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The response to treatment is commonly swift, but transient. On the contrary, seborrhoeic dermatitis is obviously more inflammatory in nature extending outside the limit of the scalp surface. Dandruff scale is a cluster of corneocytes, which have retained a large degree of cohesion with one another and detach as such from the surface of the stratum corneum. The size and abundance of scales are heterogeneous from one site to another and over time.

Parakeratotic cells often make up part of dandruff. Their numbers are related to the severity of the clinical manifestations, which may also be influenced by seborrhea. There could be several etiopathologic pathways with complex mechanisms, which may cause dandruff. The role of lipophilic yeast belonging to the genus Malassezia was widely accepted to play a role in dandruff way back in During dandruff, the levels of Malassezia increase by 1.

It has been debated that the quantitative microbial assessment of all kinds does not indicate the role of yeast; the abundance that might have been proportional to the volume of scales which it colonizes or be responsible for the altered desquamation. Interestingly, the specific relationship between a species of Malassezia appears to be the strategy for treating dandruff.

In response to the use of antifungal preparations, population of Malassezia reduces, but the bacterial population is seldom affected. After withdrawal of treatment, the clinical situation recurs and Malassezia population increases to the initial level.

Another interesting aspect on the microbial cause of dandruff is the positive treatment response of dandruff to various steroids. Steroids are known to suppress the immune flare-up and the microbe will advantageously utilize the immune suppressed opportunity.

But the good treatment response and prolonged remission period with steroid treatment raises a doubt on the microbial cause of dandruff. Whether the increased Malassezia count is the result of abundant scales or abundant scales is due to the increased Malassezia population lack clear explanation till date.

Both in dandruff and seborrhoeic dermatitis, the population of Malassezia is not uniform throughout the skin surface and inside the stratum corneum. It is presumed that perhaps the Malassezia binding site may differ in corneocytes. Another postulate is the natural antifungal peptides of the innate immunity to the above cause. The Malassezia — corneocyte hypothesis still leaves some doubt. The non-microbial cause for dandruff is well established. Excessive exposure to sunlight is known to cause desquamation of the scalp[ 19 , 20 ] Minimal irritation of scalp due to over shampooing, frequent combing, use of certain cosmetic products, dusts and dirt also, to some extent, cause dandruff.

However, there is no sufficient experimental evidence to the above assumptions. Human scalp is very androgen sensitive and sebum rich. However, sebum excretion rate in dandruff infected and non-infected subjects was found to be same. Many subjects with oily scalp did not show dandruff as well. Many authors presume that host susceptibility factors play a major role in dandruff formation. It is already known that skin surface lipids influence the transient form of M.

It is also known that dandruff affects people at puberty and middle age more than elderly subjects. However, the quantitative or qualitative difference in skin lipids in pityriasis infected and non-infected subjects doesn't seem to vary very significantly.

Many authors have considered that host susceptibility factors account more for dandruff than the lipase activity of the microbe. Although there is sufficient evidence on the growth promotion role of various lipids on Malassezia , a clear-cut correlation on the quantitative or qualitative profile of lipids in the infected and control subjects is lacking. Studies on the growth supporting ability of various water-soluble triglycerides such as glyceryl esters of long chain fatty acids triolein C17 and short chain tributyrin C4 showed that long chain fatty acids have growth-supporting ability.

Visual scoring is widely practiced to assess the severity of dandruff. It is always necessary to give two-week washout period prior to start of any clinical trial. Dandruff quantification by bioinstrumental methods such as squamometry and photography are also employed. The severity of dandruff ranges from discrete to severe among subjects, possibly the scales may be trapped in the mesh of crowded terminal hair prohibiting them from being lost.

This dandruff-hair relationship may, in part, explain the absence of dandruff in bald pates and hairless or shaved sites and in regions of vellus hairs. The presence of dandruff may precede or accompany telogen effluvium. On a two-day survey, it has been observed that about numbers of hairs were shed in dandruff sufferers instead of in normal subjects.

In some cases of dandruff, hair shedding may be a result of alterations in the teloptosis process exogen phase and hair eclipse phenomenon. Interestingly, some of the antidandruff compounds, especially ketoconazole, may limit the progression of androgenic alopecia. Another interesting study linking the role of ABO blood group carriage rate of dandruff reveals that ABO blood group system does not play a role either in the prevalence or chronicity of dandruff.

The cross reactivity between the fungal cell wall protein and the isoantign of ABO blood groups is presumed to be the cause for the selective susceptibility of certain blood group subjects to fungal diseases. Many attempts have been made to understand the pathogenesis and pathogenecity of dandruff. De Angelis et al, [ 29 ] give an interesting result - that M. They have also shown, concomitant with the elimination of these organisms, the remission of dandruff symptoms in all the cases they have studied.

They hypothesized that species' specificity and specific targeting is required to combat dandruff. However, an earlier study of Faergemann in [ 30 ] showed the presence of M. A further twist in the understanding of the role of M. Despite the elusive and idiopathic nature of dandruff, it remains a problem for great commercial exploitation. The pathogenesis of dandruff involves hyper proliferation of keratinocytes, resulting in deregulation of keratinization.

The corneocytes clump together, manifesting as large flakes of skin. Essentially, keratolytic agents such as salicylic acid and sulphur loosen the attachments between the corneocytes and allow them to get washed off. Salicylic acid is a beta hydroxyl acid keratinolytic agent that is useful in removing scaly hyperkeratotic skin.

It decreases cell-to-cell adhesion between corneocytes. This agent is widely used in the AD preparations. Sulfur, a non-metallic element has both keratolytic and antimicrobial activity. The keratolytic effect is thought to be mediated by the reaction between the sulfur and the cysteine amino acid in the keratinocytes, whereas the antimicrobial effect may depend on the conversion of sulfur to pentathionic acid by normal flora or keratinocytes.

The zinc pyrithione ZPT heals the scalp by normalizing the epithelial keratinization or sebum production or both. Some studies have shown a significant reduction in the number of yeasts after use of ZPT. Tar is widely used in the treatment of psoriasis and found to be very effective in dandruff as well. Tar preparation work through antiproliferative and cytostatic effects, although definitive analysis is difficult because of the large number of biologically active components in coal tar.

Tar products disperse scales, which may reduce Malassezia colonization. In the mouse model, it was found that topical application of tar suppresses epidermal DNA synthesis. Clinical trial of combination of polytar and ZPT based shampoo in Indian population[ 38 ] also show that the combination of the above agents are very safe and effective in controlling dandruff and associated symptoms.

The parakeratotic properties of topical corticosteroids depend on the structure of the agent, the vehicle and the skin onto which it is used. Corticosteroids work via their anti-inflammatory and antiproliferative effects. It is believed that selenium sulfide controls dandruff via its anti Malassezia effect rather than by its antiproliferative effect.

It has anti-seborrheic properties as well as cytostatic effect on cells of the epidermal and follicular epithelium. The excessive oiliness after use of this agent has been reported in many patients as adverse drug effect. Imidazole topical antifungals such as ketoconazole act by blocking the biosynthesis of ergosterol, the primary sterol derivative of the fungal cell membrane. Changes in membrane permeability caused by ergosterol depletion are incompatible with fungal growth and survival.

Ketoconazole is a broad spectrum, antimycotic agent that is active against both Candida and M. Of all the imidazoles, ketoconazole has become the leading contender among treatment options because of its effectiveness in treating seborrheic dermatitis as well. In contrast to the imidazole antifungals, the hydroxypyridones do not affect sterol biosynthesis; instead they interfere with the active transport of essential macromolecule precursor, cell membrane integrity and the respiratory process of cells.

