Eccrine Sweat Duct Research Articles

Topical therapies in hyperhidrosis care.

Primary focal hyperhidrosis affects 3% of the US population; about the same number as psoriasis. More than half of these patients have primary focal axillary hyperhidrosis: sweating that is beyond what is anticipated or necessary for thermoregulation. Most topical therapies are based on aluminum salts, which work by a chemical reaction that forms plugs in the eccrine sweat ducts. Topical anticholinergics may also be used. Instruction on proper methods and timing of antiperspirants enhances effect and may be effective alone or in combination with other treatments in patients with hyperhidrosis.

Dermal Spindle Cell Adenolipoma

Dermal Spindle Cell Adenolipoma

De Novo Epidermal Regeneration Using Human Eccrine Sweat Gland Cells: Higher Competence of Secretory over Absorptive Cells

In our previous work, we showed that human sweat gland-derived epithelial cells represent an alternative source of keratinocytes to grow a near normal autologous epidermis. The role of subtypes of sweat gland cells in epidermal regeneration and maintenance remained unclear. In this study, we compare the regenerative potential of both secretory and absorptive sweat gland cell subpopulations. We demonstrate the superiority of secretory over absorptive cells in forming a new epidermis on two levels: first, the proliferative and colony-forming efficiencies in vitro are significantly higher for secretory cells (SCs), and second, SCs show a higher frequency of successful epidermis formation as well as an increase in the thickness of the formed epidermis in the in vitro and in vivo functional analyses using a 3D dermo-epidermal skin model. However, the ability of forming functional skin substitutes is not limited to SCs, which supports the hypothesis that multiple subtypes of sweat gland epithelial cells hold regenerative properties, while the existence and exact localization of a keratinocyte stem cell population in the human eccrine sweat gland remain elusive.

Circular polarization induced by the three-dimensional chiral structure of human sweat ducts.

The upper part of the human eccrine sweat ducts, embedded within the epidermis layer, have a well-defined helical structure. It was recently suggested that, as electromagnetic entities, the sweat ducts interact with sub-mm waves [Y. Feldman et al., Phys. Rev. Lett. 100, 128102 (2008)]. Although correlation between changes in the reflectance spectrum in this frequency range and physiological activities has been shown, a direct link between the electromagnetic reflection and the helical structure itself has remained to be established. The fact that the sweat ducts manifest natural homochirality is henceforth used to produce this link. We report the detection of circular polarization asymmetry in the electromagnetic reflection from the human skin at sub-THz frequencies in vivo. We compare the results to numerical simulations and to measurements of a fabricated metamaterial. We argue that the observed circular dichroism can be interpreted uniquely as the signature of the helical structure itself. By twisting reflected electromagnetic waves, the human skin exhibits properties which are usually discussed only in the framework of metamaterial science.

HLA-DPDQDR is expressed in all lesional skin from patients with autoimmune skin diseases

Introduction: Human genes responsible for human antigen presentation and transplant rejection functions are located on the short arm of Chromosome 6, and are called the Major Histocompatibility Complex (MHC). Moreover, the primary physiologic function of MHC molecules is to present peptides to T lymphocytes. MHC molecules are integral components of the ligands that most T cells recognize, since the T cell receptor (TCR) has specificity for complexes of foreign antigenic peptides, as well as self-MHC molecules. Aim: Our investigation attempts to investigate the presence of HLA-DPDQDR within lesional skin biopsies from patients affected by autoimmune skin blistering diseases (ABDs). Materials and Methods: We utilized immunohistochemistry (IHC) to evaluate the presence of HLA-DPDQDR in lesional skin biopsies of patients affected by ABDs. We tested 30 patients with endemic pemphigus foliaceus (EPF), 15 controls from the EPF endemic area, and 15 biopsies from healthy controls from the USA. We also tested archival biopsies from patients with selected ABDs, including 30 patients with bullous pemphigoid (BP), 20 with pemphigus vulgaris (PV), 8 with pemphigus foliaceus (PF), 14 with dermatitis herpetiformis (DH) and 2 with epidermolysis bullosa acquisita (EBA). Results: Most ABD biopsies stained positive for HLA-DPDQDR in the lesional blisters and/or inflamed neurovascular neuroplexus areas in the superficial dermis, and also at mesenchymal-endothelial like-cell junctions in the dermis. In BP, EBA and EPF, the HLA-DPDQDR staining was also seen in dermal eccrine sweat gland coils and ducts. Conclusion: We document that HLA-DPDQDR is expressed in several anatomic areas of lesional skin in patients with ABDs. Notably, HLADPDQDR positivity was also consistently present in areas of the classic immune response, including epidermal intercellular junctions in pemphigus, and at basement membrane sites in bullous pemphigoid and other subepidermal blistering diseases.

