What specialist can help a patient with anhidrosis (inability to sweat)?

From the Guidelines

A patient with anhidrosis should be referred to a dermatologist, as they specialize in conditions affecting the skin, hair, and sweat glands, and are most likely to provide the necessary care and diagnosis. The dermatologist will likely perform a detailed medical history, physical examination, and possibly specialized tests such as the thermoregulatory sweat test, quantitative sudomotor axon reflex test (QSART), or skin biopsies to determine the underlying cause of the anhidrosis. According to a study published in the British Journal of Dermatology in 2019 1, hypohidrosis, a condition characterized by reduced sweating, can result from plugging of the sweat ducts by hyperkeratosis, highlighting the importance of dermatological expertise in managing such conditions. In some cases, a neurologist may also be consulted, especially if the anhidrosis is suspected to be related to an underlying neurological condition such as neuropathy or autonomic dysfunction. Endocrinologists might be involved if hormonal issues like diabetes or thyroid disorders are contributing factors. The inability to sweat can be dangerous as it impairs the body's ability to regulate temperature, potentially leading to heat exhaustion or heatstroke. While awaiting specialist care, patients should avoid excessive heat, stay well-hydrated, and use external cooling methods like cool baths or air conditioning when necessary. Treatment will depend on identifying the underlying cause, which could range from medication side effects to genetic conditions, skin disorders, or systemic diseases. Key considerations in the management of anhidrosis include:

• Detailed medical history and physical examination
• Specialized tests such as thermoregulatory sweat test or QSART
• Potential consultation with neurologists or endocrinologists
• Avoidance of excessive heat and use of cooling methods
• Identification and treatment of underlying causes, which may involve medication, lifestyle changes, or management of underlying conditions.

From the Research

Specialist for Anhidrosis

To address anhidrosis, a patient may need to consult with various specialists, including:

• Dermatologist: for skin-related issues and to rule out dermatological causes of anhidrosis 2
• Neurologist: to investigate potential neurological causes, such as damage to the autonomic nervous system, and to perform tests like microneurography and skin biopsy 3, 2, 4
• Primary care physician: to exclude exogenous causes and to perform initial evaluations, such as physical examination and thermoregulatory tests 2

Diagnostic Tests and Procedures

The following tests and procedures may be used to diagnose and manage anhidrosis:

• Thermoregulatory sweating test: to assess the patient's ability to sweat 2, 4
• Skin biopsy: to examine the skin and its innervation 3, 2
• Microneurography: to evaluate the function of the autonomic nervous system 3, 4
• Magnetic resonance imaging (MRI) of the brain and spinal cord: to investigate upper motor neuron lesions 2
• Nerve conduction tests: to evaluate lower motor neuron lesions 2
• Autonomic nerve function tests: to assess autonomic dysfunction 2
• Quantitative sudomotor axon reflex test: to evaluate the function of the sudomotor nerves 2

Treatment and Management

Treatment for anhidrosis depends on the underlying cause and may involve:

• Addressing the underlying condition: such as treating an underlying neurological disorder 2
• Avoidance of aggravating factors: such as avoiding heat and humidity 2
• Medications: such as high-dose systemic corticosteroids for acquired idiopathic generalized anhidrosis 2