There are several naturopathic agents which have been claimed to have antidandruff activity. However, in most cases, these naturopathic agents are used in combination with synthetic agents. We thank Mr. We acknowledge Mrs.

Lakshmi Madhavi and J Kasinathan for help in preparing the article and getting some valuable reprints. Source of Support: Nil. Conflict of Interest: Nil. Indian J Dermatol. S Ranganathan and T Mukhopadhyay. Find articles by S Ranganathan. Find articles by T Mukhopadhyay.

Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. Received May; Accepted Oct. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract The article discuss in detail about the prevalence, pathophysiology, clinical manifestations of dandruff including the etio-pathology. Keywords: Dandruff , cosmetic problem , scalp disease , shampoos. Introduction Dandruff is a common scalp disorder affecting almost half of the population at the pre-pubertal age and of any gender and ethnicity. Pathophysiology Even today, the debate on whether dandruff has to be treated as a disease or a disorder continues.

Dandruff - seborrhoeic dermatitis link The spectrum of dandruff is difficult to define because it blurs with seborrhoeic dermatitis and some other scaly conditions. Dandruff composition Dandruff scale is a cluster of corneocytes, which have retained a large degree of cohesion with one another and detach as such from the surface of the stratum corneum.

Microbial etiology of dandruff There could be several etiopathologic pathways with complex mechanisms, which may cause dandruff. Role of corneocytes in dandruff Both in dandruff and seborrhoeic dermatitis, the population of Malassezia is not uniform throughout the skin surface and inside the stratum corneum.

Non-microbial etiopathology of dandruff The non-microbial cause for dandruff is well established. Role of Lipids Human scalp is very androgen sensitive and sebum rich. Dandruff and hair The severity of dandruff ranges from discrete to severe among subjects, possibly the scales may be trapped in the mesh of crowded terminal hair prohibiting them from being lost. ABO blood groups and dandruff Another interesting study linking the role of ABO blood group carriage rate of dandruff reveals that ABO blood group system does not play a role either in the prevalence or chronicity of dandruff.

Changing perspectives Many attempts have been made to understand the pathogenesis and pathogenecity of dandruff. Active ingredients used in Antidandruff Ad Preparations [ Table 1 ] Table 1 Review of medicated shampoos used in the treatment of dandruff. Open in a separate window. Keratinolytic agents The pathogenesis of dandruff involves hyper proliferation of keratinocytes, resulting in deregulation of keratinization. Salicylic acid Salicylic acid is a beta hydroxyl acid keratinolytic agent that is useful in removing scaly hyperkeratotic skin.

Sulfur Sulfur, a non-metallic element has both keratolytic and antimicrobial activity. The variation in sweat [Na] as a result of smaller deviations in Na intake, more realistic to a free-living individual, is yet to be fully elucidated. In addition, some studies measured sweat [Na] via regional techniques [ , ], which may not be indicative of changes at the whole-body level.

Others have used a parallel study design where sweat [Na] was not matched between groups at baseline [ ]. Thus, it is important that future studies address these and other methodological limitations as also pointed out by McCubbin and Costa [ ]. Several studies have investigated the hypothesis that dietary intake of trace minerals and vitamins influences sweat composition. However, most [ , , — ] but not all [ , , ] studies reported no association between dietary intake of trace minerals Zn, Fe, Ca, Cu and their concentrations or excretion rates in sweat.

Regardless of study duration, the impact of diet on sweat mineral and vitamin loss seems to be minimal, at least in healthy individuals with no known deficiencies. For example, Vellar et al. There was no change in sweat [Fe] or sweating rate during 60 min of passive heat stress as a result of the acute iron load [ ].

Similarly, Lug and Ellis [ ] found no significant changes in sweat vitamin concentrations in healthy heat-acclimatized men after administration of a dietary supplement of mg L-ascorbic acid during the 24 h before sweat collection. Furthermore, in a day controlled diet study in healthy men, Jacob et al. A few studies have found a significant change in sweat mineral concentrations associated with dietary intake [ , , ] and the commonality of these studies is that they included patient populations with known mineral deficiencies or involved controlled interventions designed to deplete and subsequently replete mineral stores of healthy subjects.

For example, Milne et al. For the first 5 weeks, Zn intake was 8. Corresponding sweat Zn loss was 0. It is also important to interpret these results within the context of the source of mineral concentrations found in sweat. As pointed out by Milne et al. Therefore, in this study [ ] it is difficult to discern how much of the sweat Zn originated from the body surface epidermal cells versus the interstitial fluid secreted by the eccrine sweat gland , as changes in body mineral homeostasis can impact the mineral stores of the skin as well as that of the interstitial fluid [ , , ].

Some studies have compared mineral concentrations of cell-free and cell-rich sweat in Fe and Zn-deficient patient populations versus healthy normal controls [ , ]. Prasad et al. However, in cell-free sweat, only [Zn] was lower in patients, while there were no differences in [Fe] between Fe and Zn-deficient patients and healthy controls. This study suggests that most of the Fe collected at the skin surface originates from desquamated epithelial cells, while most of the Zn is present in the cell-free portion of sweat.

This may also partly explain why an acute increase in blood [Fe] in the study by Vellar et al. There are no known reabsorption or secretion mechanisms by which the eccrine sweat gland could actively conserve or preferentially excrete minerals. Therefore, sweat mineral concentrations may be altered in situations of depletion in intervention studies or chronic deficiencies in patient populations.

Note that this is not necessarily evidence of a homeostatic mechanism; rather a result of passive transport of minerals in accordance with concentration gradients during secretion of primary sweat in the secretory coil cell-free sweat and an artifact of surface contamination cell-rich sweat. Furthermore, the impact of diet on cell-rich and cell-free sweat mineral concentrations will differ depending upon the mineral of interest.

As discussed above, Fe and Ca are found in much higher concentrations, and Zn in lower concentrations in cell-rich versus cell-free sweat [ , , , , ]; further complicating the interpretation of study results. Future studies on diet, mineral balance, and sweat mineral losses should carefully choose the methodology employed and consider the source of the minerals measured in the sweat.

Regardless, based on the available evidence to date, the take-home message for healthy individuals is that small fluctuations in dietary mineral intake that do not significantly alter mineral status or whole-body stores seem to have minimal impact on sweat mineral loss.

Of all the substances lost in sweat, Na and Cl are lost in the highest concentrations. Therefore, it has been suggested that Na and Cl are the principal electrolytes whose loss may affect homeostasis [ 7 , , ]. Hyponatremia has been reported in healthy athletes [ ], laborers [ , , ], and soldiers [ , ], as well as clinical populations e. Based on mathematical models using the prediction equation developed by Ngyuen and Kurtz [ ], plasma [Na] is most sensitive to changes in total body water and thus the primary cause of hyponatremia is an increase in body mass due to overdrinking of water or other hypotonic fluid relative to body water losses [ ].

However, the model also predicts that plasma [Na] is moderately sensitive to changes in the mass balance of Na and K [ ], such as through loss of electrolytes in sweat. Excessive sweat Na losses can exacerbate decreases in plasma [Na] caused primarily by overdrinking for a long period of time [ ] e. Hyponatremia has also been documented concomitant with dehydration, suggesting that in these cases excessive sweat Na loss was the primary etiology underlying a fall in plasma [Na] [ , , — ].

