From a physiological standpoint, the pattern of innervation of the
sweat gland—namely, the postganglionic
sympathetic nerve fibers—allows clinicians and researchers to use
sudomotor function testing to assess dysfunction of the
autonomic nervous systems (ANS). To ensure optimal use and interpretation of the ESC,
normative values were defined in adults and
children. In addition,
reproducibility of the method was assessed under clinical conditions, including both
healthy controls and patients with common
chronic conditions. ESC has clinical utility in the evaluation and follow-up of
dysautonomia and
small fiber peripheral neuropathy which may occur in
diseases such as:
Diabetes General See
diabetes Diabetes and two of its main complications:
diabetic neuropathy and
autonomic neuropathy. Sensorimotor
polyneuropathy (DSPN) is the most common type of polyneuropathy in community-dwelling
patients with diabetes, affecting about 25% of them. The course of DSPN is insidious, though, and up to 50% of patients with neuropathy may be
asymptomatic, often resulting in delayed
diagnosis. Advanced or
painful DSPN may result not only in reduced
quality of life, but has been
statistically associated with
retinopathy and
nephropathy, and leads to considerable morbidity and mortality. The
autonomic nervous system (ANS), of which sudomotor nerves are an integral part, is the primary extrinsic control mechanism regulating
heart rate,
blood pressure, and
myocardial contractility. Cardiac autonomic neuropathy (CAN) describes a dysfunction of the ANS and its regulation of the
cardiovascular system. CAN is the strongest predictor for
mortality in diabetes. Because early
symptoms of CAN tend to be nonspecific, its diagnosis is frequently delayed and
screening for CAN should be routinely considered in diabetic patients. Assessment of
sudomotor function provides a measure of sympathetic cholinergic function in the workup of CAN.
Diabetic foot ulcer See
Diabetic foot ulcer (DFU). In diabetic wounds, issues like tissue ischemia, hypoxia, high glucose microenvironment and skin dryness disrupt the healing process, leading to delayed or nonhealing wounds and clinical complications. In some cases it led to amputations and in the worst cases to the death. In that context being able to detect earlier the diabetic neuropathies and skin dryness with electrochemical conductance to avoid complication has been proposed for DFU management.
Meta-analysis In 2025 a
meta-analysis proposed to used Electrochemical Skin conductance with an other metric, the feet skin temperature, to better anticipated diabetic peripheral neuropathies.
Amyloidosis Amyloidosis such as
familial amyloid neuropathy,
AL amyloidosis, and
AA amyloidosis [publication pending]. During the course of AL amyloidosis,
peripheral neuropathy occurs in 10–35% of patients;
dysautonomia itself is an independent prognostic factor, and assessment of sweat disturbances is routine in the evaluation of amyloidosis. ESC may provide a measure of subclinical autonomic involvement, which is not systematically assessed with more sophisticated equipment.
Cystic fibrosis The effects of
cystic fibrosis on sweat glands were described by Quinton. The performance and potential utility of ESC were assessed in this disease. ===
Parkinson's disease === Assessment of
dysautonomia is important for patient follow-up and assessment of sudomotor function can be helpful in daily practice.
Chemotherapy-induced peripheral neuropathy (CIPN) Chemotherapy-induced peripheral neuropathy is a common, potentially severe and dose-limiting adverse effect of multiple
chemotherapeutic agents. CIPN can persist long after the completion of
chemotherapy and imposes a significant quality of life and economic burden to cancer survivors. ESC allows for an objective quantification of small fiber impairment and is easy to implement in the clinic. ===
Sjögren syndrome === ESC may help in the diagnosis process.
Neuropathic pain Neuropathic pain usually manifests in the setting of
small fiber neuropathy. Small fiber neuropathy is common and may arise from a number of conditions such as
diabetes,
metabolic syndrome,
infectious diseases,
toxins, and
autoimmune disorders. The
gold standard for diagnosing small fiber neuropathy as the etiology of neuropathic pain is
skin biopsy. Sudomotor assessment, an accurate objective technique, could be considered as a good screening tool to limit skin biopsy in patients in whom it is not suitable. ESC has been evaluated for both early diagnosis of small fiber neuropathy and follow-up of treatment efficacy in each of these conditions. == References ==