I think we can all agree that Cholinergic Urticaria is a sweat issue (at least in part). However, could one of the causes maybe caused by one of the following conditions: Miliaria Rubra, Crystalline, and Profunda.
Most of us have a major issue sweating. I know that I personally cannot sweat in most cases unless the temperature gets extremely hot, or I suffer a major attack first.
Cholinergic Urticaria and Sweat Gland Obstruction?
Once some sweat glands open and I begin to sweat, it seems I am fine, and I generally won’t have a hives reaction as long as I am sweating. So recently I have been looking into sweat gland blockage issues known to modern medicine. There are several different things that can block sweat glands & hair follicles (such as bacteria, fungi, our own cells, etc.).
Also, the thing I find funny is this: Virtually all conditions that cause sweat gland obstruction will have the same symptoms, a “pins & needles” stinging sensation, and the inability to sweat!
It just makes me wonder, what exactly is it that is messing up our sweat glands/pores? Is something just clogging them up? If so, what? So here are a few common diseases that are associated with sweat gland obstruction/occlusion.
Miliaria Rubra, Crystalline, and Profunda
Miliaria is a sweat condition in which the sweat pores become blocked, and a rash usually develops. Miliaria is usually classified into 3 major types (Rubra, Crystalline, & Profunda), and they classify them based on the level of sweat gland obstruction, and the appearance of the rash. Almost every single type has similar symptoms (a “pins & needles prickly sensation). In most cases, a rash is usually present, and sweating becomes difficult. The condition, however, seems to be somewhat different from cholinergic urticaria, as this Miliaria condition seems to resolve on its own in a few weeks (according to most articles).
The most commonly encountered form of the illness is miliaria rubra, in which obstruction causes leakage of sweat into the deeper layers of the epidermis, provoking a local inflammatory reaction giving rise to the typical appearance of redness (hence rubra) and larger (but still only a few millimetres) blister-like lesions. This form of the illness is often accompanied by the typical symptoms – intense itching or “pins and needles” with a lack of sweating (anhidrosis) to affected areas. There is a small risk of heat exhaustion due to inability to sweat if the rash affects a large proportion of the body’s surface area and/or the sufferer continues to engage in heat-producing activity.
Pictures of Miliria Rubra
Here is an example of what a Miliria Rubra Rash can look like:
The most superficial obstruction (with the most mild clinical presentation), is known as miliaria crystalline; instead of a rash the patient presents with multiple tiny blister-like lesions that look like beads of perspiration and essentially cause no symptoms.
Pictures of Miliaria Crystalline
Here is what Miliaria Crystalline looks like (clear sweat bubbles sometimes form):
The most severe form of miliaria, miliaria profunda, sometimes referred to as Wildfire due to the rapid spread and severe burning sensations, generally occurs as a complication of repeated episodes of miliaria rubra. The obstruction is located deep in the structure of the sweat gland, causing the gland’s secretions to leak between the superficial and deep layers of the skin. The rash, and associated symptoms, tend to break out within hours of an activity provoking sweating but similarly fade within hours when the stimulus for the sweating is removed. The rash tends to be flesh-coloured as opposed to the prominent redness of miliaria rubra, and the risk of heat exhaustion is larger.
Pictures of Milaria Profunda
Here is what Miliaria Profunda can sometimes look like:
How is Miliaria Treated?
One thing I find interesting is that apparently antibiotics (either topical or oral) can be very helpful in treating these sweat blockage conditions. Why? In most cases natural occurring bacteria on the skin (Staphylococcus epidermidis) are thought to increase in numbers, and somehow interfere with sweat glands. They produce toxins, which become hard when combined with certain cells & tissue. This hardened substance causes the sweat gland ducts to become blocked.
Depending on the depth of the sweat blockage, different symptoms can happen (just like the 3 different types of Miliaria above).
Here is an illustration showing how the area of blockage can result in the 3 different types of symptoms of Miliaria:
An Interesting Study on Sweat Gland Blockage & Anhidrosis (Inability to Sweat)
I was doing some research on anhidrosis & sweat gland blockage concerning bacteria on the skin. I pulled up an interesting article excerpt. Here is what they did:
Anhidrosis was induced in volunteers by covering the skin with an impermeable plastic film.
The degree of sweat suppression and miliaria after a thermal stimulus was directly proportional to the increase in the density of resident aerobic bacteria, notably cocci. No anhidrosis resulted when antibacterial substances were used to prevent the expansion of the microflora.
Histological study showed a PAS-positive diastase resistant amorphous mass deep within the acrosyringium after 2 days of occlusion, accompanied by a periductal dermal infiltration of leukocytes. After another 2 days the duct became clogged by an amalgam of degenerating leukocytes. This impaction sloughed after about 3 weeks as a result of epidermal renewal. Colonies of bacteria were never found within the ducts.
It is postulated that cocci secrete a toxin which injures luminal cells and precipitates a cast within the lumen. Infiltration by leukocytes creates an impaction which completely obstructs the passage of sweat for several weeks.
Translation: Apparently they covered someone’s skin with plastic film to simulate sweat pore blockage. They then made the person’s body heat up. Here is the interesting part: The level of Miliaria experienced was directly proportional to the amount of bacteria on the skin. When they used an antibacterial substance on the skin, NO ANHIDROSIS occurred! When no anti-bacterial substance was used, there was an increase in bacterial flora on the skin, and this resulted in occlusion of the sweat pores (hence no sweating).
Again, this is very interesting. No sweat blockage occurred in the presence of antibacterial substance!! As I mentioned above, Miliaria seems to be sometimes treated by an antibacterial lotion or by taking antibiotics orally.
Could It Really Be This Simple? Sweat Pore Blockage in Cholinergic Urticaria? Does This Also Mean it is Potentially Treatable?
Okay, at this point I am 100% convinced that SOMETHING is blocking ou sweat pores, right? After all, when do we get cholinergic urticaria attacks? Only when we get hot, excited, nervous, etc. When do most people normally sweat? When they get hot, excited, nervous, etc. So it makes perfect sense that our sweat glands are simply blocked. When our bodies go to sweat, we get prickly & itchy because of this sweat pore occlusion. The question now is, “What?”
One possible theory is that we have bacterial flora that has over-grown on our skin & is emitting toxins that are sticking to our tissue, resulting in blockage of our sweat pores. As the excerpt above mentions, apparently if you have an overgrowth of this bacteria, it secretes some toxin that causes normal skin tissue to “harden.” This hardened substance blocks the sweat pores.
Another possible theory is too much keratin production. Many of us have Keratosis Pilaris, and this could be blocking the pores too (as I have written about in past articles about sunlight).
Or it could be something totally unrelated (fungi, etc.) Or it could be a combination of things.
Wouldn’t it be so AWESOME if we could simply take a course of antibiotics to completely be rid of cholinergic urticaria forever? It would be like a dream come true!
This has actually been brought up on the forum in the past.
It seems at least one person has been on antibiotics while having Cu, and didn’t notice a difference. However, at least one person on a forum (Yahoo answers) mentioned that their hives cleared up after being on antibiotics.
It also seems that some people had antibiotics before they got CU, and they wondered if perhaps the antibiotics actually caused the CU. This brings up an interesting point: Could we have “Super-bacteria” on our skin from all of the antibiotics & antibacterial soaps? Could we have a stronger than average breed on our skin? Or could it be some fungal thing? Could we be cured by a round of antibiotics?