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The picture and comment by Bronkhorst and Bouwman (Minerva page: BMJ
2008:337:a1323) was a nice example of an unusual form of hyperhidrosis,
but does deserve to be given its proper name. It is a typical example of
idiopathic unilateral circumscribed hyperhidrosis.
The authors discuss palmar and plantar hyperhidrosis, and secondary
forms of hyperhidrosis (usually generalised), but none of these have
anything to do with the condition illustrated. The long duration, lack of
progression and lack of neurological features, allow a confident diagnosis
in this case. Localised hyperhidrosis can also occur in the vicinity of
some vascular lesions and (usually affecting broader and more symmetrical
areas) from various internal causes. At head and neck sites, gustatory
hyperhidrosis needs to be considered, and rare causes of generalised
anhidrosis (such as Ross syndrome - with tonic pupils and loss of tendon
reflexes) may present due to a localised patch of compensatory
hyperhidrosis.
It is of interest that the patient's bandaged arm was noticed during
her work as a secretary in a surgical clinic - symptoms in idiopathic
unilateral circumscribed hyperhidrosis may be constant but more typically
are felt to be provoked by mental activity.
Treated but not diagnosed - idiopathic unilateral circumscribed hyperhidrosis
The picture and comment by Bronkhorst and Bouwman (Minerva page: BMJ
2008:337:a1323) was a nice example of an unusual form of hyperhidrosis,
but does deserve to be given its proper name. It is a typical example of
idiopathic unilateral circumscribed hyperhidrosis.
The authors discuss palmar and plantar hyperhidrosis, and secondary
forms of hyperhidrosis (usually generalised), but none of these have
anything to do with the condition illustrated. The long duration, lack of
progression and lack of neurological features, allow a confident diagnosis
in this case. Localised hyperhidrosis can also occur in the vicinity of
some vascular lesions and (usually affecting broader and more symmetrical
areas) from various internal causes. At head and neck sites, gustatory
hyperhidrosis needs to be considered, and rare causes of generalised
anhidrosis (such as Ross syndrome - with tonic pupils and loss of tendon
reflexes) may present due to a localised patch of compensatory
hyperhidrosis.
It is of interest that the patient's bandaged arm was noticed during
her work as a secretary in a surgical clinic - symptoms in idiopathic
unilateral circumscribed hyperhidrosis may be constant but more typically
are felt to be provoked by mental activity.
Competing interests:
None declared
Competing interests: No competing interests