Eccrine sweat gland

Hypodermis & appendages · Sympathetic cholinergic M3 receptor CFTR in duct

Two to four million simple coiled tubular glands distributed over almost the whole body surface, with a secretory coil at the dermal-hypodermal border and a duct spiralling up through the epidermis. They are the body's principal effector for evaporative heat loss.

Traced from the start

  1. Stratum basale (germinativum)
  2. Lamina densa (type IV collagen basement membrane)Sublamina densa anchoring fibrils (type VII collagen)
  3. Papillary dermis
  4. Reticular dermis
  5. Eccrine sweat gland

Detail

Innervation
Sympathetic postganglionic fibres that are cholinergic, acting on M3 muscarinic receptors — the standing exception to the noradrenergic rule for sympathetic postganglionic neurons
Secretion
The coil produces an isotonic primary secretion driven by NKCC1; the duct then reabsorbs sodium through ENaC and chloride through CFTR without water, so sweat reaching the surface is hypotonic
Capacity
Up to 1-2 L/hour, and higher in the heat-acclimatised; acclimatisation also lowers sweat sodium concentration through increased aldosterone-driven ductal reabsorption
Distribution
Densest on palms, soles and forehead; present in palmoplantar skin where hair follicles are absent, so they are the only adnexal reservoir for healing there

When it goes wrong

Defective CFTR preventing ductal chloride reabsorption (cystic fibrosis)

Sweat chloride above 60 mmol/L on the pilocarpine iontophoresis sweat test (30-59 intermediate), and salt-loss crises with hyponatraemic dehydration and metabolic alkalosis in hot weather

Antimuscarinic drugs (atropine, tricyclic antidepressants, sedating antihistamines, oxybutynin) blocking M3 receptors

Anhidrosis with dry skin, heat intolerance and a risk of hyperthermia in the elderly during a heat wave

Excess cholinergic sudomotor output (primary focal hyperhidrosis)

Symmetrical palmar, plantar and axillary sweating; treated stepwise with topical aluminium chloride, iontophoresis, botulinum toxin (which blocks acetylcholine release) and rarely sympathectomy, with compensatory sweating a common complication

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