A Rare Case of Abdominal Porocarcinoma

Eccrine porocarcinoma (EPC) is a cutaneous malignancy that arises from the intraepidermal portion of the eccrine sweat duct (acrosyringium). The eccrine sweat gland is a major sweat gland that is found in virtually all skin. EPC accounts for 0.005% to 0.01% of all cutaneous tumors. It predominantly occurs in elderly people who are more than 60 years old and has a female predominance [1]. As far as we know, only five cases of this medical condition have occurred on the abdomen since Pinkus and Mehregan first described EPS in 1963 [1],[2]. Here, we report an unusual case of a 65-year-old female patient with EPC that developed primarily on the abdomen.

Multiple unilateral zosteriform syringomas on the abdomen.

Dear Editor: Syringomas are benign adnexal tumors of eccrine sweat duct origin. Clinically, they usually present as multiple, soft, skin-colored or yellowish papules and generally measure 1 to 2 mm in diameter. The sites of predilection are the face (especially the lower eyelids), cheeks, thigh, and axilla in a symmetrical or bilateral fashion1. A 39-year-old female patient presented with asymptomatic multiple flesh-colored papules on her trunk. The lesions had developed in crops about a month previously. Without spontaneous regression or improvement, the lesions had increased in number gradually. The patient's medical history was unremarkable, and she was not on any medication. She had no family history of similar skin lesions. Physical examination revealed multiple, flesh-colored to light-brownish, 2 to 4-mm-diameter papules across the right side of the trunk (Fig. 1). The lesions had a zosteriform distribution along the right T8 and T9 dermatomes. No other lesions were observed elsewhere on the whole body. Histopathological examination of the abdomen revealed numerous epithelial strands and small ducts in a fibrous stroma of the upper dermis (Fig. 2). Taking the clinicopathological features into consideration, the lesions were diagnosed as zosteriform syringomas and were successfully treated with carbon dioxide laser. The patient was followed for 6 months after the treatment, without any sign of recurrence and new lesion formation elsewhere on the whole body. Fig. 1 (A, B) Multiple, flesh-colored to light-brownish papules across the right side of the trunk in a zosteriform distribution (arrows). (C) Close-up view of the lesion. Fig. 2 Histopathological findings showing numerous epithelial strands and ductal differentiation in a fibrous stroma of the upper dermis (HE A: ×40, B: ×100). Syringomas usually present with a bilateral or symmetrical distribution. Although Hayashi et al.2 and Goday et al.3 reported about unilateral linear syringomas on the arm, until now cases of zosteriform syringomas have not been reported in the Korean literature. There was only one case report by Ceulen et al.4 in 2008 in Europe. In that case, the syringomas were distributed on the left side of the chest of an 18-year-old Caucasian male patient. Here, we report the first case of unilateral zosteriform syringomas on the right side of the abdomen. Typical periorbital syringomas may be easy to diagnose; however, when they show an unusual clinical manifestation, they could be misdiagnosed as sebaceous hyperplasia, milia, acne vulgaris, or lichen planus5. When encountering unilateral, zosteriform, popular dermatosis, dermatologists should consider syringomas in the differential diagnosis. The case presented here is a rare clinical form of syringomas that occurred in a zosteriform fashion. Although further investigations of the cellular and molecular levels are needed to uncover the precise pathogenesis of syringomas, we suggest that unilateral zosteriform patterns may well provide clues to the pathogenesis of syringomas with unknown etiology.

