Cholinergic Urticaria, a New Pathogenic Concept: Hypohidrosis due to Interference with the Delivery of Sweat to the Skin Surface

Abstract

Background: Acetylcholine has been suspected to be a pathogenetic factor for cholinergic urticaria (CU), without definite evidence. In contrast, there are scattered reports of CU associated with acquired generalized hypohidrosis. We have recently examined 2 patients with CU in both of whom we noticed the presence of extensive hypohidrosis that occurred only in winter. Objective: In these 2 patients, acquired hypohidrosis due to superficial obstruction of the acrosyringium was suspected as the cause. Both case 1, a 22-year-old Japanese man, and case 2, a 21-year-old Japanese man, began to have anhidrosis and numerous red macules on their body whenever they felt hot in winter. These symptoms ceased to appear in summer. Methods: We studied histologically their lesional skin in addition to provocation tests for CU. Results: The diagnosis of CU was confirmed by the provocation of typical wheals after physical exercise in both cases. Histological study revealed findings suggestive of the presence of occlusion of the superficial acrosyringium. Conclusion: We think that such a hypohidrosis due to occlusion of superficial sweat ducts may also play a role in many other patients with CU of unknown etiology that becomes exacerbated in winter when sweating is not a frequent event.

New concepts of hive formation in cholinergic urticaria

“…It has been reported that biopsy specimens from skin lesions show infl ammatory infi ltrates, including lymphocytes, neutrophils, and occasionally eosinophils around vessels and skin appendages [3,[21][22][23]. Winkelmann [21] reported that four CU patients showed infi ltrates around their hair follicles, whereas four others had infi ltrates around their sweat ducts.…”

“…In a report of the literature that summarized cases with both CU and acquired anhidrosis/hypohidrosis, 12 of 16 patients with AIGA were suggested to be associated with CU [22]. Kobayashi et al [23] showed that biopsy specimens from two patients with both CU and AIGA showed an occlusion of the superfi cial acrosyringium and a lymphocytic infi ltration around the upper sweat duct. They proposed that the occlusions and subsequent leakage from the sweat ducts are responsible for the development of CU associated with anhidrosis.…”

Acquired Generalized Anhidrosis: Review of the Literature and Report of a Case with Lymphocytic Hidradenitis and Sialadenitis Successfully Treated with Cyclosporine

“…Among cases of anhidrosis, AGA is rare [13,15,22,23,24,25,26,27,44,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65] (table 3). A total of 37 previous cases of AGA with detailed clinical features were identified in the English language literature as far as we could determine.…”

Urticaria inducible: serie de casos y revisión de la literatura

“…Otra hipó-tesis sugiere que podría existir un componente inmunológico contra el sudor con la producción de anticuerpos IgE, lo cual se ha podido comprobar por la reacción cutánea que ocurre en estos pacientes con la inyección de su propio sudor diluido (47). En algunos estudios japoneses se ha clasificado la urticaria colinérgica en cuatro grupos: urticaria colinérgica con oclusión de poros, urticaria colinérgica con hipohidrosis, urticaria colinérgica con alergia contra el sudor y urticaria colinérgica idiopática (48).…”