# Anhidrosis (absent sweating) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Anhidrosis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK555988/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SD73.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Anhidrosis (absent sweating) - disease-level clinical article (anhidrosis-full.txt) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Anhidrosis (absent sweating) - disease-level clinical article (anhidrosis-clinical.txt) - Anhidrosis (absent sweating) - disease-level clinical article (anhidrosis-full.txt) ## Treatment metadata - Stop the cause, keep the patient cool (Recognition & Referral) ## Complete treatment card ```text ANHIDROSIS (ABSENT SWEATING) Sources: Anhidrosis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK555988/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SD73.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Anhidrosis (absent sweating) - disease-level clinical article (anhidrosis-full.txt) Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Anhidrosis (absent sweating) - disease-level clinical article (anhidrosis-clinical.txt), Anhidrosis (absent sweating) - disease- level clinical article (anhidrosis-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Heat intolerance, fatigue, drowsiness, or trouble concentrating in warm settings [drowsiness · fatigue · heat intolerance · poor concentration] - Central or neuropathic anhidrosis may come with neurological signs such as ptosis and miosis, as in Horner syndrome [ptosis · small pupil] - Congenital insensitivity to pain with anhidrosis, though rare, presents with self-mutilation - History should cover past medical history, medications, treatments such as radiation therapy, and family history SIGNS - what you find (2) - Anhidrosis from tissue destruction shows exam findings of the cause, such as burn scarring or sclerotic skin as in morphea [scarring] - Anhidrosis from duct obstruction shows findings of its cause, such as psoriatic plaques or lamellar ichthyosis [plaques] TESTS (8) - Colorimetric or gravimetric testing can show reduced or absent sweating - Intradermal cholinergic drug injection can provoke sweating but is limited to a small area given its risk profile - Suspected peripheral neuropathy can be tested with the axon reflex sweat response using intradermal picrate or nicotine sulfate - Skin biopsy of an affected area should always be taken in suspected anhidrosis to check for sweat gland abnormalities - QSART assesses the autonomic nerves that control sweating - In QSART, electrical stimulation drives acetylcholine into the skin, which triggers the sweat glands so the response can be measured - The silastic sweat imprint test uses pilocarpine-stimulated electrodes; droplets leave indentations in a silicone rubber material - The thermoregulatory sweat test uses core body temperature to gauge the thermoregulatory sudomotor mechanism IF NOT THIS - what else fits (8) - Space-occupying lesions or strokes affecting the brainstem structures - hypothalamus, pons, medulla - or the spinal cord - Horner syndrome, or degenerative disorders like Ross syndrome and Shy-Drager syndrome - Autoimmune autonomic neuropathy or congenital insensitivity to pain with anhidrosis - Peripheral neuropathy from diabetes, alcoholism, leprosy, or amyloidosis - Drug-induced anhidrosis from nicotinic or muscarinic acetylcholine receptor blockers such as hexamethonium, trimethaphan, atropine, or scopolamine - Genetic causes include Fabry disease, incontinentia pigmenti, ectodermal dysplasias, and Bazex-Dupre-Christol syndrome - Sweat gland destruction from tumors, burns, radiation, systemic sclerosis, morphea, Sjogren syndrome, graft-versus-host disease, or acrodermatitis chronica atrophicans - Sweat duct obstruction from miliaria, ichthyoses, psoriasis, eczematous dermatoses, or bullous disease Source StatPearls "Anhidrosis" - disease-level clinical article Status traced to the source above 1. STOP THE CAUSE, KEEP THE PATIENT COOL (RECOGNITION & REFERRAL)[1st line] Adult Reduced or absent sweating - uncommon as a presenting complaint and dangerous in Egypt's heat. The management is causal and physical, not pharmacological. Treating whatever underlies it is the cornerstone, the article's own example being a lung carcinoma that has produced a Horner syndrome and with it the anhidrosis. Where no offending agent can be stopped, it warns that there may be little else to offer, and that keeping the patient in a cool environment has to be pressed hard. The practical measures it gives are a water spray bottle for cooling, and - where the sweat glands are blocked - exfoliating often and gently. Review the drug list for an anticholinergic cause, and refer for the neurological or dermatological cause. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Reduced or absent sweating - uncommon as a presenting complaint and dangerous in Egypt's heat. The management is causal and physical, not pharmacological. Treating whatever underlies it is the cornerstone, the article's own example being a lung carcinoma that has produced a Horner syndrome and with it the anhidrosis. Where no offending agent can be stopped, it warns that there may be little else to offer, and that keeping the patient in a cool environment has to be pressed hard. The practical measures it gives are a water spray bottle for cooling, and - where the sweat glands are blocked - exfoliating often and gently. Review the drug list for an anticholinergic cause, and refer for the neurological or dermatological cause. Caution Heat intolerance and risk of heat stroke in a hot climate; generalised anhidrosis needs urgent evaluation to prevent hyperthermia. RED FLAG - Children with anhidrosis are at particularly higher risk of heat-related illness because their core body temperature rises faster and their heat-loss mechanisms are less efficient. No drug row is listed here. The article names exactly one drug class, for one rare subtype, with no drug, no dose and an explicit caveat about the evidence: it acknowledges that nothing substantial supports corticosteroids, while noting that many case reports still advise giving them early in AIGA. (AIGA is acquired idiopathic generalised anhidrosis, a dermatology diagnosis.) And the window closes - once treatment is delayed, or the sweat glands have already been destroyed, corticosteroids may then be of no benefit. That decision belongs to the dermatologist who makes the AIGA diagnosis. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. 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