To the Editor.—
In the article entitled "Apical Pulmonary Adenocarcinoma With Contralateral Hyperhidrosis" by McCoy and published in the October 1981 Archives (117-659-661), McCoy failed to evaluate one important aspect of the sweat gland function of the skin ipsilateral to the tumor. A provocative sweat test would probably have shown hypohidrosis or even anhidrosis on the ipsilateral side.The test requires that the patient's legs be submerged in water at a temperature of 45 °C for 30 minutes to raise his core temperature; the starch iodide test normally shows sweating over the entire upper part of the body.1 Photographs should be taken as soon as a good sweat response appears and before dripping and pooling of sweat confuse the pattern.A tumor invading the sympathetic nerves either irritates them, causing ipsilateral hyperhidrosis,2 or destroys them, causing ipsilateral hypohidrosis.3 In the case of ipsilateral hypohidrosis, reflex contralateral compensatory
Chan P. Pulmonary Carcinoma and Provocative Sweat Testing. Arch Dermatol. 1983;119(3):185. doi:10.1001/archderm.1983.01650270003001
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