Hyperhidrosis 

After an SCI, autonomic dysfunction can disrupt sweating (with or without core temperature dysregulation). The sweat glands are largely sympathetically innervated in the upper part of the body from T1-T5, and in the lower part of the body from T6-L2.  

Changes in sweat secretion are common after an SCI, and excessive sweating (hyperhidrosis), absence of sweating (anhidrosis) and diminished sweating (hypohidrosis) may occur. The most common pattern is increased sweating above the level of injury and minimal/no sweating below the level of injury.   

In some cases — particularly with cervical and high thoracic injuries (above T8-T10) — reflex sweating may occur exclusively below the level of injury, and is usually a symptom of a massive autonomic response. 

Episodic hyperhidrosis is also common, post-injury, although a clinician should exclude autonomic dysreflexia and other causes such as sepsis. Contact the QSCIS medical team if there are persisting symptoms.

Hyperhidrosis management

Autonomic dysreflexia can trigger vasodilation above the level of injury, cause sweating. Refer to autonomic dysreflexia pathophysiology and management for more information.

• Evaluate other potential health issues that can cause sweating and check for any associated rise in temperature. This can be discussed with the treating medical officer.  
• If hyperhidrosis is not due to autonomic dysreflexia, consider anticholinergic medications, such as propantheline bromide.

Post sweating management 

• Regulate temperature post-sweating, when the skin is ‘wet’.  
• Consider skin management and pressure injury risk from the increased moisture.