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A. Fukunaga, T. Horikawa, M. Sato, C. Nishigori, Acquired idiopathic generalized anhidrosis: possible pathogenic role of mast cells, British Journal of Dermatology, Volume 160, Issue 6, 1 June 2009, Pages 1337–1340, https://doi.org/10.1111/j.1365-2133.2009.09113.x
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Conflicts of interest: none declared.
Sir, A 37‐year‐old man experienced anhidrosis of almost his entire body and cholinergic urticaria accompanied by severe heat intolerance for 5 months, which caused him to leave his job as an electrical engineer. A physical examination revealed no abnormalities except for slightly dry skin on his trunk and extremities. A neurological examination yielded no abnormal findings for his sensory system and sympathetic function. Laboratory tests, including blood counts, antinuclear antibody, anti‐SS‐A/Ro, anti‐SS‐B/La, total IgE and other biochemical profiles were normal except for a slightly elevated total bilirubin (1·2 mg dL−1; normal 0·0–1·0 mg dL−1).
Intradermal injection of 0·05 mL acetylcholine (100 μg mL−1) produced no local sweating (Fig. 1). A thermoregulatory sweating test using the iodine–starch method showed almost generalized anhidrosis except for the axillary zones (Fig. 1). After 15 min of exercise on a treadmill, only 0·06 mL of sweat was collected from both forearms; pinpoint‐sized weals characteristic of cholinergic urticaria were observed. In order to check his responsiveness to autologous sweat, autologous sterilized sweat (diluted 1 : 100) was injected intradermally, resulting in a negative response.1 A skin biopsy specimen was taken from his right forearm where sweating did not occur. The eccrine glands and ducts were surrounded by infiltrates of CD3‐positive lymphocytes and a considerable number of mast cells (0·88 mast cells per gland) that were metachromatically stained with toluidine blue (Fig. 2). Serial sections of the skin biopsy revealed focal hyperkeratosis at the acrosyringium and normal eccrine glands (Fig. 2).