The Helical Structure of Sweat Ducts: Their Influence on the Electromagnetic Reflection Spectrum of the Skin

The helical structure of human eccrine sweat ducts, together with the dielectric properties of the human skin, suggested that their electromagnetic (EM) properties would resemble those of an array of helical antennas. In order to examine the implications of this assumption, numerical simulations in the frequency range of 100-450 GHz, were conducted. In addition, an initial set of measurements was made, and the reflection spectrum measured from the skin of human subjects was compared to the simulation results. The simulation model consisted of a three layer skin model (dermis, epidermis, and stratum corneum) with rough boundaries between the layers and helical sweat ducts embedded into the epidermis. The spectral response obtained by our simulations coincides with the analytical prediction of antenna theory and supports the hypothesis that the sweat ducts can be regarded as helical antennas. The results of the spectrum measurements from the human skin are in good agreement with the simulation results in the vicinity of the axial mode. The magnitude of this response depends on the conductivity of sweat in these frequencies, but the analysis of the phenomena and the frequencies related to the antenna-like modes are independent of this parameter. Furthermore, circular dichroism of the reflected electromagnetic field is a characteristic property of such helical antennas. In this work we show that: 1) circular dichroism is indeed a characteristic of the simulation model and 2) the helical structure of the sweat ducts has the strongest effect on the reflected signal at frequencies above 200 GHz, where the wavelength and the dimensions of the ducts are comparable. In particular, the strongest spectral response (as calculated by the simulations and measured experimentally) was noted around the predicted frequency (380 GHz) for the axial mode of the helical structure.

Eccrine Poroma on the Postauricular Area: A Rare Presentation

An eccrine poroma is a benign neoplasm that originates from the intraepidermal ductal portion of the eccrine sweat duct. Although eccrine poromas are most commonly found on the sole or side of the foot, eccrine poromas have been observed on other areas of the skin, such as the scalp, neck, and chest. We report an interesting case of an eccrine poroma, which presented as a 1×1 cm protruding dome-shaped, skin-colored-to-black nodule on the right postauricular area. The patient denied a previous history of trauma to this area. The histopathologic diagnosis was consistent with an eccrine poroma. There has been no local recurrence 5 months after complete excision.

Recurrent Milia-Like Idiopathic Calcinosis Cutis on the Upper Eyelid

Dear Editor: Milia-like idiopathic calcinosis cutis (MICC) is a distinctive type of idiopathic calcinosis cutis, and shows remarkable clinical and histological features. Most cases of MICC appear in children with Down syndrome, but cases of MICC unassociated with Down syndrome are occasionally reported1. Herein, we report a rare case of recurrent MICC after complete removal in a patient who had no evidence of Down syndrome. A 17-year-old healthy Korean boy presented with a solitary whitish papule on the right upper eyelid for several months. Six years ago, he had complete removal of this lesion but the MICC recurred in the same area (Fig. 1). At the time of the patient's arrival at the clinic, physical examination revealed a 5 mm sized firm white papule (Fig. 1B), and it was noted to be similar to the milia that had been there before. His physical and mental development was normal, and he denied any history of previous trauma or dermatosis at the site of the lesion. Also, there were no specific findings in the past history or family history. Histologic examination of the biopsied lesion showed a condensed deposit of basophilic amorphous material within the upper dermis (Fig. 2B). Von Kossa staining showed a black colored reaction (confirmed as calcium) of the lesion, and the serial sectioning did not show the presence of an epidermal cyst. Laboratory findings, including the complete blood count, serum calcium, phosphate, and parathyroid hormone levels, were within normal limits, ruling out the diagnosis of metastatic calcinosis. With all the above findings, we diagnosed the lesion as MICC. After it was removed completely, there has been no recurrence for several months. Fig. 1 (A) Several milia-like whitish papules on the right upper eyelid (6 years ago). (B) A solitary, firm, 5 mm sized whitish papule was observed in the same area (at present). The authors are indebted to the patient for his permission for publication. Fig. 2 (A) Amorphous basophilic material surrounded by collagen fibers and fibroblasts in the papillary dermis (H&E, ×40). (B) Amorphous homogenous and basophilic material that stained black with Von Kossa stain in the upper dermis (H&E, ... MICC appears as smooth, firm, whitish papules resembling milia, and they are occasionally surrounded by erythema and some have a central crust that indicates transepidermal elimination of calcinosis2. So, MICC may clinically be mistaken for warts, epidermal cysts, molluscum contagiosum, and syringomas3. Sites of predilection of the disease are the hands and feet, but the involvement of the face has been reported occasionally although it is rare. In addition, most cases of MICC have been reported in children with Down syndrome and these patients may have palpebral or perilesional syringomas occurring simultaneously with the MICC2. The pathogenesis of MICC remains unknown, but several theories have been suggested. One is the premature aging process, as in Down syndrome. Cultured fibroblasts of Down syndrome patients contain higher levels of calcium than those of controls3. Another theory is that eccrine sweat ducts play a role in calcium deposits, and calcified sweat ducts have been described in several patients4. The last theory proposes that the lesions, including the microepidermal cysts, secondarily produce a chronic inflammatory reaction and calcium deposition2. In our case, serum levels of calcium and phosphate were normal, and tissue or metabolic abnormalities were not observed. And the patient was a healthy boy, with was no evidence of calcified sweat ducts. So, we consider that this lesion might be calcium deposition due to a chronic inflammatory reaction of an intangible lesion. In the case presented here, we think that this is the first description of recurrent solitary MICC of the face in a healthy person who had no evidence of Down syndrome or palpebral or perilesional syringoma. So, we announce a rare form of MICC with a review of the published literature, and alert clinical dermatologists to the existence of this rare phenomenon.

