Clinical Significance
Given the role of sweat glands in thermoregulation, both eccrine and apocrine glands have correlations with various diseases ranging from mild and discomforting to life-threatening. Disorders of sweating can have emotional, social, and professional implications.[9][10][11]
Hyperhidrosis is the excessive excretion of sweat above the quantity needed for thermoregulation. It can be idiopathic or due to other endocrine, neurologic, cardiovascular, neoplastic, infectious disorders, or secondary to intake of medication. Treatment options include topical medications, oral medications, surgical procedures, or botulinum toxin injections. Bromhidrosis is a similar disorder that presents with excessive malodorous perspiration. It can involve either apocrine or eccrine sweat glands; apocrine bromhidrosis tends to develop after puberty, while eccrine bromhidrosis may develop at any age. It is caused by excessive perspiration that secondarily becomes malodorous by the bacterial breakdown. Because poor hygiene most often aggravates bromhidrosis, an effective treatment strategy includes improving personal hygiene. Surgical approaches, antibacterial agents, and antiperspirants are treatment options as well.[12][13][14]
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The sweat glands of patients with cystic fibrosis are ineffective at reabsorbing salt, which has significant implications. Cystic fibrosis is an autosomal recessive congenital disease in which the defective cystic fibrosis transmembrane regulator (CFTR) normally inhabits the apical membrane of epithelial cells. CFTR is a transmembrane protein that functions as part of a cAMP-regulated chloride ion channel; in normal sweat glands, the ductal epithelium reabsorbs sodium and chloride ions in response to aldosterone so that sweat is hypotonic. In CF patients, the sweat glands fail to reabsorb chloride, affecting sodium reabsorption, resulting in salty sweat and sweat glands’ inability to regulate ions. Disruption of the same membrane proteins in the respiratory and gastrointestinal epithelium results in accumulations of thick mucus.[15]
Another autosomal recessive congenital disorder that affects sweat glands is lamellar ichthyosis. Infants with this condition present with persistent scaling skin and impaired hair growth are possible. Impairment of sweat gland development often causes infants to suffer in severely hot weather as they cannot maintain thermoregulation through sweating. General defectiveness of the skin barrier function can also lead to dehydration and increased susceptibility to infections.[16]
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Hidradenitis suppurativa is a chronic, inflammatory disease affecting the hair follicles. It is a multifactorial disease where environmental factors and genetics play a significant role. This ailment has classically been associated with the apocrine sweat glands as it manifests after puberty in the apocrine-gland concentrated areas of the body. However, the pathophysiology involves follicular occlusion rather than an apocrine disorder, as previously thought. Patients often present with tender, suppurative subcutaneous nodules and abscesses in the axillae and groin. The lesions can form sinus tracts and extensive scarring.[17]
Hypohydrotic ectodermal dysplasia is a disease characterized by hypotrichosis (decreased growth of scalp and body hair), hypodontia (congenital absence of teeth), and hypohidrosis. This disease is inherited through an X-linked recessive inheritance mode normally seen in males. The term “hypohidrotic” indicates impairment in the ability to perspire. Patients born with hypohidrotic ectodermal dysplasia have difficulty regulating body temperature and, therefore, must learn to modify their environment to control exposure to heat.[18]
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