Anhidrosis
Anhidrosis is an abnormal deficiency of sweating and can be classified as generalized (complete) or localized (partial). Generalized anhidrosis can lead to life-threatening impairment of thermoregulation and a lack of sweating, eventually leading to retention of excess body heat. Localized anhidrosis rarely interferes with thermoregulation because it affects only a small percentage of the body’s sweat glands.
The absence, obstruction, atrophy, or degeneration of sweat glands can produce anhidrosis at the skin surface, even if neurologic stimulation is normal. (See Eccrine dysfunction in anhidrosis, pages 22 and 23.)
Other causes of anhidrosis include neurologic disorders that disturb the central or peripheral nervous pathways that normally activate sweating, skin disorders, and congenital, atrophic, or traumatic changes to sweat glands. Use of certain drugs can also lead to anhidrosis.
Anhidrosis may go unrecognized until significant heat or exertion fails to raise sweat. However, localized anhidrosis commonly provokes compensatory hyperhidrosis in the remaining functional sweat glands — which, in many cases, is the patient’s chief complaint.
Act Now: If the patient’s skin feels hot and flushed with an obvious lack of perspiration, ask whether he’s experiencing nausea, dizziness, palpitations, and substernal tightness. If these symptoms are present, quickly take the patient’s rectal temperature and other vital signs, and assess his level of consciousness (LOC). If a rectal temperature higher than 102.2° F (39° C) is accompanied by tachycardia, tachypnea, altered blood pressure, and decreased LOC, suspect life-threatening heatstroke (anhidrotic asthenia). Start rapid cooling measures, such as swabbing or spraying with very cold water and giving I.V. fluid replacements. Continue these measures and frequently check the patient’s vital signs and neurologic status until his temperature drops below 102° F (38.9° C). Then move him to a room with good ventilation, fans, or air conditioning.
Assessment
History
Ask the patient to characterize his sweating, especially during heat spells or strenuous activity. Is the sweating slight or profuse? Ask about recent prolonged or extreme exposure to heat and about the onset of anhidrosis or hyperhidrosis. Obtain a complete medical history, focusing on neurologic disorders, skin disorders such as psoriasis, autoimmune disorders such as scleroderma, and systemic diseases such as diabetes mellitus, which can cause peripheral neuropathies. Ask about drug use.
Physical examination
Inspect skin color, texture, and turgor. If you detect skin lesions, document their location, size, color, texture, and pattern. Note the presence of localized sweating and document the area, amount of perspiration, and skin differences in that area.
Pediatric pointers
In infants and children, miliaria rubra and such congenital skin disorders as ichthyosis and anhidrotic ectodermal dysplasia are the most common causes of anhidrosis.
Because delayed development of the thermoregulatory center renders an infant — especially a premature infant — anhidrotic for several weeks after birth, caution parents against overdressing.
Geriatric pointers
Pre-existing disease states and advanced age may place elderly patients at greater risk for anhidrosis. Onset may occur more swiftly in elderly patients.
Medical causes
Burns
Depending on their severity, burns may cause permanent anhidrosis in affected areas as well as blistering, edema, and increased pain or loss of sensation.
Cerebral lesions
Cerebral cortex and brain stem lesions may cause anhidrotic palms and soles, along with various motor and sensory disturbances specific to the site of the lesions.
Heatstroke (anhidrotic asthenia)
In the early stages of heatstroke, a life-threatening disorder, the patient may still exhibit signs of sweating and his LOC may be normal, but the rectal temperature may already exceed 102.2° F (39° C). He may experience severe headache and muscle cramps, which later disappear. Associated signs and symptoms include fatigue, nausea and vomiting, dizziness, palpitations, substernal tightness, and elevated blood pressure followed by hypotension. Within minutes, hot, flushed skin will be noted with anhidrosis. Accompanying symptoms include tachycardia, tachypnea, and confusion with a progression to seizures or loss of consciousness.
Horner’s syndrome
A supraclavicular spinal cord lesion affecting a cervical nerve produces unilateral facial anhidrosis with compensatory contralateral hyperhidrosis. Other findings include ipsilateral pupillary constriction and ptosis.
Miliaria crystallina
This usually innocuous form of miliaria causes anhidrosis and tiny, clear, fragile blisters, usually under the arms and breasts.
Miliaria profunda
If severe and extensive, this form of miliaria can progress to life-threatening anhidrotic asthenia. Typically, it produces localized anhidrosis with compensatory facial hyperhidrosis. Whitish papules appear mostly on the trunk but also on the extremities. Associated signs and symptoms include inguinal and axillary lymphadenopathy, weakness, shortness of breath, palpitations, and fever.
Miliaria rubra (prickly heat)
This common form of miliaria typically produces localized anhidrosis. Small, erythematous papules with centrally placed blisters appear on the trunk and neck and, rarely, on the face, palms, or soles. Pustules may also appear in extensive and chronic miliaria. Related symptoms include paroxysmal itching and paresthesia. In rare instances, severe and extensive miliaria rubra can progress to life-threatening anhidrotic asthenia.
Peripheral neuropathy
Anhidrosis over the legs usually appears with compensatory hyperhidrosis over the head and neck. Associated findings mainly involve extremities and include glossy red skin, diminished or absent deep tendon reflexes, flaccid paralysis and muscle wasting, footdrop, burning pain, and paresthesia, hyperesthesia, or anesthesia in the hands and feet.
Shy-Drager syndrome
Shy-Drager syndrome, a degenerative neurologic syndrome, causes ascending anhidrosis in the legs. Other signs and symptoms include severe orthostatic hypotension, loss of leg hair, impotence, constipation, urine retention or urgency, decreased salivation and tearing, mydriasis, and impaired visual accommodation. Eventually, focal neurologic signs — such as leg tremors, incoordination, and muscle wasting and fasciculation — may appear.
Spinal cord lesions
Anhidrosis may occur symmetrically below the level of the lesion, with compensatory hyperhidrosis in adjacent areas. Other findings vary according to the site and extent of the lesion, but may include partial or total loss of motor and sensory function below the lesion as well as impaired cardiovascular and respiratory function.
Other causes
Drugs
Anticholinergics, such as atropine and scopolamine, can cause generalized anhidrosis.
Nursing considerations
Perform careful monitoring of the patient’s vital signs, with particular attention to temperature. Frequently assess the skin and sweating pattern. Assess the patient’s LOC.
Because even a careful evaluation can be inconclusive, you may need to administer specific tests to evaluate anhidrosis. These include wrapping the patient in an electric blanket or placing him in a heated box to observe the skin for sweat patterns, applying a topical agent to detect sweat on the skin, and administering a systemic cholinergic drug to stimulate sweating.
Patient teaching
Review the signs and symptoms of overheating and heatstroke. Inform the patient about measures to prevent dehydration and heatstroke, such as spending time in a cool environment, moving slowly during warm weather, and avoiding strenuous exercise and hot, spicy foods. Tell him to drink about a quart of noncaffeinated, nonalcoholic fluids an hour when in extremely hot environments.
Educate the patient about the anhidrotic effects of certain medications.
Pictures
Book Source Details
- Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Night sweats
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- Skin, clammy
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Anhidrosis
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- Skin, clammy
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- Anhidrosis
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- Diaphoresis
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- Sweating
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
More About Causes of Night sweats
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Skin, clammy (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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