Excessive Sweating and Flushing in Patients with MS

Sweating on the back and beads of sweat on the arms?

Hello Dr.
Chen,
My daughter is 32 years old.
On March 104, she underwent a tracheostomy due to pneumonia and respiratory failure, compounded by her existing autoimmune disease (multiple sclerosis).
She is bedridden and requires assistance.
However, in the past two months, she has experienced facial flushing and excessive sweating on her back (soaking a large area, resembling night sweats?), with beads of sweat on her arms, while other areas remain normal.
This seems to occur during her afternoon naps; when she is gently awakened and moves her hands outside the blanket, the flushing and sweating gradually subside, and her body temperature does not rise at that time.

I have consulted several doctors, some of whom mentioned a problem with the autonomic nervous system, while others attributed it to multiple sclerosis.
It is discouraging to think that MS can encompass all diseases as a root cause.
Could you please provide guidance on what possibilities to consider? Even if it is an autonomic nervous system issue, is there a specific medical specialty that would be appropriate for her to see? In other words, what potential causes might be considered based on her reported symptoms?
Thank you for taking the time to share your thoughts and suggestions.

Best regards,
Yang Jun
February 5, 105

Yang Jun, 50~59 year old female. Ask Date: 2016/02/05

Dr. Chen Bozhang reply Family Medicine

I'm sorry, I cannot answer that.

Reply Date: 2016/02/05

More Info

Excessive sweating and flushing in patients with multiple sclerosis (MS) can be quite distressing and may stem from various underlying mechanisms. In your daughter's case, the symptoms of facial flushing and excessive sweating, particularly localized to the back and arms, could be attributed to several factors related to her MS and overall health condition.

Firstly, MS is known to affect the autonomic nervous system, which regulates involuntary bodily functions, including sweating and temperature control. Dysregulation of this system can lead to abnormal sweating patterns, such as hyperhidrosis (excessive sweating) or flushing. This is particularly relevant in MS patients, as the disease can disrupt the normal signaling pathways that control these functions. The fact that your daughter experiences these symptoms primarily during the afternoon and upon waking suggests a possible link to her sleep cycle or the body's natural thermoregulation processes.

Additionally, the presence of other medical conditions, such as the respiratory issues that led to her tracheostomy, could also contribute to these symptoms. Infections, medications, or even anxiety can exacerbate sweating and flushing. For instance, certain medications used to manage MS or other conditions may have side effects that include increased sweating or flushing. It would be beneficial to review her current medication list with her healthcare provider to identify any potential culprits.

Given the complexity of her symptoms, it is advisable to consult with a neurologist who specializes in MS, as they can provide insights into how her condition may be influencing her autonomic functions. Additionally, a referral to an autonomic specialist or a dermatologist may be warranted to further investigate the sweating and flushing. These specialists can conduct tests to evaluate her autonomic nervous system's function and determine if there are any underlying issues that need to be addressed.

Moreover, lifestyle modifications can also play a role in managing these symptoms. Encouraging your daughter to stay cool, wear breathable fabrics, and practice stress-reduction techniques may help alleviate some discomfort. Keeping a symptom diary to track when the flushing and sweating occur, along with any associated activities or dietary factors, can provide valuable information for her healthcare team.

In summary, while excessive sweating and flushing in MS patients can be challenging to manage, understanding the potential underlying causes is crucial. A multidisciplinary approach involving her neurologist, possibly an autonomic specialist, and lifestyle adjustments can help improve her quality of life. It is essential to maintain open communication with her healthcare providers to ensure that all aspects of her health are being addressed comprehensively.

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