Regardless of the underlying cause of the high sweat [Na] and [Cl], case reports and theoretical models alike demonstrate that excessive electrolyte losses through sweating can contribute to the development of Na and Cl imbalances. There have been some suggestions that athletes may require dietary supplementation of certain trace minerals due in part to excessive losses in sweat.

The two trace minerals that have received the most attention in terms of sweat-induced deficiencies are Ca and Fe. For example, the most recent consensus statement from the International Olympic Committee mentions that excess losses in sweat, in combination with other factors, may lead to suboptimal Fe status in athletes and therefore may require dietary supplementation [ ]. Other papers have suggested that sweat or dermal Ca losses in athletes may contribute to reduced bone mineral density through stimulation of parathyroid hormone during training [ , , ].

However, the balance of the evidence suggests that sweat losses probably contribute minimally to whole-body trace mineral and vitamin deficiencies [ , , , , — ]. First, it is important to reiterate that many of the studies reporting substantial trace mineral and vitamin losses in sweat have used methods e. For example, 65 years ago Robinson and Robinson [ ] recognized that a primary source of Ca and Fe found in sweat is associated with desquamated cell debris, which is characteristic of the arm bag technique.

Regional measures of sweat trace minerals are also higher and more variable e. Studies have shown that during an acute bout of 1—2 h exercise serum ionized [Ca] decreases, resulting in subsequent elevation of parathyroid hormone and activation of bone reabsorption. While the underlying mechanisms are yet to be elucidated, one hypothesis is that the exercise-induced increase in PTH is triggered by sweat Ca loss.

However, only one study has reported an association between sweat Ca loss and any measure of Ca homeostasis or bone mineral density. Several other studies have reported no association between sweat Ca loss and measures of Ca homeostasis bone mineral density, parathyroid hormone, C-terminal telopeptide of Type I collagen, or bone-specific alkaline phosphatase in female cyclists [ ], male cyclists [ , ], basketball players [ ], or firefighters [ ]. It is important to note that Ca supplementation or infusion can attenuate increases in PTH and activation of bone resorption during exercise [ , , ]; however, the underlying mechanism is apparently unrelated to replacement of sweat Ca loss.

In addition to the lack of evidence discussed above, the timing of changes in Ca homeostasis during exercise does not agree with the sweat Ca loss hypothesis. As pointed out by Kohrt et al. Furthermore, while in extreme circumstances excess mineral loss cannot be ruled out as a contributing factor to suboptimal trace mineral status [ ], for most athletes the main routes of loss are likely through other avenues such as urine or the gastrointestinal tract [ , , ]. Taken together, micronutrient supplementation does not seem to be necessary on the basis of sweat excretion during physical activity, provided that dietary intakes are normal [ ].

The sweat glands are often compared to the nephrons of the kidneys, whose main function, among others, is to conserve the vital constituents of the body [ ]. Indeed, sweat glands share some similarities with the renal system; as eccrine glands have mechanisms to conserve Na, Cl, and bicarbonate losses in sweat as discussed in detail in the Mechanisms of secretion and reabsorption section above. For example, in response to aldosterone, sweat glands increase Na reabsorption in the duct leading to a decrease in sweat [Na], albeit with a greater time lag than that of the kidneys.

These adjustments are mediated through changes in renal water reabsorption in response to arginine vasopressin AVP concentrations in the plasma [ ]. With hyperosmotic hypovolemia, AVP binds to vasopressin type 2 receptors of the distal tubule and collecting duct of the kidneys, stimulating aquaporin transport of water.

It has been suggested that AVP might facilitate eccrine gland water reabsorption in a similar manner, resulting in attenuated sweating rates and more concentrated sweat as a consequence of water removal from the primary fluid along the duct [ — ]. However, the majority of studies have concluded that neither administration of AVP e. These studies also reported no correlation between plasma AVP concentrations and sweating rate or sweat [Na] [ , , ].

Moreover, one study showed that pharmacological manipulation of vasopressin type 2 receptors with an agonist desmopressin or antagonist tolvaptan prior to exercise had no effect on sweat [Na] [ ]. These results may be explained in part by the relatively sparse ductal membrane expression of aquaporin-5 compared with the secretory coil [ ]. Taken together it appears that AVP does not regulate water loss via the sweat glands as it does in the kidneys; and the sweat duct does not play an important role in water conservation during exercise-heat stress [ , , , ].

Additionally, a recent study suggests that intradermal administration of atrial natriuretic peptide, a cardiac hormone that promotes urinary excretion of sodium and water, has no effect on sweating rate in young adults nor does it affect sweating in response to muscarinic receptor activation [ ]. The notion that sweating is a means to accelerate the elimination of persistent environmental contaminants from the human body has been around for many years [ , ]. Detoxification methods include several hours per day of sauna bathing to stimulate excessive sweating, resulting supposedly in purification of the body and release of toxins from the blood.

Some proponents of this method claim that increasing sweating via exercise or heat stress sauna is an effective clinical tool to protect against or overcome illness and disease [ — ]. Others suggest that physical activity leads to better health outcomes as a result of accelerated toxin elimination via thermal sweating [ , ]. As attractive as this idea sounds, there is little if any evidence to date that supports these claims [ , ].

In a series of studies, Genuis et al. The overall finding of these studies was that many chemicals, including persistent organic pollutants, heavy metals, bisphenol A BPA , and phthalate are excreted in sweat. Such reports [ , , ] have led some to hypothesize that these chemicals are perhaps preferentially excreted in sweat to reduce the body burden.

However there are several important methodological limitations to consider when measuring environmental toxicants in sweat. First, many of these studies used sweat collection methods that are susceptible to surface contamination and sweat evaporation, which would artificially increase the concentration of toxicants measured in sweat samples. For instance, in most of these studies [ — , — ], sweat was collected by the subjects on their own uncontrolled, unsupervised , from any site on their body, by scraping sweat from the skin surface with a stainless steel spatula into a glass jar.

With these methods, it is probable that sweat samples were tainted with sebum secretions. Scraping methods increase the likelihood of skin surface epidermal cells contamination because scraped sweat contains x more lipid than clean sweat [ ]; potentially explaining the high concentrations of some the of lipophilic toxicants in sweat. Furthermore, the method of sweat stimulation exercise, sauna and timing with respect to how long sweating had commenced before collection were not controlled [ — , — ].

Other studies [ , ] used the arm bag method which is also susceptible to skin surface contamination. As previously discussed the epidermis contains many contaminants, including heavy metals measured in these studies arsenic and lead [ , ]. When using these methods Genuis et al. Furthermore, BPA was detected in the sweat of 16 of the 20 subjects, but only two of the 20 subjects had BPA in their serum.

In another study, PCB 52 concentration was higher in sweat than blood and urine [ ]. Given that interstitial fluid is the precursor to primary sweat secretion it is unlikely that the BPA or PCB 52 collected at the skin surface in these studies can be attributed to eccrine sweat if the chemical is absent in the blood. Instead the chemicals could have originated from sebum secretions or epidermal cell contamination.

One study lends support for this line of thinking: Porucznik et al. The primary avenue for heavy metals excretion, based on tracer studies, is fecal output [ ]. Meanwhile, there are no known mechanisms by which the sweat glands would preferentially secrete concentrate BPA, persistent organic pollutants, and trace metals to facilitate transport out of the body.

Thus direct evidence for sweating as an effective detoxification method is lacking. Still, future well-controlled studies designed to collect clean eccrine sweat are needed to clarify or refute any potential role of sweating as a therapeutic tool to eliminate toxins from the body.

