have flushing of the face, nasal
congestion, and headache.[119]
Orthostatic hypotension occurring in patients with cervical
spine injury can trigger a similar exaggerated sympathetic
discharge, leading to hyperhidrosis in the face, neck, and upper
trunk.[119]
Posttraumatic syringomyelia, a fluid-filled cavity in the
spinal cord occurring months to years after the acute injury,
can also cause focal hyperhidrosis.[119]
Central nervous system injuries such as strokes leading
to hemispheric or medullary infarcts can lead to hyperhidrosis
on the ipsilateral and contralateral side, respectively.[57]
Injury to the cranial part of the sympathetic chain by accessory
cervical ribs can lead to hyperhidrosis on the face, neck,
and shoulder.[57]
An intrathoracic tumor impinging on the sympathetic trunk
or postganglionic nerves can cause hyperhidrosis by a similar
mechanism.[119]
In reflex sympathetic dystrophy, hyperhidrosis is often seen
in the affected area.[57]
When injury occurs to a large portion of the sympathetic
chain, either in the spine or in the central nervous system, widespread
anhidrosis is common. If this area of anhidrosis is sufficiently
large, compensatory hyperhidrosis can occur in innervated
areas. Compensatory hyperhidrosis is also seen in diabetic
neuropathy, after thoracic sympathectomy, and in Ross syndrome,
a rare syndrome in which anhidrosis occurs in a dermatomal
pattern due to focal dysfunction of the sympathetic fibers
innervating sweat glands.[57]
Conditions sometimes associated with palmoplantar hyperhidrosis
include Raynaud’s disease, erthromelalgia, atrioventricular
fistula, cold injury, rheumatoid arthritis, and some rare dermatologic
syndromes (see below).[119]
In one type of focal hyperhidrosis, gustatory sweating,
increased perspiration occurs on the cheek or mandibular area
of the face simultaneously with salivation. This auriculotemporal
syndrome, also known as Frey syndrome, has several causes.
After inflammation or surgery near the parotid gland, “cross-talk”
between regenerating nerves that cause salivation and sympathetic
nerves causes excessive facial sweating. High thoracic sympathectomy
and diabetic neuropathy involving nerves to the same area
can also lead to this syndrome.[119]
Foods known to stimulate gustatory sweating include coffee,
chocolate, spicy or sour foods, hot foods, alcohol, citric
acid, and/or sweets.[19,83,145]
There is also an idiopathic variety of gustatory sweating
that occurs only with certain foods.[19]
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