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.

Keywords:
Cholinergic urticaria, Hypohidrosis
1.
Black AK, Champion RH: Urticaria; in Champion RH, Burton JL, Burns DA, Breathnach SM (eds): Textbook of Dermatology, ed 6. Oxford, Blackwell Science Publications, 1998, vol 3, pp 2113–2131.
2.
Hirschmann JV, Lawlor F, English JSC, Louback JB, Winkelmann RK, Greaves MW: Cholinergic urticaria. Arch Dermatol 1987;123:462–467.
3.
Itakura E, Urabe K, Yasumoto S, Nakayama J, Furue M: Cholinergic urticaria associated with acquired generalized hypohidrosis. Br J Dermatol 2000;143:1064–1066.
4.
Comments CA, Greaves MW: Tests to establish the diagnosis in cholinergic urticaria. Br J Dermatol 1978;98:47–51.
5.
Peters GA, Silverman JJ: Role of histamine and acetylcholine in the mechanism of heat allergy: Report of studies on a soldier. Arch Intern Med 1946;77:526–543.
6.
Moore-Robinson M, Warin RP: Some clinical aspects of cholinergic urticaria. Br J Dermatol 1968;80:794–799.
7.
Kaplan AP, Natbony SF, Tawil AP, Fruchter L, Foster M: Exercise-induced anaphylaxis as a manifestation of cholinergic urticaria. J Allergy Clin Immunol 1981;68:319–324.
8.
Udassin R, Harari Z, Shoenfeld Y, Keren G: Cholinergic urticaria: A seasonal disease. Arch Intern Med 1981;141:1029–1030.
9.
Hopkins JG, Kesten BM, Hazel OG: Urticaria provoked by heat or by psychic stimuli. Arch Dermatol Syphilol 1938;38:679–691.
10.
Sato K, Othsuyama M, Samman G: Eccrine sweat gland disorders. J Am Acad Dermatol 1991;24:1010–1014.
11.
Tsuji T, Yamamoto T: Acquired generalized anhidrosis. Arch Dermatol 1976;112:1310–1314.
12.
Costa JLDA, Ed MRCP, Glasg MRCP, Tan KK, Path MC: Generalized anhidrosis following exposure to radiant heat. Br J Dermatol 1966;78:311–321.
13.
Terui T, Ohkawa Y, Tagami H: Idiopathic acquired generalized anhidrosis: Electron-microscopic and immunohistochemical studies and analysis of lectin-binding pattern of the cell membrane. Dermatologica 1989;178:123–125.
14.
Peters MS, Winkelmann RK: Neutrophilic urticaria. Br J Dermatol 1985;113:25–30.
15.
Papa CM: Mechanisms of eccrine anhidrosis. 3. Scanning electron microscopic study of poral occlusion. J Invest Dermatol 1972;59:295–298.
16.
Hu CH: Sweat-related dermatoses: Old concept and new scenario. Dermatologica 1991;182:73–76.
17.
Jones AP, Webb LMC, Anderson AO, Leonard EJ, Rot A: Normal human sweat contains interleukin-8. J Leukoc Biol 1995;57:434–437.
18.
Jung K, Schlenvoigt G, Ladwig K, Hermann D, Mot C, Linse R, Neumann C: The sweat of patients with atopic dermatitis contains specific IgE antibodies to inhalant allergens. Clin Exp Dermatol 1996;21:347–350.
19.
Sulzberger MB, Herrmann F, Borota A, Strauss MB: Studies of sweating. J Invest Dermatol 1953;21:293–303.
20.
Hanifin JM, Rajka G: Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1980;92:44–47.
21.
Aoki T, Akimoto T, Nakamura Y: Cholinergic urticaria associated with hypohidrosis. Hifu (Skin Res) 1983;25:103–107.
22.
Kay DM, Maibach HI: Pruritus and acquired anhidrosis. Arch Dermatol 1969;100:291–293.
© 2002 S. Karger AG, Basel
2002
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