The diaphoresis refers to the abundant production of sweat at the body level. Although there are normal sweating conditions, it implies an exaggerated response to a specific clinical condition. It is a different situation than the normal sweating or perspiration of an individual.
There are discrepancies in the terms used with respect to sweating. Diaphoresis is sometimes considered a physiological response to stimuli such as heat and exercise, however, it is a mechanism triggered by an organic alteration or abnormal clinical condition.
The human body has millions of sweat glands distributed throughout the entire skin. Its objective is to produce perspiration that eliminates toxins through sweat and regulates body temperature. It is a mechanism where both these glands and the autonomic nervous system intervene.
Sweating has its regulatory center in the central nervous system. The existence of non-physiological stimuli -such as disease- produce loss of normal regulation. Diaphoresis, then, becomes a secondary symptom of diseases or pathologies capable of triggering it..
The treatment of the causes of diaphoresis will eliminate the presence of this condition, unpleasant for those who present it..
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Diaphoresis is a symptom that rarely occurs in isolation. It usually accompanies other diseases and is characterized by uncontrolled sweat production. The symptoms that occur are a consequence of both excessive sweating and the causative diseases.
Under normal conditions, the skin is smooth, slightly moist, elastic and with a uniform coloration. The moisture maintained in the skin leads to changes in its own characteristics that can produce:
- Softening.
- Loss of stamina.
- Dry.
- Whitish, dark, or reddish spots.
A characteristic symptom associated with excess moisture from sweat is bad body odor. The skin contains eccrine and apocrine sweat glands. The secretion characteristics of these glands make it susceptible to bacterial decomposition, the result of which is a pungent and unpleasant odor..
The sweat produced by the apocrine glands is the densest due to its protein and fat content, which is why it tends to break down more easily. For this reason the symptom is marked especially in areas such as the armpits, genitals and feet, where these abound..
Some diseases that produce diaphoresis, such as liver or kidney failure and diabetes, impart a characteristic odor to sweat.
Some conditions related to visceral pain - intestinal, biliary or kidney colic - stimulate excessive sweat production. This is due to stimulation of the autonomic nervous system.
An increase in body temperature above 38 - 38.5 ° C can trigger a stimulus whose response is sweating. This response is a consequence of the need to lower the temperature to basal levels..
In shock, profuse sweating may be seen as a related clinical sign. Shock, whatever the cause, produces symptoms of hemodynamic instability:
- Tachycardia.
- Hypotension.
- General paleness.
- Dizziness or confusion.
- Body coldness.
- Feeling of impending doom.
The normal function of perspiration and the different ways in which it can be affected must be taken into account to understand the causes of sweating..
Sweat is secreted by the sweat glands and is a liquid substance made up of water, mineral salts, ammonia, urea, and glucose. Through this secretion, sweating fulfills its objective.
The mechanisms that produce and regulate sweating are still under study. Today it is known that it depends entirely on the autonomic nervous system, so it is an involuntary process.
The function of perspiration is to regulate body temperature and remove waste substances from the body. Changes in temperature and electrolyte concentration in the body can determine the production of sweat, under normal conditions.
Structures that allow this physiological mechanism are involved in sweat secretion:
- Specific receptors, connected to afferent nerve fibers. These conduct the signal produced by the stimuli to the integration centers.
- Eccrine and apocrine sweat glands.
- Effector innervation by the sympathetic nervous system. Additionally, the information that activates sweat secretion is mediated by the release of acetylcholine..
- An integrating center - in the central nervous system - that receives the signals transmitted by the afferent nerve fibers. This system involves the preoptic region of the hypothalamus, the brainstem, and the spinal cord..
Normal sweating or perspiration occurs as a result of:
- Environmental temperature.
- Physical exercise
- Food intake, due to food-induced thermogenesis.
- Hormonal changes, such as those that occur in pregnancy and climacteric.
Situations that cause abnormal profuse sweating are:
It is a term that is often confused with diaphoresis. Although hyperhidrosis is a type of excessive perspiration, it is caused by an alteration of the autonomic nervous system. Increased secretory stimulus on the sweat glands produces increased secretion of sweat.
Hyperhidrosis can be localized or generalized. Likewise, it may present in a paroxysmal or permanent form..
- Stress.
- Afraid.
- Anxiety.
- Anguish.
- Pituitary dysfunction.
- Hyperthyroidism.
- Increased adrenergic activity.
- Hypoglycemia in people with diabetes.
- Malaria or malaria.
- Tuberculosis
- Central nervous system infections.
- Systemic infections in general.
- Infectious endocarditis
- Shock of any cause.
- Head injuries.
- Hypovolemia.
- Severe dehydration.
- Acute coronary syndromes, such as angina and heart attack.
- Antibiotics and antivirals.
- Weight loss medications
- Epinephrine
- Caffeine.
- Antidepressants
- Analgesics
- Insulin overdose and oral hypoglycemic agents.
- Hormonal preparations (thyroxine)
- Drugs of abuse, such as amphetamines or cocaine.
- Chemotherapeutic agents.
- Antidepressants.
- Endocrine tumors.
- Lymphomas.
- Leukemias.
- Pheochromocytoma.
- Meningitis.
- Parkinson's disease.
- Peripheral neuropathies.
- Spinal tumors or injuries.
Depending on the extent of the sweating area, two types can be identified:
It occurs in cases of hyperhidrosis, where sweating predominantly occurs in the armpits, hands and feet. It is considered a primary or idiopathic diaphoresis.
Hyperhidrosis is related to a dysfunction of the sympathetic nervous system, however the specific cause is not yet clear. Hyperhidrosis is permanent and can be present from childhood and last a lifetime.
Also called secondary diaphoresis. Corresponds to sweating over the entire body surface as a result of direct causes, such as diseases or medications.
Generalized perspiration is usually temporary, since it disappears when the cause that produces it is treated.
Diaphoresis does not have a specific treatment. To stop excessive sweating, the cause must be identified and the corresponding treatment applied.
- Neutral soaps to keep skin clean and healthy.
- Astringent and moisturizing lotions.
- Antiperspirants and deodorants.
Some products with anticholinergic properties - such as benzotropine - are effective in reducing sweating, however, their side effects are annoying.
Local botulinum toxin inoculation is an effective therapy. Its administration is limited to the armpits, it is not permanent, it is painful and can cause hypersensitivity reactions..
- Iontophoresis
- Laser therapy.
Sympathectomy is a treatment that involves removing the nerve fibers responsible for stimulating the sweat glands. It is performed through a thoracoscopy and is a safe intervention.
Some adverse effects, such as compensatory sweating and the involvement of other nerve fibers should be taken into account before performing it..
Identifying the clinical condition causing excess sweating is important in establishing the appropriate treatment. Some examples of medical treatment specific to the causes include:
- Antibiotic therapy for infections.
- Hydration.
- Anxiolytics and antidepressants.
- Treatment for medical emergencies.
- Discontinue the use of medications that cause the clinical picture.
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