A 58 years old man with reduced perspiration and coarseness over dorsal forearm, dorsal hands and back and chest since 20 years

This is a HIPAA de-identified open-online-patient-record with initial information in duty-doctors notes as well as patient's voice, posted here early winter 2015 after collecting informed patient consent (form downloadable here ) by LNMCH research assistant and patient-information-communication-executive for a discussion initiated by patient's primary care physician in-charge: 

He first noticed this gradually since last 20 years especially when he would work in the fields and sweat profusely from all areas of his body except dorsal forearm, dorsal hands and back and chest  and over time also developed a peculiar coarseness and dryness over the same skin.

Clinical images:

investigation images:

Conversational decision support:

Prakhar Gupta Sir, as I remember according to history, the area having anhidrosis is increasing with age. So the disease is on going and patient has a history of occasional burning of eyes, joint pain. May be they all are related and point to a single disease process.

Unlike · Reply · 1 · December 16, 2015 at 8:50am

Rakesh Biswas Thanks Prakhar, This could be a very important lead.Michele any rheumatology condition that may be associated here?

Like · Reply · December 16, 2015 at 7:56pm

Ashwani K Gupta If thinking autoimmune and progressive disease it could be some antibody against sweat glands. If not progressive likely congenital absence of sweat glands in these regions. Maybe someone can enlighten us about how the sweat glands are derived emryonically. In any case biopsy please

Unlike · Reply · 1 · December 17, 2015 at 9:05pm

Rakesh Biswas Thanks Ashwani, Yes biopsy is done and report awaited.Prakhar can you share more about Ross's syndrome?

Like · Reply · December 17, 2015 at 9:47pm

Rakesh Biswas We shall have to check his reflexes tomorrow. Also please upload the pupil video you took to you-tube and share here. More:http://www.scielo.br/scielo.php...

Anhidrosis as the first sign of Ross Syndrome

Marcus H.S.B XavierI; Fábio H.G. PortoII; Gabrilela B. PereiraI; Luiz Peres QuevedoIII; Paula M. de FreitasI; Osvaldo J.M. do NascimentoIV; Marcos R.G. de FreitasIV

SCIELO.BR

Like · Reply · Remove Preview · December 17, 2015 at 9:51pm

Prakhar Gupta okay sir.. Will share in a few minutes. And yes sir we will need to check for reflexes tomorrow, sensations are decreased in the affected area, reflex status will give a better idea.

Unlike · Reply · 1 · December 17, 2015 at 9:54pm

Prakhar Gupta Sir, here's the video of his pupil. Video is little hazy, can try again tomorrow with proper lighting to get a better video. Have added some description in the video's text on youtube. Watch video after choosing higher quality.

https://youtu.be/XjhgbuRzTXk

Like · Reply · December 17, 2015 at 10:36pm · Edited

Rakesh Biswas You forgot the link?

Like · Reply · December 17, 2015 at 10:44pm

Prakhar Gupta https://m.youtube.com/watch?feature=youtu.be&v=XjhgbuRzTXk

Pupil's pulsatile response to light

Video is not very clear but on looking closely, there's a pulsatile response of…

YOUTUBE.COM

Unlike · Reply · Remove Preview · 1 · December 17, 2015 at 10:47pm

Michele Meltzer I wish I could help you on this one.

Unlike · Reply · 1 · December 17, 2015 at 10:51pm

Prakhar Gupta skin biopsy report

Like · Reply · December 26, 2015 at 11:27am

Rakesh Biswas Abhimanyu, Nidhi any inputs on this skin biopsy. Where do we go from here? Minakshi can you review the causes of absent sweat glands and other associations this patient has?

Like · Reply · 1 · December 26, 2015 at 2:08pm

Minakshi Sahu sir, I didn't find much about ABSENT sweat gland. it may be developmental defect as discussed above. a condition I found "anhidrotic ectodermal dysplasia" but it also carry other ectodermal anomely like hair teeth n skin problem along with absent sweat gland. but this patient dont have so. apart from this, some skin damages like trauma radiation burn can destroy sweat glands, but again patient has no history of it all. some skin disorders are also in this list. psoriasis is also there. this patient has hyperkeratosis n parakeratosis too in his skin biopsy report. we should rule out this, if patient has any symptom of psoriasis or any neglected psoriatic changes if he noticed ever in his skin. sir