Prince Andrew, Under Questioning, Doesn't Break a Sweat

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Prince Andrew, 8th in line for the throne (fat chance!), cited a medical condition, anhidrosis, an inability to sweat, as proof that an affair with an underage woman girl was untrue. While there are other concerns about the veracity of his statements [1], let us take a moment to consider this newly popular disease.

Sweating is a way we humans cool our body temperature, in place of having a nice coat of fur and panting, among other means to cool off. Millions of glands, eccrine are their names, open up releasing sweat – the cooling effect comes from the evaporation of the liquid off of our skin. There are other glands, the apocrine system, located primarily in our armpits and genitals that also release liquid when excited, along with perhaps a musk-like pheromone. Because of the location of the apocrine glands, this fluid may mix with bacteria, which in turn use the liquid as a nutrient exchanging it with us for an unpleasant odor.

While sweating is associated with exertion, it is not a result of a heightened cardiovascular system, but the response of a portion of the brain, the hypothalamus. Because it is a neurologic response, its distribution follows the nerve pathways. It is fair to say that Prince Andrew does not suffer from global anhidrosis, which is most often associated with a spinal cord injury, or injury to multiple systems.

Most frequently, patients with anhidrosis have an underlying neuropathy. Diabetes comes readily to mind. In this instance, it affects the areas associated with diabetic neuropathy, like the feet and hands. The loss of sweating changes the pH of the skin and microflora (an old term for the microbiome). Those changes are just a few of the factors that increase the incidence of infections in patients with diabetes.

Other bodily distributions of anhidrosis are similar to those of Shingles, along the sides of the chest and abdomen, following the dermatome (skin mapping) of the nerves. Other causes of anhidrosis include direct trauma to the nerves and is a side effect of various anti-depressants. I failed to identify that a jolt of adrenaline, Prince Andrew’s physician’s underlying cause, as a known etiology or risk factor. My experience and that of a majority of our species are that epinephrine (the more medicalized term for adrenaline) promotes sweating.

The classic test for anhidrosis is the sweat test, where the area of concern is covered with a powder that changes color when moistened. With a thermometer in their mouth, a temperature sensor on the skin, the patients are placed in a warm room. Areas without a color change are not sweating. This simple test can be bolstered by testing various neurologic pathways to identify a “culprit” lesion.

Finally, the yang to anhidrosis’s yin is excessive sweating or hyperhidrosis. In this case, there is excessive sweating, the kind you hear about in those commercials for clinical strength antiperspirants. In addition to that option, there are several medicines, and in some cases, a nerve block is done.

Prince Andrew has cast a light on a relatively undiscussed disease. When I looked for patient numbers, most sites indicate actual patient statistics are unknown, because so many individuals have small areas of anhidrosis that they do not even recognize. So in that regard, Prince Andrew, thank you for your service. As to whether this medical condition buys him a “Get out of Jail Free” card, it is for others to decide.  

[1] The Prince says he fails to remember the events or even the photograph of him and the accuser. His memory improves when he states he had taken Princess Beatrice to Pizza Express in Woking on the day in question. Memory is tricky that way.