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Causes of Secondary Hyperhidrosis: Rare forms of hyperhidrosis
Rare syndromes with dermatologic symptoms can be associated
with focal hyperhidrosis. In POEMS syndrome, seen primarily
in the Japanese population, patients have polyneuropathy,
organomegaly, endocrinopathy, monoclonal gammopathy, and skin
changes accompanied by hyperhidrosis.[77]
Several subtypes of a rare ectodermal dysplasia, pachyonychia
congenita, are associated with palmoplantar hyperhidrosis,
as is pachydermoperiostosis, in which patients appear to have
acromegaly with finger clubbing, periosteal new bone formation,
and coarsened facial features.[77]
Hyperhidrosis can also be seen with nail-patella syndrome,
a disorder involving hypoplastic nails, bony abnormalities
including hypoplastic patellae, and renal disease.[77]
Hyperhidrosis can be seen in skin overlying a blue rubber
bleb nevus and in skin adjacent to glomus tumors. Localized
sweating around these types of lesions as well as painful
skin ulcers may be the basis of axon-reflex sweating.[119]
This type of sweating is due to a direct axon reflex that
occurs around the border of painful lesions.[57]
In an idiopathic form of excessive sweating, localized unilateral
hyperhidrosis (LUH), excessive sweating occurs in a small
area of the forehead or forearm. This rare type of hyperhidrosis
differs from primary hyperhidrosis in that there are no triggers.
Sweating occurs spontaneously and during sleep.[78]
One theory is that LUH is caused by “a misdirected reconnection
of the sympathetic nerve fiber network after injury, similar
to Frey syndrome.”[78]
A functional nevus has also been found to be associated
with focal hyperhidrosis. A nevus sudoriferus, located on
the face or forearms, excretes excessive sweat in response
to thermal or emotional triggers. These nevi can be linear
or circular and of varying size.[57]
Histologic exam reveals hyperplastic eccrine glands but only
rarely increased numbers of glands. There are several case
reports of localized unilateral hyperhidrosis caused by this
type of nevus.[78,107]
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