Eccrine squamous syringometaplasia secondary to cutaneous extravasation of docetaxel: report of three cases

Eccrine squamous syringometaplasia is characterized by the metaplasia of cuboidal epithelial cells of the eccrine sweat ducts into squamous epithelial cells. It has been associated with several conditions including chemotherapy-related bilateral dermatitis, an entity that can take place in body areas rich in eccrine glands, as well as in acral erythema related to chemotherapy. Only a few cases because of cutaneous extravasation of chemotherapy have been previously reported. We report three cases of eccrine squamous syringometaplasia secondary to extravasation of docetaxel.

Congenital Miliaria Crystallina in a Term Neonate Born to a Mother with Chorioamnionitis

Miliaria crystallina (MC) is a self-limiting, superficial obstruction of the eccrine sweat ducts with subsequent extravasation of sweat, resulting in rapidly surfacing, tiny, clear, noninflammatory vesicles. The disease is seen frequently in hot, humid, tropical climates and in the neonatal period, but congenital occurrence is rare. We report a case of congenital MC in a baby born to a mother with chorioamnionitis.

Low abundance of sweat duct Cl- channel CFTR in both healthy and cystic fibrosis athletes with exceptionally salty sweat during exercise.

To understand potential mechanisms explaining interindividual variability observed in human sweat sodium concentration ([Na(+)]), we investigated the relationship among [Na(+)] of thermoregulatory sweat, plasma membrane expression of Na(+) and Cl(-) transport proteins in biopsied human eccrine sweat ducts, and basal levels of vasopressin (AVP) and aldosterone. Lower ductal luminal membrane expression of the Cl(-) channel cystic fibrosis transmembrane conductance regulator (CFTR) was observed in immunofluorescent staining of sweat glands from healthy young adults identified as exceptionally "salty sweaters" (SS) (n = 6, P < 0.05) and from patients with cystic fibrosis (CF) (n = 6, P < 0.005) compared with ducts from healthy young adults with "typical" sweat [Na(+)] (control, n = 6). Genetic testing of healthy subjects did not reveal any heterozygotes ("carriers") for any of the 39 most common disease-causing CFTR mutations in the United States. SS had higher baseline plasma [AVP] compared with control (P = 0.029). Immunostaining to investigate a potential relationship between higher plasma [AVP] (and sweat [Na(+)]) and ductal membrane aquaporin-5 revealed for all groups a relatively sparse and location-dependent ductal expression of the water channel with localization primarily to the secretory coil. Availability of CFTR for NaCl transport across the ductal membrane appears related to the significant physiological variability observed in sweat salt concentration in apparently healthy humans. At present, a heritable link between healthy salty sweaters and the most prevalent disease-causing CFTR mutations cannot be established.