While therapeutic health benefits mostly subjective measures from detoxification protocols in some patient populations have been documented, it is important to note that sauna is only one component of a holistic intervention [ ]. Most protocols also include several weeks of strict changes in diet, exercise, and sleep and therefore it is not possible to attribute any benefit solely to sauna therapy [ , , — ].

The efficacy of lower rates of sweat loss, more realistic to the context of everyday life, is unknown [ ]. In fact, increased sweating is often considered a hangover symptom and is part of the Alcohol Hangover Severity Scale used as the standard in alcohol hangover research [ ]. Furthermore, it is commonly believed that an effective cure for hangovers after heavy drinking is to stimulate sweating via exercise or sauna bathing to accelerate recovery from alcohol intoxication. However, the evidence to date does not support these ideas; not to mention there are significant health concerns with sauna bathing during alcohol hangover [ ].

Interestingly though, perceived sweating was not significantly different between the hangover and control groups in this naturalistic study, while all other individual symptoms successfully differentiated between the two conditions [ ]. Furthermore, alcohol intake has been found to have no or minimal impact on sweating rate in laboratory intervention studies [ , — ].

For instance, two separate studies found no differences in regional sweating rate chest or upper arm in response to hot water immersion [ ] or exercise-heat stress [ ] after alcohol ingestion that lead to 0. However, the elevated sudomotor response was transient, as sweating rate decreased after 30 min and became even with the water trial by 40 min into heating [ ].

In addition, differences in sweating rates were very low up to 0. It does seem that sweat ethanol concentration increases with ethanol ingestion and rises linearly with increases in blood alcohol concentration. For example, Buono et al. This nearly identical ethanol concentration between blood and sweat supports the idea that sweat ethanol originates from the interstitial fluid and its concentration is not significantly altered during transport through the duct onto the skin surface; which is counter to the suggestion that the sweat glands have homeostatic mechanisms to detoxify the blood via concentrating mechanisms.

Moreover, the main avenue of ethanol elimination from the body is known to be via oxidation by alcohol dehydrogenase and aldehyde dehydrogenase eventually breaking ethanol down to acetyl CoA, all of which occurs in the liver.

Taken together the available evidence suggests that sweating likely plays a very small role in alcohol detoxification or hangover cures. Another important function of the kidneys is excretion of metabolic and dietary waste products. Since some waste products appear in sweat the eccrine glands are also thought of as an excretory organ.

For example, sweat contains urea, the major nitrogen-containing metabolic product of protein catabolism. According to Sato [ 15 ], urea readily crosses the eccrine glandular wall and cell membrane and therefore concentrations of urea in sweat are expected to be about the same as that of the plasma. Some studies report very high urea concentrations in sweat [ — ], up to 50x that of serum [ ], and suggest that this is evidence for a selective transport mechanism across the sweat gland, especially in patients with kidney damage, to clear the blood of high urea concentrations [ ].

However, many of these studies used methods susceptible to sample evaporation collection of sweat drippage [ , ] or surface contamination sweat collected at onset of exercise [ ], which can lead to artificial increases in sweat urea concentrations see Table 2. Other studies have shown that uric acid and creatinine excretion via sweat is insignificant compared with elimination rates through the kidneys [ , ].

Taken together, there is limited evidence that the sweat glands excretory function makes a substantial contribution to homeostasis [ , ]. As shown in Table 6 , certain medical conditions and medications can impact sweating rate and sweat composition.

As discussed in the Thermoregulation section above, evaporation of sweat is crucial for temperature regulation in warm conditions and this is evident in patients suffering from anhidroses. In particular, heat intolerance is well documented in patients with anhidrotic ectodermal dysplasia, a genetic condition resulting in a paucity of sweat glands over the entire body surface [ 3 , 15 ].

Other conditions associated with reduced sweating include burns and skin grafting [ — ], sunburn [ ], miliaria rubra [ , ], and atopic dermatitis [ , , ], as well as medications that interfere with neural sudomotor mechanisms e. Hyperhidrosis, where sweating occurs in excess of thermoregulatory demands, can occur with primary etiology [ 3 , 29 ] or secondary to physiologic condition fever, pregnancy, menopause , pathology malignancy, endocrine, metabolic, or psychiatric disorder , or medication cholinesterase inhibitors, SSRIs, opioids [ 3 , — ].

The reader is referred to the supporting references in Table 6 for more details on each of the conditions and medications that alter sweat gland function. This paper discussed sweat gland physiology and the state of the evidence regarding various roles of sweating and sweat composition in human health.

Based on this review of the literature, the following conclusions were drawn:. Lindsay B. Lindsay has been conducting sports nutrition, hydration, and sweat studies for the GSSI research program since The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of PepsiCo, Inc. Temperature Austin. Published online Jul Author information Article notes Copyright and License information Disclaimer.

Baker moc. This article has been cited by other articles in PMC. Types of sweat glands The purpose of this section is to compare and contrast the three main types of sweat glands: eccrine, apocrine, and apoeccrine [ 5 , 6 ], which are illustrated in Figure 1. Open in a separate window. Figure 1. Comparison of the apocrine, eccrine, and apoeccrine glands in the axilla. Eccrine sweat glands Eccrine glands were the first type of sweat gland discovered; as they were initially described in by Purkinje and Wendt and in by Breschet and Roussel de Vouzzeme, but were not named eccrine glands until almost years later by Schiefferdecker [ 11 ].

Apocrine sweat glands The apocrine gland is a second type of sweat gland, which was first recognized by Krause in and later named by Schiefferdecker in [ 20 , 21 ]. Apoeccrine sweat glands A third type of sweat gland, only recently described by Sato et al. Sebaceous glands Sebaceous glands are not a type of sweat gland but worth mentioning here since their secretions can impact the composition of sweat collected at the skin surface [ 25 ].

Structure and function of eccrine sweat glands Anatomy The anatomical structure of the eccrine sweat gland, illustrated in Figure 2 , consists of a secretory coil and duct made up of a simple tubular epithelium. Figure 2. Mechanisms of secretion and reabsorption Secretion The basic mechanism by which secretion of primary sweat occurs in the clear cells, according to the Na-K-2Cl cotransport model, is illustrated in Figure 2 c.

Ion reabsorption Figure 2 d shows the mechanism of ion reabsorption according to the modified Ussing leak-pump model. Sweat gland metabolism Transport of Na across cellular membranes is an active process, thus sweat secretion in the clear cells and Na reabsorption in the duct require ATP. Control of eccrine sweating Eccrine sweat glands primarily respond to thermal stimuli; particularly increased body core temperature [ 40 ], but skin temperature and associated increases in skin blood flow also play a role [ 9 , 46 — 49 ].

Figure 3. Modifiers of eccrine sweating Several intra- and interindividual factors can modify the control of sweating [ 60 ], some of which are shown in Figure 3. Table 1. Host and environmental factors that modify sweat gland function. Limited data on sweat composition. Sudomotor changes due to gland hypertrophy, increased cholinergic and aldosterone sensitivity, and decreased threshold for sweat onset see Figure 3. Aerobic training Chronic Increase in WBSR and RSR because of increased cholinergic sensitivity and decreased threshold for sweat onset [ 66 — 69 ] see Figure 3 ; limited data for sweat composition Sex Chronic Higher WBSR and RSR in men because of greater cholinergic responsiveness see Figure 3 and maximal sweating rate, but only at high evaporative requirements for heat balance [ 83 , 99 — ]; otherwise higher WBSR often observed in men are related to higher body mass and metabolic heat production, rather than sex per se [ — ].

