10.5826/dpc.1302a70
text/xml
2160-9381
2548
en
Juhi Sharma
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
histopathology
 An Enigmatic Case of Focal Sweating: Naevus Sudoriferous
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-04-29
2022-04-20
2023-04-29
2023-06-05
e2023070
Dermatol Pract Concept
Juhi Sharma
2023/04/29
10.5826/dpc.1302a70
e2023070
Department of Dermatology, Central Command Hospital, Lucknow, India
2160-9381
histopathology
en
e2023070
Kawaoka JC, Gray J, Schappell D, Robinson-Bostom L. Eccrine nevus. J Am Acad Dermatol. 2004;51(2):301-304. DOI: 10.1016/j.jaad.2003.12.030. PMID: 15280853.
 An Enigmatic Case of Focal Sweating: Naevus Sudoriferous
https://dpcj.org/index.php/dpc/article/download/2548/2106
                   An Enigmatic Case of Focal Sweating:
                          Naevus Sudoriferous
               Deepak Vashisht1, Preema Sinha1, Parul Kamboj1, Manoj G Madakshira2,
                                     Kumar Alok1, Juhi sharma1


1 Department of Dermatology, Central Command Hospital, Lucknow, India
2 Department of Pathology, Central Command Hospital, Lucknow, India



Key words: eccrine, sudoriferous, dermoscopy, vaporimeter, histopathology
Citation: Vashisht D, Sinha P, Kamboj P, Madakshira MG, Alok K, Sharma J. An Enigmatic Case of Focal Sweating: Naevus Sudoriferous.
Dermatol Pract Concept. 2023;13(2):e2023070. DOI: https://doi.org/10.5826/dpc.1302a70
Accepted: June 20, 2022; Published: April 2023
Copyright: ©2023 Vashisht et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Juhi Sharma, Department of Dermatology, Command Hospital, Lucknow, India 226002,
Email: drjuhisharma.sharma17@gmail.com




Introduction                                                                  Examination   revealed    focal   hyperhidrosis   in    a
                                                                         well-defined area measuring 10 × 0.5 cm on the antero-
Nevus sudoriferous is a rare entity with only a few reports in           lateral aspect of the distal forearm (right), it lacked hyper-
literature [1]. These nevi usually present during childhood or           trichosis, comedones, nodules, plaque, or papules. Axillary,
adolescence as excessive sweating in a well-defined area on              palmoplantar and forehead sweating was normal. General,
forehead, trunk or extremities. It is of two types ie pure ec-           physical and neurological examination was normal. Thyroid
crine nevus and eccrine angiomatous hamartoma. We report                 function test and vertebral column radiograph were also
a rare case of pure eccrine nevus and discuss its histopathol-           normal. Objective assessment of hyperhidrosis by vaporim-
ogy, immunohistochemistry, vaporimeter, and dermoscopic                  eter (Delfin technologies Ltd) in standard room conditions
findings.                                                                at a temperature of 26˚C showed sweat loss at the rate of
                                                                         44 g/m2h. Dermoscopy revealed larger and clearly visible

Case Presentation                                                        sweat pores compared to normal adjacent skin (Figure 1B).
                                                                         Skin biopsy showed lobular pattern of hyperplastic eccrine
A 12-year-old girl presented with excessive focal sweating               sweat glands (Figure 2A), immunohistochemistry with ep-
on distal forearm (right) of one month duration (Figure 1A).             ithelial membrane antigen stain, highlighted the outer cells
She experienced more than three episodes of hyperhidrosis                of the eccrine duct and luminal surface of the sweat glands
per week. Sweating was not associated with rise of environ-              suggesting naevus sudoriferous (Figure 1B). The patient was
mental temperature, emotional stress, or exercise. There was             treated with intralesional injections of botulinum, which sig-
no history of trauma.                                                    nificantly improved her symptoms.




Research Letter | Dermatol Pract Concept. 2023;13(2):e2023070                                                                         1
    Figure 1. (A) Area over anterolateral aspect of right forearm shows excessive sweating. (B) Larger and clearly visible sweat pores (black
    arrows) on dermoscopy.




    Figure 2. (A) H&E stain 100x magnification. The glands show increased number of coils indicating hyperplasia. (B) I­ mmunohistochemistry
    400x magnification with EMA highlights the luminal cells of the glands by the membranous staining pattern in the luminal aspect.




Conclusions                                                               Assessment of eccrine gland density variability not only aids
                                                                          in the diagnosis of sweat gland abnormality but also helps
Hyperhidrosis is characterized by excessive sweating, and                 in therapeutic evaluation and monitoring [4]. Nevus sudo-
it not only adversely affects patient quality of life but also            riferous has increased eccrine secretory and ductal elements
has a tremendous emotional and psychological bearing. It                  and lacks enlargement of vascular channels seen in eccrine
can either be generalized or focal. Diagnostic criteria of pri-           angiomatous hamartoma [5].
mary focal hyperhidrosis include either of the two: age less                  Depending on the severity, nevus sudoriferous can be
than 25 years, positive family history, cessation of sweating             managed with topical application of aluminum chloride,
during sleep, frequency of at least one episode per week, im-             iontophoresis, or intralesional injections of botulinum toxin.
pairment of daily activities, bilateral and relatively symmet-            However, the definitive treatment is surgical excision.
rical sweating [2].                                                           This case is being reported for the rarity of pure eccrine
      The vapometer is an effective non-invasive device which             naevus, as only a few cases have been reported till date. It
assist in measuring trans-epidermal water loss [3], simi-                 also highlights the role of different investigation modalities
larly dermoscopy is also assists in assessing hyperhidrosis               such as histopathology, immunohistochemistry, vaporimeter
by ascertaining the number and activity of sweat glands.                  and dermoscopy in arriving at the correct diagnosis.




2                                                                              Research Letter | Dermatol Pract Concept. 2023;13(2):e2023070
References                                                                system to assess transepidermal water loss vs. the open cham-
                                                                          ber Tewameter. Skin Res Technol. 2005;11(1):61-69. DOI:
 1. Vázquez MR, Gómez de la Fuente E, Fernández JG, Martin FJ,            10.1111/j.1600-0846.2005.00101.x. PMID: 15691261.
    Estebaranz JL, Moraleda FP. Eccrine naevus: case report and lit-   4. Sonthalia S, Errichetti E, Sehgal VN. “Hidroscopy”-­Suggesting
    erature review. Acta Derm Venereol. 2002;82(2):154-156. DOI:          Dermoscopy for expendable indications. Skin Res Tech-
    10.1080/00015550252948310. PMID: 12125955.                            nol. 2019;25(6):909-911. DOI: 10.1111/srt.12724. PMID:
 2. Hornberger J, Grimes K, Naumann M, et al. Recognition, di-            31120561.
    agnosis, and treatment of primary focal hyperhidrosis. J           5. Kawaoka JC, Gray J, Schappell D, Robinson-Bostom L. Ec-
    Am Acad Dermatol. 2004;51(2):274-286. DOI: 10.1016/j.                 crine nevus. J Am Acad Dermatol. 2004;51(2):301-304. DOI:
    jaad.2003.12.029. PMID: 15280848.                                     10.1016/j.jaad.2003.12.030. PMID: 15280853.
 3. De Paepe K, Houben E, Adam R, Wiesemann F, Rogiers V.
    Validation of the VapoMeter, a closed unventilated chamber
    ­




Research Letter | Dermatol Pract Concept. 2023;13(2):e2023070                                                                         3