Cystic Dilatation of Eccrine Sweat Ducts in Hypertrophic Scar, Basal Cell Epithelioma and Nevus Pigmentosus

Cystic Dilatation of Eccrine Sweat Ducts in Hypertrophic Scar, Basal Cell Epithelioma and Nevus Pigmentosus

Acrosyringium Is the Main Site of the Vesicle/Pustule Formation in Palmoplantar Pustulosis

Pustulosis palmaris et plantaris or palmoplantar pustulosis (PPP) is a refractory pustular eruption on the palms and soles with unknown etiology. Numerous eccrine sweat pores exist on the palms and soles, suggesting the involvement of eccrine sweating in the pathogenesis of PPP. To the best of our knowledge, however, no definite abnormality in sweating has been documented in PPP. Accordingly, we analyzed the eccrine sweat duct involvement in the mechanism of vesicle formation in PPP. Dermatoscopy showed that PPP vesicles are located on the top of the ridges but not in the furrows. The sweat secretion in the lesional area was much lower than that in the nonlesional area, with or without pain stimulation to induce sweating. Immunostaining of horizontal sections of the lesions using antibodies against gross cystic disease fluid protein-15 (GCDFP-15) and epithelial membrane antigen (EMA) showed that these markers were localized in the cells lining the intraepidermal vesicles. Although the sweat antimicrobial peptides, dermcidin and human cathelicidin antimicrobial peptide 18 (hCAP-18)/LL-37, were detected in the fluid of the vesicles/pustules, neither dermcidin nor hCAP-18/LL-37 were overexpressed by neighboring keratinocytes. These findings suggest that the acrosyringium may be involved as the main site of the vesicle formation in the pathomechanism of PPP.

A Case of Primary Cutaneous Mucinous Carcinoma with Neuroendocrine Differentiation

Primary cutaneous mucinous carcinoma is a rare malignant tumor that originates from the deepest portion of the eccrine sweat duct. Common sites of involvement are the face and scalp. Biopsy shows dermal epithelial cell islands embedded in mucin pools separated by fibrous septae. It is difficult to differentiate this tumor histologically from metastatic adenocarcinoma. Recurrence after excision is common but metastases are rare. We report a primary cutaneous mucinous carcinoma with neuroendocrine differentiation on the right cheek of a 63-year-old man.

Dermoscopy of eccrine poroma with calcification

Eccrine poromas are relatively common slow-growing benign solitary adnexal tumors originating from the intraepidermal portion of the eccrine sweat duct (acrosyringium). Dystrophic calcification is rarely found in lesions of eccrine poroma, and only 2 cases of eccrine poroma with calcification have been reported thus far. In the present report, we describe another case of eccrine poroma with calcification occurring in the palm of the hand. Also, we show dermoscopic features of this case. A 73-year-old man with hemiparesis, who had a 10-year history of tumor on his right palm, which was occasionally injured by a walking crutch, causing bleeding and ulceration. Physical examination revealed a pigmented dome-shaped tumor. Dermoscopic analysis revealed glomerular vessels, multiple pink-white structureless areas, and lacunae. Histological examination revealed that the tumor was composed of cords of tumor cells extending from the epidermis into the dermis. These were uniformly cuboidal cells with round, basophilic nuclei and dense vascular stromas with telangiectasia. The tumor showed cystic structures and calcification. The patient was diagnosed with Pinkus-type eccrine poroma on the basis of histological findings. Although cutaneous neoplasms commonly associated with calcification are of follicular origin, it is known that dystrophic calcification may be triggered also in tumors of eccrine origin by multiple factors, including mechanical injury. Dermoscopy may be helpful in establishing clinical diagnosis of calcified eccrine poromas.

Clinicopathological diversity of syringomas

Usually, syringomas display a wide spectrum of benign adnexal neoplasms derived from the intraepidermal part of eccrine sweat ducts. Women are more frequently affected than men. Syringomas mainly occur in the periorbital area, but also affect the scalp, forehead, neck, abdomen, and extremities. A variety of clinical presentations of syringomas have been published, as well as cases associated with Down`s syndrome and familial syringoma. The eruptive occurrence of multiple syringomas in healthy persons has been reported rarely. We report a small case series of patients with syringomas, highlighting the different clinicopathologic manifestations and variations, and review the recent literature.

A 2-month-old Girl with an Enlarging Lesion of the Nasal Root

A 2-month-old Girl with an Enlarging Lesion of the Nasal Root

Generalized eruptive syringomas

Generalized eruptive syringoma is a rare clinical presentation of a benign adnexal tumor that derives from the intraepidermal portion of the eccrine sweat ducts. It presents as successive crops of small flesh-colored papules on the anterior body surfaces. It generally occurs in the peripubertal period. Treatment of this benign condition is cosmetic only. A case of a 28-year-old female with an eight-year history of eruptive syringoma is presented.