Turkish Journal of Physical Medicine and Rehabilitation 2009 , Vol 55 , Num 4
Balneotherapy-induced Hemifacial Flushing and Hyperhidrosis: Harlequin Syndrome
Erkan Kaya 1 ,Selçuk Özdoğan 2 ,Ali Hikmet Kayar 3 ,Mehmet Zeki Kıralp 4
1 Mareşal Çakmak Asker Hastanesi, Fiziksel Tıp ve Rehabilitasyon Servisi, Erzurum, Türkiye
2 Bursa Asker Hastanesi, Dermatoloji Servisi, Bursa
3 Bursa Asker Hastanesi, Fizik Tedavi ve Rehabilitasyon Servisi, Bursa, Türkiye
4 Gülhane Askeri Tıp Akademisi Haydarpaşa Eğitim Hastanesi Fiziksel Tıp ve Rehabilitasyon Servisi, İstanbul, Türkiye

Harlequin syndrome is a rare condition characterized by hemifacial flushing and sweating, particularly during exercise and heat. There are sudomotor and vasomotor deficits in the cervical sympathetic chain. The sympathetic deficits are usually restricted to the face. Rarely, autonomic deficits affect the arm or the parasympathetic neurons of the ciliary ganglia. We report a 47-year-old woman who presented with facial flushing and sweating in the right side, which were mainly induced by balneotherapy. We used the starch-iodine test to show left hemifacial anhidrosis and the sympathetic skin response. 

Keywords : Balneotherapy, flushing, harlequin syndrome, hemifacial, hyperhidrosis