A 74-year-old male with a 35-year history of T3-4 traumatic paraplegia, complaining of 1 year of excessive intermittent left-sided sweating. The patient is an ophthalmologist himself and had been dealing with his medical problems by himself so far. However, this was a very rare condition and was totally out of control. The sweating only occurred while in the seated position.
When examined upright, the patient had excessive sweating on the left side of the body below the T3-4 level. The sweating ceased when he was laid down. The skin examination showed intact ischial region. Pressure applied to the ischium caused sweating to recur whereas releasing pressure subsided it. This happened every time the pressure was applied. The patient had been using a gel cushion which was replaced with an air-filled cushion which gave permanent relief from hyperhydrosis.
Hyperhidrosis is caused by overactivation of sweat glands. The reasons may be unknown and are generally very difficult to control. Unilateral hyperhidrosis isn’t very commonly heard of and so controlling it becomes a task. It is many times untreated or overlooked and can cause significant distress that leads to a negative impact on social and professional quality of life. It can become so severe that sweat drips off a person’s clothes and body and can even require multiple changes of clothing daily. Patients with untreated hyperhidrosis have an increased risk for cutaneous skin infection if the abnormal physiology is not adequately corrected.
The following case report describes unilateral hyperhidrosis secondary to a subtle contralateral noxious stimulus.
Causes of Unilateral Hyperhidrosis in Paraplegics & Its Treatment-Case Study
The patient is a 74-year-old South Asian male with long-standing T3-4 traumatic paralplegia secondary to a crush injury caused due to a motor vehicle accident which occurred 35 years ago. He is a surgeon himself and had been practicing Ophthalmology effectively, but is unable to do surgeries due to his condition. His hands work perfectly fine but has no sensation below the level of the T3-4 vertebral level. Being a doctor, he has been managing the problems that came across by himself sometimes taking opinions from his colleague physicians of the concerned specialty. For the past one year, he had developed severe hyperhidrosis on the left side of his body. Initially, it was thought to be temporary condition, but as time went by, it became more severe where his shirts used to get wet on one side. The wetting was up to the level that one can squeeze out a lot of sweat from it. He had been controlling it by putting an absorbent cloth under it.
Later, a neurosurgeon, surgical specialist, and a medical specialist, and orthopedic physicians were consulted. Most of them could not conclude anything or make a diagnosis. He was suggested to take oral medication by a neurosurgeon; however, there was no guarantee that the condition will be fully controlled. The patient was on no medications other than taking drugs to control his urinary tract infections which are common in such patients.
An article published in October 2010 showed a possibility of pressure in the region of the ischial tuberosity. This led to a decision to reduce that pressure. The patient was using gel cushion for the last 9 years and the next best option was an air-cushion which the article had also recommended. When placed on the air-filled cushion, the sweating had reduced for the initial 2-3 days. The patient continued using the air-filled cushion, and apparently without using any other oral or local medications, he was able to sit for extended periods of time without experiencing hyperhidrosis.
A contralateral source of irritation was causing the unilateral hyperhidrosis. An efficacious management of the pressure on the ischial tuberosity may greatly improve hyperhidrosis in such patients. The air cushions significantly lowers the amount of pressure on the ischial tuberosity and hence the sweating was subsided. Thus, if any paraplegic or quadriplegic is suffering from unilateral hyperhidrosis can certainly try this out.