Minimal differences in sweat [Na], [Cl], and [lactate] due to sex per se [ , , , — ]; limited data on other constituents Menstrual cycle Cyclical No effect on WBSR [ , — ], but lower RSR at a given body core temperature increased threshold and decreased slope during luteal phase [ — ]; no effect on sweat [Na], [Cl], or [K] [ ] Circadian Rhythm Cyclical Increased sweating threshold in the afternoon — h vs. Limited data on sweat composition, but there seems to be no impact of age per se on sweat [Na] [ 67 ].

Table 2. Common methodological issues. Sebum contamination [ 25 , ]. Overestimation by up to 2—3x of micronutrient concentrations, but negligible effect on Na and Cl [ , , , ]. Overestimation of lipophilic compounds abundant in secretions from sebaceous glands e. Thoroughly clean skin site when measuring microminerals [ ].

Avoid sebum contamination by collecting sweat from sites with fewer sebaceous glands and using absorbent pad technique [ ]. Sweat collected at the onset of exercise includes skin surface contamination from residual sweat in ductal lumen [ , ]. Sweat collection at onset of exercise when sweating rate is low not representative of sweat electrolyte concentrations at steady state sweating rate.

Overestimation by 1. Bacteria, xenobiotics in steam contaminate skin, sweat [ 25 , ]. Use regional method such as absorbent patch for ease of application with athletes and to avoid contamination [ ]. Variability among regional sites [ 16 ]. Usually not an accurate surrogate for whole-body sweat composition see Tables 3 and 4. Creates microenvironment increases local skin temperature and humidity [ ] and can alter regional sweating rate compared with uncovered skin [ , ].

Absorbent pad may introduce background contamination [ , ]. Limit duration of patch on skin and remove well before saturation [ ]. Contaminants from the environment cannot penetrate adhesive barrier Tegaderm TM so can be worn during normal activities, including exercise and swimming [ ].

Measure and correct for any relevant background in the absorbent pad [ ]. Collection is limited to certain regions back [ ]. Particularly susceptible to skin surface contamination due to desquamation and difficulty in cleaning irregular surfaces of hand [ ]. Microenvironment created by encapsulation which alters RSR [ , , ]. Evaporation of water portion of sweat [ ]. Artificial elevation of concentrations of contaminants of epidermal origin e.

Criterion laboratory-based methods are ion chromatography, inductively coupled mass spectroscopy, flame atomic emission, or absorption spectrometry [ — ]. Portable ion-selective electrode acceptable for field analysis [ , , ]. RSR: regional sweating rate. Table 3. Sweat micronutrients: Mechanisms and methodological considerations. Primary sweat is nearly isotonic with blood plasma [ 6 , 8 , ]; Mixed results with respect to relation between flow rate and sweat [K] [ 6 , , , ]; thought to be secreted during sweat passage along the duct, but mechanism unknown [ — ] Often overestimated by up to x with arm bag technique due to surface contamination [ , ] Calcium b 0.

Table 4. Inverse relation between sweating rate and sweat lactate concentration dilution effect , but direct relation between sweating rate and lactate excretion rate [ — ]. Natural skin moisturizer [ 15 , ] Excretion of metabolic waste — not enough evidence [ ] Concentration varies with changes in sweating rate. Readily crosses glandular wall and cell membrane and therefore concentrations expected to be same as or slightly higher than plasma [ 15 ].

However, measured concentrations are often significantly higher in sweat than plasma [ — ]; possibly because synthesis of urea by the gland [ 6 ] or surface contamination issues. Natural skin moisturizer [ 15 ] Excretion of metabolic waste — not enough evidence [ ] Concentration changes with variation in sweating rate [ 6 ].

Primarily derived from plasma NH 3 by nonionic passive diffusion of NH 3 to acidic ductal sweat and ionic trapping of NH 4 [ 6 , 15 ]. HCO 3 reabsorption is inversely related to sweating rate i. Thus final sweat pH is lower more acidic at lower sweating rate [ 5 , 8 , 37 , ] Dictates pH of sweat [ 5 , 8 ] Concentration varies with changes in sweating rate [ 37 , ] Glucose 0. Plasma glucose is the primary energy source for eccrine sweat gland secretory activity [ 6 , 41 ].

NA specific to its presence in sweat Possible skin surface contamination from residual glucose in sweat ducts Heavy Metals e. IgG, IgA and Antimicrobial peptides e. Potential for contamination by epidermal protein [ 6 ]. Cytokines e. Concentrations increase with increasing sweating rate [ ]. NA specific to its presence in sweat Skin surface contamination, both of epidermal origin and residual cytokines in the sweat gland lumen [ ] Amino acids e.

Skin maintenance and protection via desquamation of horny layer, hydrolysis of debris in the ductal lumen, allergen inhibition [ ] Skin surface contamination, both of epidermal origin [ ] and residual proteolytic enzymes in the sweat gland lumen [ ] Persistent Organic Pollutants e. Persistent organic pollutants are lipophilic and thus may appear on skin surface through sebum secretions [ ]. BPA, phthalate, polybrominated diphenyl ethers a NA No [ , , ] Concentrations are often significantly higher in sweat than plasma [ , , ], but no known mechanisms for preferential secretion.

Table 5. Formula diet: Upper arm: 47 vs. Figure 4. Eccrine sweat composition Methodological considerations In science, the accuracy and reliability of study methodology are critical to interpret results and draw conclusions about the impact of an intervention or other factor on the outcome measure of interest. Overview of sweat composition Sweat is a very complex aqueous mixture of chemicals. Sodium chloride It is well established that sweat [Na] and [Cl] can vary considerably among individuals.

Figure 5. Effect of sweat flow rate Sodium chloride Sweat flow rate is another important factor determining final sweat [Na] and [Cl] and of other aspects of sweat composition. Figure 6. Figure 7. Figure 8. Figure 9. Bicarbonate, pH, and lactate In addition to Na and Cl conservation, another important function of the sweat gland is reabsorption of bicarbonate for the maintenance of acid-base balance of the blood [ 8 ].

Sweat composition as a biomarker There has been considerable interest recently in the use of sweat as a non-invasive alternative to blood analysis to provide insights to human physiology, health, and performance. Skin health Eccrine sweat is thought to play a role in epidermal barrier homeostasis through its delivery of water, natural moisturizing factors, and antimicrobial peptides to the skin surface. Role in micronutrient balance Sweat gland adjustments in response to deficiency or excess Heat acclimation Sodium chloride The changes in sweat [Na] and [Cl] during heat acclimation have been well established and reviewed in previous papers [ , ] and therefore will not be comprehensively discussed here.

Trace minerals A common question on the topic of heat acclimation is whether or not electrolytes or minerals other than NaCl are conserved. Diet Sodium chloride It is a common perception that Na ingestion influences sweat [Na] or the rate of sweat Na excretion.

Trace minerals Several studies have investigated the hypothesis that dietary intake of trace minerals and vitamins influences sweat composition. Sweating-induced deficiencies Sodium chloride Of all the substances lost in sweat, Na and Cl are lost in the highest concentrations. Trace minerals and vitamins There have been some suggestions that athletes may require dietary supplementation of certain trace minerals due in part to excessive losses in sweat. Comparison of sweat gland and kidney function Water conservation and excretion The sweat glands are often compared to the nephrons of the kidneys, whose main function, among others, is to conserve the vital constituents of the body [ ].

