Perspiration, also known as sweat, diaphoresis and hidrosis, is the fluid secreted by sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and apocrine glands. The eccrine sweat glands are distributed over much of the body and are responsible for secreting the watery, brackish sweat most often triggered by excessive body temperature. Apocrine sweat glands are restricted to the armpits and a few other areas of the body and produce an odorless, oily, opaque secretion which then gains its characteristic odor from bacterial decomposition. In humans, sweating is primarily a means of thermoregulation, which is achieved by the water-rich secretion of the eccrine glands. Maximum sweat rates of an adult can be up to 2–4 litres (0.5–1 US gal) per hour or 10–14 litres (2.5–3.5 US gal) per day, but is less in children prior to puberty. Evaporation of sweat from the skin surface has a cooling effect due to evaporative cooling. Hence, in hot weather, or when the individual's muscles heat up due to exertion, more sweat is produced. Animals with few sweat glands, such as dogs, accomplish similar temperature regulation results by panting, which evaporates water from the moist lining of the oral cavity and pharynx. Although sweating is found in a wide variety of mammals, relatively few (apart from humans, horses, some primates and some bovidae) produce sweat in order to cool down. In horses, such cooling sweat is created by apocrine glands and contains a wetting agent, the protein latherin which transfers from the skin to the surface of their coats.
Definitions The words diaphoresis and hidrosis can both mean either perspiration (in which sense they are synonymous with sweating) or excessive perspiration (in which sense they can be either synonymous with hyperhidrosis or differentiable from it only by clinical criteria involved in narrow specialist senses of the words). Hypohidrosis is decreased sweating from whatever cause. Hyperhidrosis is excessive sweating, usually secondary to an underlying condition (in which case it is called secondary hyperhidrosis) and usually involving the body as a whole (in which case it is called generalized hyperhidrosis). Focal hyperhidrosis is increased or excessive sweating in certain regions such as the underarm, palms, soles, face, or groin. Hidromeiosis is a reduction in sweating that is due to blockages of sweat glands in humid conditions. A substance or medicine that causes perspiration is a sudorific or sudatory.
Signs and symptoms Sweat contributes to body odor when it is metabolized by bacteria on the skin. Medications that are used for other treatments and diet also affect odor. Some medical conditions, such as kidney failure and diabetic ketoacidosis, can also affect sweat odor.
Causes
Diaphoresis is a non-specific symptom or sign, which means that it has many possible causes. Some causes of diaphoresis include physical exertion, menopause, fever, ingestion of toxins or irritants, and high environmental temperature. Strong emotions (anger, fear, anxiety) and recall of past trauma can also trigger sweating. This is sometimes referred to as flop sweat. The vast majority of sweat glands in the body are innervated by sympathetic cholinergic neurons. Sympathetic postganglionic neurons typically secrete norepinephrine and are named sympathetic adrenergic neurons; however, the sympathetic postganglionic neurons that innervate sweat glands secrete acetylcholine and hence are termed sympathetic cholinergic neurons. Sweat glands, piloerector muscles, and some blood vessels are innervated by sympathetic cholinergic neurons.
Pathological sweating and symptoms Diaphoresis may be associated with some abnormal conditions, such as hyperthyroidism and shock. If it is accompanied by unexplained weight loss, fever/chills, or by palpitations, shortness of breath, unconsciousness, fatigue, dizziness, muscle pain, nausea, vomiting, diarrhea, and chest discomfort, it suggests serious illness. Diaphoresis is also seen in an acute myocardial infarction (heart attack), from the increased firing of the sympathetic nervous system, and is frequent in serotonin syndrome, which can result in serious sickness or even death. Diaphoresis can also be caused by many types of infections, often accompanied by high fever and/or chills which can trigger the result of hyperthermia. Most infections can cause some degree of diaphoresis and it is a very common symptom in some serious infections such as malaria and tuberculosis. In addition, pneumothorax can cause diaphoresis with splinting of the chest wall. Neuroleptic malignant syndrome and other malignant diseases (e.g. leukemias) can also cause diaphoresis. Diabetics relying on insulin shots or oral medications may have low blood sugar (hypoglycemia), which can also cause diaphoresis. Drugs (including caffeine, morphine, alcohol, antidepressants and certain antipsychotics) may be causes, as well as withdrawal from alcohol, benzodiazepines, nonbenzodiazepines or narcotic painkiller dependencies. Sympathetic nervous system stimulants such as cocaine and amphetamines have also been associated with diaphoresis. Diaphoresis due to ectopic catecholamine is a classic symptom of a pheochromocytoma, a rare tumor of the adrenal gland. Acetylcholinesterase inhibitors (e.g. some insecticides) also cause contraction of sweat gland smooth muscle leading to diaphoresis. Mercury is well known for its use as a diaphoretic, and was widely used in the 19th and early 20th century by physicians to "purge" the body of an illness. However, due to the high toxicity of mercury, secondary symptoms would manifest, which were erroneously attributed to the former disease that was being treated with mercurials. Infantile acrodynia (childhood mercury poisoning) is characterized by excessive perspiration. A clinician should immediately consider acrodynia in an afebrile child who is sweating profusely. Some people can develop a sweat allergy. The allergy is not due to the sweat itself but instead to an allergy-producing protein secreted by bacteria found on the skin. Tannic-acid has been found to suppress the allergic response along with showering.
Hyperhidrosis
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