CASE REPORT Localized crossed hyperhidrosis and the coexistence of thyroid gland disease Zehra A. SERDAR, 1 Ilknur K. ALTUNAY, 2 Sirin YASAR, 1 Semra KAYAOGLU, 3 Pembegu ¨l GU ¨ NES 4 1 Departments of Dermatology, and 4 Pathology, Haydarpasa Training and Research Hospital, 2 Department of Dermatology, Sisli Etfal Training and Research Hospital, and 3 Department of Family Medicine Clinic, Sisli State Hospital, Istanbul, Turkey ABSTRACT Hyperhidrosis is the most common type of sweat gland disorder. It may be localized or generalized. The localized type usually occurs in a symmetrical fashion over the palms, soles and armpits as a response to emotional stimuli. Another form of the localized type is idiopathic localized unilateral hyperhidrosis which is very rare and the etiopatho- genesis remains unclear. Here, we report a female patient who had localized crossed hyperhidrotic areas on her body (on the left side of the scalp, face and the shoulder and on the right side of the trunk) and also had thyroid gland disease. We herein discuss this extremely rare presentation of the disease and its association with thyroid gland disease. Key words: eccrine glands, hyperhidrosis, sweating, thyroid gland, thyrotoxicosis. INTRODUCTION Hyperhidrosis is characterized by increased sweat- ing, which can be generalized as involving the entire body or localized as involving only some parts of the body. Localized hyperhydrosis (LH) occurring sym- metrically on the palms, soles and ⁄ or armpits is an ordinary and idiopathic disorder which represents a complex dysfunction of the autonomic nervous sys- tem. 1,2 It occurs very rarely on the body unilaterally or lesionally. 3–17 Occasionally, a craniofacial involve- ment occurs secondary to selective serotonin re- uptake blockers. 18 These situations are different from eccrine nevi because of the existence of normal eccrine glands in the sweating areas. LH involving only one side of the body is unilateral LH which may be caused by organic disorders, traumas or can be idiopathic. 3–8 Neurological disorders and some malig- nancies are considered among organic etiologies. There is only one report in the published work in which crossed body areas (left side of the upper part of the body, right side of the lower part of the body) were involved and this case was called ‘‘localized crossed hyperhidrosis’’. 19 Lesional LH was reported only twice in myxedema lesions of the legs and asso- ciated with thyrotoxicosis and the EMO syndrome which consists of exophthalmus, pretibial myxedema and osteoarthropathia. 16,17 Actually, this clinical picture is highly different to unilateral LH. We report a 58-year-old female patient who had hyperhidrosis and erythema on the left side of the scalp and the face, and additionally on the right side of her trunk. This is the second case in the published work show- ing the areas of localized hyperhidrosis on the crossed sides of the body. Moreover, she had a thy- roid gland disease diagnosed as multinodular goiter and hyperthyroiditis. This association has not been reported so far. CASE REPORT A 58-year-old female patient was admitted to our clinic with excessive sweating on the left side of the scalp, face and left shoulder, and also at an area on Correspondence: Ilknur K. Altunay, M.D., Sisli Etfal Training and Research Hospital, Sisli, _ Istanbul, Turkey. Email: ialtunay@gmail.com Received 19 June 2009; accepted 18 September 2009. doi: 10.1111/j.1346-8138.2009.00742.x Journal of Dermatology 2010; 37: 554–558 554 Ó 2010 Japanese Dermatological Association