Excretion of toxicants The notion that sweating is a means to accelerate the elimination of persistent environmental contaminants from the human body has been around for many years [ , ]. Excretion of metabolic waste Another important function of the kidneys is excretion of metabolic and dietary waste products.

Altered sweat gland function from conditions and medications As shown in Table 6 , certain medical conditions and medications can impact sweating rate and sweat composition. Table 6. Conditions and medications that alter sweat gland function. Etiology involves neurogenic overactivity of otherwise normal sweat glands [ 3 , 29 ]; associated with genetic predisposition [ , ]. Tattoos Chronic Reduced sweating rate and higher sweat [Na] in response to pharmacologically-induced local sweating than non-tattooed skin; unknown etiology [ — ].

More research involving exercise or heat-induced whole body sweating is needed. Conclusions This paper discussed sweat gland physiology and the state of the evidence regarding various roles of sweating and sweat composition in human health. Based on this review of the literature, the following conclusions were drawn: It is well established that eccrine sweat glands have a tremendous capacity to secrete sweat for the liberation of heat during exercise and exposure to hot environments.

They also have the capacity to enhance sweating rate with heat acclimation for improved heat tolerance. Eccrine sweat glands reabsorb NaCl and bicarbonate to minimize disruptions to whole-body electrolyte balance and acid—base balance, respectively. NaCl reabsorption by the sweat glands improves with whole-body NaCl deficits heat acclimation, dietary restriction , but the response is somewhat delayed 1—3 days compared with that of the kidneys within 1—3 h.

Individuals with salty sweat e. Eccrine gland mechanisms for secretion and reabsorption of other sweat solutes are poorly understood; nonetheless, sweating-induced deficiencies appear to be of minimal risk for trace minerals e. Ca and Fe , vitamins, and other constituents. Eccrine sweating may play a role in skin hydration and microbial defense, but additional research is required.

The role of the sweat glands in eliminating waste products and toxicants from the body seems to be minor compared with other avenues of breakdown liver and excretion kidneys and gastrointestinal tract. Evidence for a selective mechanism to excrete metabolic and dietary waste products and toxicants via the sweat glands is lacking.

That is, sweat glands do not appear to adapt in any way to increase excretion rates of these substances either via concentrating sweat or increasing overall sweating rate as the kidneys do in contributing to the regulation of blood concentrations.

Unlike the renal system, sweat glands do not appear to conserve water loss or concentrate sweat fluid through AVP-mediated water reabsorption. Studies suggesting a larger role of sweat glands in clearing waste products or toxicants from the body e. The utility of sweat composition as a biomarker for human physiology is currently limited; more research is needed to determine potential relations between sweat and blood solute concentrations.

Fluid needs for training, competition, and recovery in track-and-field athletes. Fluid balance, hydration, and athletic performance. Biology of sweat glands and their disorders. Disorders of sweat gland function. J Am Acad Dermatol. Encapsulated environment. Compr Physiol. The physiology and pharmacology of the eccrine sweat gland In: Goldsmith L, editor.

Biochemistry and physiology of the skin. New York: Oxford University Press; The physiology, pharmacology, and biochemistry of the eccrine sweat gland. Rev Physiol Biochem Pharmacol. Sweating: its composition and effects on body fluids. Ann N Y Acad Sci. J Lab Clin Med. Exercise, heat, and thermoregulation. Eccrine sweat gland disorders. The structure and function of skin.

The sweat glands. Biol Rev. Human perspiration. Springfield IL : Charles C. Thomas Publisher; Variations in secretory activity of human sweat glands. Normal sweat gland function. Regional variations in transepidermal water loss, eccrine sweat gland density, sweat secretion rates and electrolyte composition in resting and exercising humans. Extrem Physiol Med. Distribution of heat-activated sweat glands in obese and lean men and women.

Hum Biol. Functional and morphological changes in the eccrine sweat gland with heat acclimation. J Appl Physiol Regional and individual variations in the function of the human eccrine sweat gland. J Invest Dermatol. Electron microscopy of human apocrine sweat glands. Apocrine sweat glands In: Goldsmith LA, editor. Morphology and development of an apoeccrine sweat gland in human axillae. Am J Physiol. Sweat secretion by human axillary apoeccrine sweat gland in vitro.

Working up a good sweat - the challenges of standardising sweat collection for metabolomics analysis. Clin Biochem Rev. Why do we have apocrine and sebaceous glands? J R Soc Med. Sebaceous glands In: Goldsmith LA, editor. Axillary hyperhidrosis: eccrine or apocrine? Clin Exp Dermatol. Apocrine glands in health and disorder.

Int J Dermatol. Immunolocalization and translocation of aquaporin-5 water channel in sweat glands. J Dermatol Sci. Functional requirement of aquaporin-5 in plasma membranes of sweat glands. Biomed Res Int. Effects of some ion transport inhibitors on secretion and reabsorption in intact and perfused single human sweat glands. Pflugers Arch. Rapid regulation of electrolyte absorption in sweat duct. J Membr Biol. Hydrogen ion and electrolyte excretion of the single human sweat gland.

The effect of intracutaneous d-aldosterone and hydrocortisone on human eccrine sweat gland function. Sodium secretion and reabsorption in the human eccrine sweat gland. J Clin Invest. Glucose metabolism of the isolated eccrine sweat gland. The relation between glucose metabolism and sodium transport.

The secretion of salt and water by the eccrine sweat gland. Arch Dermatol. Local control of eccrine sweat gland function. Fed Proc. Effect of local heating and arterial occlusion on sweat electrolyte content. J Appl Physiol. Observations on lactate content of sweat. Sweating responses during changes of hypothalamic temperature in the rhesus monkey. Skin blood flow and local temperature independently modify sweat rate during passive heat stress in humans.

Importance of skin temperature in the regulation of sweating. Peripheral modifications to the central drive for sweating. Evidence that transient changes in sudomotor output with cold and warm fluid ingestion are independently modulated by abdominal, but not oral thermoreceptors. Staying warm in the cold with a hot drink: the role of visceral thermoreceptors. Does intramuscular thermal feedback modulate eccrine sweating in exercising humans? Acta Physiol Oxf.

Stimulation of pentose cycle in the eccrine sweat gland by adrenergic drugs. Integrated physiological mechanisms of exercise performance, adaptation, and maladaptation to heat stress. Mechanisms and controllers of eccrine sweating in humans. Front Biosci Schol Ed. Non-thermoregulatory modulation of sweating in humans. Exerc Sport Sci Rev. Function of human eccrine sweat glands during dynamic exercise and passive heat stress.

Regional differences in the effect of exercise intensity on thermoregulatory sweating and cutaneous vasodilation. Acta Physiol Scand. Effects of training, environment, and host factors on the sweating response to exercise. Int J Sports Med. Control of sweating rate while exercising in the heat. Med Sci Sports. Plasma aldosterone and sweat sodium concentrations after exercise and heat acclimation. Influence of acclimatization on sweat sodium concentration.

Thermoregulatory responses of middle-aged and young men during dry-heat acclimation. Human heat acclimitization. Indianapolis: Benchmark Press; Maximal oxygen uptake, sweating and tolerance to exercise in the heat. Int J Biometeorol. Exercise- and methylcholine-induced sweating responses in older and younger men: effect of heat acclimation and aerobic fitness.

Effects of ageing and physical training on the peripheral sweat production of the human eccrine sweat gland. Age Ageing. Effect of physical training on peripheral sweat production. Human heat adaptation. Skin blood flow and sweating changes following exercise training and heat acclimation. Mechanisms of thermal acclimation to exercise and heat.

