Thoracic surgeon Malcolm Brock discusses the latest research being conducted to detect dysautonomia among hyperhidrosis patients and novel ways to treat this condition.
Yeah. Earlier on, we realized that our hyperhidrosis patients seem not to just have only hyperhidrosis and had other signs of disorder. No, Mia. Things like brain fog, chronic fatigue, um, dizziness, sink api, irritable bowel. And we Insomnia was another one, sometimes intractable itching. And we realized that over time, sometimes even thes symptoms would get worse. And we then, um, saw that thes symptoms tended to run families so that patients that had hyperhidrosis often their mother or father and then it was a long one line of the family would have these problems on. And usually anxiety was also associated with this. And so what we did was we applied to an N I H funded study that essentially would, uh, asked us to do pedigrees of these families. We then did the pedigrees and wrote out pedigrees of about 50 families, and we took it to the geneticists and they said, Yes, this looks like this is due to amend alien inheritance and that there are set of genes behind this. We then drew blood from 100 families, and we've now sequenced most of those families. And sure enough, we're starting to find evidence off genetic problems. Not that not only cause just hyperhidrosis, which of course, is just to the skin but also seems to explain what's going on in some of the other organs, like the brain. I like the gut, and I can say that these, uh, genes seemed, uh, to cause an imbalance in the autonomic nervous system and particularly, it seems like it causes sympathetic over activation. And so that's the hypothesis that we're working with now, Interestingly, when we give drugs that seem to contract the effect of these genes e, uh, contract the effect of sympathetic of activation, we see resolution not only off hyperhidrosis, but also some of the other effects of disorder. No, Mia, we're seeing as well as a consequence of realizing that hyperhidrosis was a part of disorder. No, Mia, we have now put together a group. Um, and there are several physicians. It gets sort of bigger every month. Who are tackling disorder? No. Mia from various organ, uh, specific areas. So, for example, uh, the physicians that looking at disorder No, me and the gut come together with us. Um, others who are looking anxiety are coming together. Those air looking at pots, which is a larger disorder. No, me a syndrome. They all come together. And every Thursday we have lectures. We have case discussions of patients, and we all are realizing that we're seeing the same patients. I'll be it from different points of view. So I would be seeing a patient who has hyperhidrosis. But at the same time, that person has chronic fatigue and the chronic fatigue physician will interact. And so we've created a very nice group and think that we have maybe even found a set of disorders That sort of has slipped through the cracks of modern medicine, where no one really knows what causes all of this. Um, but it might be that there are some explanations. Um, one explanation that, um, I personally have a hypothesis, and this is sort of my own, uh, hypothesis. Is that the hyperhidrosis we see very early at child birth? Usually, um, of course in childhood, and mothers and fathers would say, Oh, yes, on day were crawling across the carpet. They were leaving prints, and so that occurs early. But some of these other disorder no mia symptoms seemed to occur a little later, usually around puberty. And so there could be a hormonal cause. But it and often it's in young, uh, young girls. But then we often also see it again after a viral illness. Um, usually it's due to mononucleosis that occurs a lot at that time or in this area after Lyme disease. And you see, then not only hyperhidrosis, but this frank, huge, uh, sort of syndrome of disorder. No, Mia, Um, Interestingly, we're now seeing it with Cove it. And so it is not uncommon for us to see patients with hyperhidrosis whose family members have gotten cove it. And all of a sudden they have the family members have a wider sort of disorder. No, me a picture. So, um, my hypothesis is that there is maybe sort of, like, cancer or genetic predisposition. Uh, that has to come. And then there is a viral or immune or even hormonal second hit. That can also happen here. So I think there's a lot for us to learn where still not 100% sure what's going on. But I believe that the genetics are an important part of this whole story.
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