Hypohidrosis in Individuals with Exertional Heat Injury: A Prospective Open Cohort Study

Abstract

Background: Hypohidrosis is a risk factor for developing heat-related illnesses. Objective: To determine the prevalence of hypohidrosis in heat injury. Methods: Soldiers from the Singapore Armed Forces who developed heat injury between January 1, 2012 and December 31, 2013 were invited to participate in the study. Subjects were induced to sweat through exercising in a temperature- and humidity-regulated room, and then atomized starch-iodine powder was administered over their whole body to detect hypohidrosis. If this was found to be present, investigations to elucidate the cause of anhidrosis were performed. Results: Out of 65 males, 30 consented to participation. One was excluded because an exogenous cause resulted in heat injury. Nine (31%) demonstrated hypohidrosis. Of these, 1 (11%) had miliaria profunda, 2 (22%) had acquired idiopathic generalized anhidrosis and 6 (67%) manifested a new phenotype which we termed acquired symmetrical hypohidrosis (ASH). Conclusion: Thirty-one percent of healthy soldiers who developed heat injury had hypohidrosis. Concurrently, a new clinical phenotype of ASH was identified.

Individual risk factors associated with exertional heat illness: A systematic review

“…Health conditions: Hypohidrosis (Lim et al., 2016); malignant hyperthermia (Poussel et al., 2015); altered cytokine production (Chang, 1993); type II fibre predominance (Hsu, Lee, Chang, Shieh, & Tsao, 1997); burns (Seth & Juliana, 2011); sympathectomy (Sihoe, Liu, Lee, Lam, & Cheng, 2007); sickle cell trait (Singer et al., 2018)…”

“…Individual volition Armstrong et al (1990) Being overweight or obese Bedno et al (2010Bedno et al ( , 2014; Chung and Pin (1996); Donoghue and Bates (2000); Epstein et al (1999); Gardner et al (1996); Moore et al (2015); Rav-Acha et al ( 2004 (Epstein et al, 1999;Armed Forces Health Surveillance Center, 2009Nelson et al, 2018b); sex (Armed Forces Health Surveillance Center" 2009Nelson et al, 2018a); ethnicity (Carter et al, 2005) Health conditions: Hypohidrosis (Lim et al, 2016); malignant hyperthermia (Poussel et al, 2015); altered cytokine production (Chang, 1993); type II fibre predominance (Hsu, Lee, Chang, Shieh, & Tsao, 1997); burns (Seth & Juliana, 2011); sympathectomy (Sihoe, Liu, Lee, Lam, & Cheng, 2007); sickle cell trait (Singer et al, 2018) Environmental factors Accumulation of thermal load (previous day of exposure); (Garzon-Villalba et al, 2006;Wallace et al, 2006); high wet-bulb globe temperature (Day & Grimshaw, 2005;Garzon-Villalba et al, 2006; Organizational factors Branch of Armed forces and personnel rank (Bedno et al, 2014;Armed Forces Health Surveillance Center, 2009Nelson et al, 2018a); early stage of recruit training and aptitude on entry (possible link to inexperienced personnel; Nelson et al, 2018b); intense physical work (Armstrong et al, 1990;Day & Grimshaw, 2005;O'Donnell, 1975); time into exercise (suggestive of rate of temperature increase; Epstein et al, 1999); geographical region (Be...…”

“…Traditional risk factors for EHI have been identified and can be categorized as those attributable to the environment (hot and humid conditions, lack of acclimatization to heat, cumulative effect of heat exposure on repeated days, and inappropriate clothing), behavioural (disrupted sleep patterns, inadequate hydration, poor nutrition and certain medications) and physical factors (low physical fitness levels, being overweight/obese, experiencing high metabolic loads and underlying medical conditions; Armstrong et al, 2007;Casa et al, 2012;Epstein, 1990;Rav-Acha et al, 2004). Other risk factors, such as a history of EHI, sweat gland dysfunction, sunburn and sex have also been reported (Armstrong et al, 2007;Epstein, Shapiro, & Brill, 1983;Gifford et al, 2019;Lim, Kok, Bin Ali, Chong, & Tey, 2016).…”

“…Armstrong et al, 2007;Casa et al, 2012;Epstein, 1990;Rav-Acha et al, 2004). Other risk factors, such as a history of EHI, sweat gland dysfunction, sunburn and sex have also been reported (Armstrong et al, 2007;Epstein, Shapiro, & Brill, 1983;Gifford et al, 2019;Lim, Kok, Bin Ali, Chong, & Tey, 2016).…”

Serum carcinoembryonic antigen as a clinical marker in hypohidrosis

“…Of the 26 cases included in analysis, seven were AIGA (19–29 years old, male:female = 6:1) while 19 were non‐AIGA (16–43 years old, all male). The latter comprised of miliaria profunda ( n = 10), acquired symmetrical hypohidrosis ( n = 4), secondary to atopic dermatitis ( n = 2), and normal sweating ( n = 3).…”