Long distance runners present upregulated sweating responses than sedentary counterparts. PLoS One. Adaptive modifications in the thermoregulatory system of long-distance runners. Cholinergic sensitivity of the eccrine sweat gland in trained and untrained men. Thermoregulatory and blood responses during exercise at graded hypohydration levels. Control of thermoregulatory sweating is altered by hydration level and exercise intensity. Effect of hyperosmolality on control of blood flow and sweating.

Local sweating responses of different body areas in dehydration-hydration experiments. J Physiol Paris. Divergent roles of plasma osmolality and the baroreflex on sweating and skin blood flow. Plasma hyperosmolality augments peripheral vascular response to baroreceptor unloading during heat stress. Effect of blood volume on sweating rate and body fluids in exercising humans.

Sweating as a heat loss thermoeffector. Handb Clin Neurol. Eccrine sweating and mortality during heat waves in very young and very old persons. Isr J Med Sci. Methylcholine-activated eccrine sweat gland density and output as a function of age.

Longitudinal effects of age on heat-activated sweat gland density and output in healthy active older men. Age-related decrements in heat dissipation during physical activity occur as early as the age of Sweat responses in the aged. Regional differences in the sweating responses of older and younger men.

Regional differences in age-related decrements of the cutaneous vascular and sweating responses to passive heating. Nonuniform, age-related decrements in regional sweating and skin blood flow. Mechanisms underlying the age-related decrement in the human sweating response.

Invited review: aging and human temperature regulation. Comparison of thermoregulatory responses to exercise in dry heat among prepubertal boys, young adults and older males. Exp Physiol. Sweating and skin blood flow during exercise: effects of age and maximal oxygen uptake. The effect of ageing and fitness on thermoregulatory response to high-intensity exercise. Scand J Med Sci Sports. Thermoregulation at rest and during exercise in healthy older adults In: Holloszy JO, editor.

Exercise and sport sciences reviews. Responses of older and younger women to exercise in dry and humid heat without fluid replacement. Med Sci Sports Exerc. Sex differences in acetylcholine-induced sweating responses due to physical training. J Physiol Anthropol.

Sex differences in postsynaptic sweating and cutaneous vasodilation. Sex differences in thermoeffector responses during exercise at fixed requirements for heat loss. Sex modulates whole-body sudomotor thermosensitivity during exercise.

J Physiol. Exercise and the Female. A Life Span Approach. Body mapping of sweating patterns in athletes: a sex comparison. American college of sports medicine position stand. Exercise and fluid replacement. Physiological responses of men and women to prolonged dry heat exposure. Aviat Space Environ Med. Physiological responses of men and women to humid and dry heat.

The relative influence of physical fitness, acclimatization state, anthropometric measures and gender on individual reactions to heat stress. Variations in body morphology explain sex differences in thermoeffector function during compensable heat stress.

Sex hormone effects on autonomic mechanisms of thermoregulation in humans. Auton Neurosci. Modeling of gender differences in thermoregulation. Mil Med. A review of comparative responses of men and women to heat stress. Environ Res. Reproductive hormone influences on thermoregulation in women.

Does sex have an independent effect on thermoeffector responses during exercise in the heat? Thermoregulation during exercise in the heat in children: old concepts revisited. Sweat electrolyte loss during exercise in the heat: effects of gender and maturation. Sweat gland response to exercise in the heat among pre-, mid-, and late-pubertal boys. Local sweating and cutaneous blood flow during exercise in hypobaric environments.

Effect of acute normobaric hypoxia on peripheral sweat rate. High Alt Med Biol. The influence of acute and 23 days of intermittent hypoxic exposures on the exercise-induced forehead sweating response. Eur J Appl Physiol. Nocturnal lowering of thresholds for sweating and vasodilation. Menstrual cycle phase and time of day alter reference signal controlling arm blood flow and sweating. Sex- and menstrual cycle-related differences in sweating and cutaneous blood flow in response to passive heat exposure.

Effects of physical training on heat loss responses of young women to passive heating in relation to menstrual cycle. Control of sweating during the human menstrual cycle. Thermoregulation and the menstrual cycle. Effect of the menstrual cycle on performance of intermittent, high-intensity shuttle running in a hot environment. Exercise performance over the menstrual cycle in temperate and hot, humid conditions.

Menstrual cycle phase does not modulate whole body heat loss during exercise in hot, dry conditions. Humid heat stress affects trained female athletes more than does their menstrual phase. Individual variations in structure and function of human eccrine sweat gland. Sports Med. Minimal sodium losses through the skin. Chemical composition of sweat. Physiol Rev.

Loss of minerals through the skin of normal humans when sweating is avoided. Characterization of sweat induced with pilocarpine, physical exercise, and collected passively by metabolomic analysis. Skin Res Technol. Metabolomics analysis of human sweat collected after moderate exercise.

The proteomic and metabolomic characterization of exercise-induced sweat for human performance monitoring: A pilot investigation. Dissolution of materials in artificial skin surface film liquids. Toxicol In Vitro. Sweat lactate in man is derived from blood glucose. Stress biomarkers in biological fluids and their point-of-use detection.

ACS Sens. Quantification of cortisol in human eccrine sweat by liquid chromatography - tandem mass spectrometry. Formulation and stability of a novel artificial human sweat under conditions of storage and use. Whole body sweat collection in humans: an improved method with preliminary data on electrolyte content.

Oxford textbook of sports medicine. Comparison of regional patch collection vs. Variations in regional sweat composition in normal human males. Sweat composition in exercise and in heat. Body map of regional versus whole body sweating rate and sweat electrolyte concentrations in men and women during moderate exercise-heat stress.

Low abundance of sweat duct Cl- channel CFTR in both healthy and cystic fibrosis athletes with exceptionally salty sweat during exercise. Factors influencing chloride concentration in human sweat. Osmotic pressure of human sweat. Changes in composition of sweat during acclimatization to heat. Changes in the index of sweat ion concentration with increasing sweat during passive heat stress in humans.

Normative data for regional sweat sodium concentration and whole-body sweating rate in athletes. J Sports Sci. Physiological consequences of hypohydration: exercise performance and thermoregulation. Effect of skin temperature on salt concentration of sweat. Exercise intensity effects on total sweat electrolyte losses and regional vs. The local training effect of secretory activity on the response of eccrine sweat glands.

Lactate in human sweat: a critical review of research to the present day. J Physiol Sci. The relationship between exercise intensity and the sweat lactate excretion rate. Sweat lactate in exercising children and adolescents of varying physical maturity. Studies in cystic fibrosis of the pancreas; a simple test for the detection of excessive chloride on the skin. N Engl J Med. Abnormal electrolyte composition of sweat in cystic fibrosis of the pancreas; clinical significance and relationship to the disease.

A test for concentration of electrolytes in sweat in cystic fibrosis of the pancreas utilizing pilocarpine by iontophoresis. Cystic fibrosis. CFTR in cystic fibrosis and cholera: from membrane transport to clinical practice. Adv Physiol Educ.

Genetic and other determinants of sweat sodium. Curr Sports Med Rep. Sweat-testing: a review of current technical requirements.

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Scalping forex without indicators of a chemical reaction Meanwhile, there are no known mechanisms by which the sweat glands would preferentially secrete concentrate BPA, persistent organic pollutants, and trace metals to facilitate transport out of the body. Effects of physical training on heat loss responses of young women to passive heating in relation to menstrual cycle. But make no mistake, when it comes to the BB setup, we are not just dealing here with another trick to take a with-trend trade at the end of a pullback, although that is one of its functions. Observations on lactate content of sweat. The new PMC design is here! Sports Med.

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Now that you learned how to do scalping strategies in forex, there are some useful features that can be hugely advantageous if implemented properly. Indeed, your 1min or 5min scalping forex trading system will be ineffective without the extensive use of indicators, charting features, and in some cases automated forex tools.

Since we are taking advantage of intricate price moves on small time frames, it is not surprising that forex scalping is heavily reliant on daily chart patterns and indicators. Scalpers will typically use 1-minute M1 to minute M15 charts, though the latter is the least common.

Indicators help to identify bullish and bearish zones in which you can buy or sell. Make sure you understand the basics, including how to read candle wicks and Heiken Ashi charts. Many scalping strategies involve using moving averages, though other common forex indicators include envelopes, Bollinger Bands, Fibonacci retracements, and MACD. More advanced trading plans can even include scalping cycle forex indicators. Some forex traders prefer to perform scalping with price action analysis, which is a strategy involving no indicators.

Instead, scalpers focus only on price using candlestick charts, trendlines, support, and resistance to identify trend continuations. A scalping bot will take into account a range of indicators when scanning the market, including moving averages and Relative Strength Index RSI , though custom forex bots can be programmed accordingly.

Scalper robots and EAs can be free to download from some platforms, although paid bots are typically better in quality. You can also find useful scalping forex tips and robot trading ideas on community platforms, such as Myfxbook. Trading signals are produced through technical analysis and will indicate when to buy or sell an asset.

Scalping forex signals can be distributed using a range of means, including SMS, email, within the trading platform, or via a social site such as Telegram. Moreover, you cannot really be sure which signals you can trust, since they are provided by other traders.

A good tip is to only consider services provided by professionals who trade their own signals and offer their own live trading room. This will allow you to learn the ins and outs of the strategy and pick up tips and testimonials from other investors. Due to the small profits gained when scalping forex, traders should expect to use larger leverage than usual.

It can boost your profits, but it can also lead to significant losses. If you plan on using a higher leverage ratio, proper stop-loss money management is important. One of the top rules of FX trading is that you should not risk more than you can afford to lose. You may also want to pay attention to your risk-reward ratio but bear in mind it can be more difficult to maintain compared to other forms of trading.

This is because investors will often get stopped out in the majority of cases where the gap between their take profit and stop loss levels are narrow. Scalping the forex market certainly comes with its merits, depending on your personal preferences and trading goals. Check the forex scalping brokers top list above. The offering of assets is another consideration. Some traders scalp stocks, futures, gold, or popular indices like the US30, though these scalping trading systems can get rather technical.

For example, Gamma scalping in forex options trading is a popular method for experienced traders. Beginners should just stick to forex pairs until they have developed their system. Forex scalpers should also consider the execution speed and quality, regulation and licensing, fund security, and educational tools, which we discuss below. Before you login, make sure to check on the website which platforms are offered and whether they are available via web and mobile apps iOS and APK.

Access to good quality research and training resources will make all the difference in mastering your scalping forex strategy. A good broker will offer a range of educational materials on how to scalp the forex market day and night, ideally in a range of formats.

This might include scalping webinars and strategy videos for dummies, a blog, a forex academy, or even help via a community forum or discussion group. Some brokers also offer handy e-books and cheat sheets via PDF that you can download, though you can also easily find a scalping forex book to buy elsewhere online.

A demo account is the best way to learn whether a broker is a good fit for you. Once you have registered for an account, you can open up your charts and start analyzing the markets. You can then start applying your indicators and graphical objects to map out volatility and trends. Nonetheless, scalping forex can sometimes be an exception to this rule as scalping requires rapid trading where every second counts.

As such, some traders will opt for manual scalping, whereby they will manually close trades when they hit the desired levels of loss or profit. Learning how to be a forex scalper can be overwhelming for the inexperienced trader and mastering the strategy will require discipline, patience, and a few good tips and tricks under your belt.

Scalping Forex strategies are high-intensity processes that require consistency. Note also that the examples provided above might work better for some forex assets than others, so it will take some trial and error to find the most accurate scalping strategy for you. This highlights the importance of utilizing a demo account at the start of your journey. You can also find numerous video tutorials online to guide you through the process, so be ready to take notes.

Scalp forex trading relies on liquidity, so you will need to make sure you are trading at optimum times of the day. This is usually in the morning after monetary policy and other news announcements have been made. When looking for a broker, pay attention to the spreads offered on the forex assets you wish to scalp. There may also be commission charges or other account fees to take into consideration.

Failing to take into consideration the costs of investing will eat into your market profits every day or even turn a profitable trade into a loss. Most brokers offer these with the tightest spreads as they typically have the highest trading volume in the forex market. Market volatility can be created when certain announcements and reports are released, such as GDP or macroeconomic data. These are usually followed by high levels of unpredictability where traders might look to make quick gains.

However, news reports can actually throw you off course as they typically only last up to 15 minutes before the prices start to revert back again. How does the scalper know when to take profits or cut losses? The best ribbon trades set up when Stochastics turns higher from the oversold level or lower from the overbought level.

Likewise, an immediate exit is required when the indicator crosses and rolls against your position after a profitable thrust. You can time that exit more precisely by watching band interaction with price. Take profit into band penetrations because they predict that the trend will slow or reverse; scalping strategies can't afford to stick around through retracements of any sort. Also, take a timely exit if a price thrust fails to reach the band but Stochastics rolls over, which tells you to get out.

Once you're comfortable with the workflow and interaction between technical elements, feel free to adjust standard deviation higher to 4SD or lower to 2SD to account for daily changes in volatility. Better yet, superimpose the additional bands over your current chart so that you get a broader variety of signals. Finally, pull up a minute chart with no indicators to keep track of background conditions that may affect your intraday performance.

Add three lines: one for the opening print and two for the high and low of the trading range that set up in the first 45 to 90 minutes of the session. Watch for price action at those levels because they will also set up larger-scale two-minute buy or sell signals. In fact, you'll find that your greatest profits during the trading day come when scalps align with support and resistance levels on the minute, minute, or daily charts.

Scalpers can no longer trust real-time market depth analysis to get the buy and sell signals they need to book multiple small profits in a typical trading day. Fortunately, they can adapt to the modern electronic environment and use the technical indicators reviewed above that are custom-tuned to very small time frames.

Securities and Exchange Commission. Day Trading. Trading Strategies. Technical Analysis. Your Money. Personal Finance. Your Practice. Popular Courses. Trading Strategies Day Trading. Key Takeaways Scalpers seek to profit from small market movements, taking advantage of the constant market activity. Scalpers can meet the challenge of this era with three technical indicators that are custom-tuned for short-term opportunities.

Scalping strategies work best when strongly trending or strongly range-bound action controls the intraday tape; they don't work so well during periods of conflict or confusion. Article Sources. Investopedia requires writers to use primary sources to support their work.

These include white papers, government data, original reporting, and interviews with industry experts. We also reference original research from other reputable publishers where appropriate. You can learn more about the standards we follow in producing accurate, unbiased content in our editorial policy. Compare Accounts. The offers that appear in this table are from partnerships from which Investopedia receives compensation.

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Scalping is all about price action, wicks and indicators. The smaller the timeframe the more experienced in trading you need to be. I am talking about trading. › Finance & Accounting › Investing & Trading › Forex. Scalping strategy based on Trend momentum using HEIKEN Ashi and the currency strength meter for Scalping Forex pairs.