Health

Harlequin Syndrome

The story of a startling reflection

February 11, 2010

While working out at the gym one afternoon in August of 2008, Francis Lam began feeling “sweaty and hot, and — kinda weird,” as though there was a cool breeze blowing only on the right side of his face.  “I look over and see that there’s sweat dripping down my left arm,” remembers Lam, “and my right arm is somehow totally, totally dry.”

In the locker room afterward, Lam glanced in the mirror to find a bizarre reflection staring back at him: his face was flushed deep red and sweating profusely — but only on the left side. “I looked like the jester or something. There was literally a line down the middle of my face,” he recalls. His left arm, too, was sweaty and florid, while his right was dry and pale.

The startling nature of Lam’s normally healthy thirty-year-old reflection was a sign of Harlequin syndrome, a rare and poorly understood disorder of the nervous system.

The symptoms vary from one individual to the next, but always include the “Harlequin Sign,” where one side of the face doesn’t sweat or flush at all, a condition known as anhidrosis. The effect is extremely pronounced because the other half of the face compensates by sweating and flushing excessively — a condition called hyperhidrosis.

Harlequin syndrome is a result of damage to the autonomic nervous system, the “unconscious” part of the nervous system that controls the involuntary muscle contractions of organs, gland activities such as sweating and crying, and the fight-or-flight response. Nerves carry instructions for these actions to different parts of the body, so damage to a single nerve can result in loss of function at its destination.

However, like most diseases of the central nervous system, cases of Harlequin syndrome are almost always “idiopathic,” meaning doctors don’t know what causes the nerve damage, says Dr. Peter Drummond, a neurologist at Murdoch University in Australia who first described the syndrome in 1988. “Our best guess is that the nerves are being attacked by a virus, but we really don’t know,” says Dr. Drummond.

Lam’s case may be one of the few with a discernible cause — a cause whose story is as unlikely and, well, double-sided as the condition itself.

One evening a few months before discovering his Harlequin syndrome, Lam, who works as a food writer in New York, was mugged and beaten while walking home to his Queens apartment. A trip to the emergency room revealed a mild fracture in his eye socket, as well as something Lam hadn’t seen coming: a chest x-ray showed a large, solid mass in his torso, above his right lung.

Several weeks of doctors’ visits and tests resulted in a diagnosis: a tennis-ball sized “schwannomma” — a benign tumor growing off of the second nerve in his thoracic spine. It would have to be removed.

When Lam noticed his strange sweating pattern a few months before the surgery to remove the tumor, Lam called his neurologist, Dr. Mark Bilsky, at Sloan-Kettering Memorial Hospital in New York. Dr. Bilsky told Lam that the growth of the tumor may be at fault, but added that some damage to the sympathetic nervous system would almost certainly occur during surgery, anyway, because the system is so sensitive that “if you look at it the wrong way it’ll screw up.”

In the fall of 2008, Lam’s doctors managed to remove his tumor without damaging the nerves responsible for motor control in his hand — which were wrapped around the growth like twine on a package. But symptoms of Harlequin syndrome have persisted.

Though natural nerve regeneration is possible, says Dr. Drummond, nerves sometimes grow back in “haphazard ways” that have strange manifestations. Sometimes sweat nerves reconnect with salivary nerves, resulting in “gustatory sweating,” in which the brain’s instructions to salivate are mistranslated into instructions to sweat.

But how could a tumor in Lam’s chest have caused a sweating condition in his face and arm?

The connection, explains Dr. Martin Duddy, a neurologist at Newcastle upon Tyne in the United Kingdom, lies in the unique arrangement of the sympathetic nervous system. The system is linked together in a chain that starts in the brain, at the hypothalamus, and progresses down the spinal cord. Nerves split off from the spinal cord through small holes in the vertebra.

The nerves that travel to the face from the spinal cord “actually track all the way down into the chest cavity and then make their way back up to the face,” Dr. Duddy explains, emerging from the spine around the same vertebra where Lam’s tumor was growing. Dr. Drummond notes that tumors in that location can put pressure on nerves, pinching them like a kink in a hose or, if the tumor grows large enough, disrupting the nerve altogether.

Whether or not the symptoms of Harlequin syndrome diminish, Lam feels lucky to have sustained so little physical damage throughout his trauma. Though his good sense of humor keeps him from fretting too much about the disorder, he still seems somewhat baffled by the strangeness of it. “My left arm sweats a lot,” he says, “but then I only sweat on the right side of my torso. I’ll look down and see that my shirt is totally soaked in this perfect square, but then the other side of my shirt will be completely dry. It’s weird.”

About the Author

Discussion

99 Comments

Chioke says:

Great reporting!

Faye says:

Hi…
My name is Faye and I was diagnosed with Harlequin in 1980 a year after being
diagnosed with stage 4 Hodgkins disease. I didn’t know what was wrong only
that I thought I now had a neurological disorder too from taking chemo and or
radiation! Like the story above I had half of my entire face and neck red and
sweaty and the other half white and dry! When I tried finding out what can be
done there was virtually nothing written and no one seemed to be able to help..
It’s now 2010 and I still have it especially when I run and exercise and I’m
now more nervous about having than ever before since I believe it’s probably
impairing my blood and oxygen flow in my brain and throughout my body!!!
Can you comment about that…does it impair oxygen and blood supply througout
the brain and body and what other damage does occur from having Harlequin???
Thanks kindly for some info and support!!
Faye~

Kali says:

My grandfather and I both have this. We were both born with it and only noticed it as we grew up playing sports. My face will turn white on one side and red and sweaty on the other side. It will do that if I eat really spicy food too. I was complaining one day and my grandpa mentioned he has the same thing! Of course he doesn’t exercise enough to see it on his face anymore, but when he eats spicy food, it still happens. I’ve had an MRI and been checked out my a neurologist and they say I’m healthy and its nothing to worry about. Odd condition though! But the fact that my grandfather has had it his whole life, reassures me its not dangerous and that it is most likely genetic. At least in our family.

Holly says:

Hey everyone:

My Brother has also been diagnosed with Harlequin Syndrome. He has the same symptoms such as the red face and the sweating only his whole body goes half and half. Hey is now at age 17; We noticed it a few years ago as he was playing outside with friends as any normal child would. He is a very active teenager who plays in sports of all kinds throughout highschool, etc. He is a very healthy young man which the Doctor says, and would shouldn’t have anything to worry about. As his older brother I tend to make fun of him lots haha, but he knows I loves him… It’s quite interesting though once you read up on it. Wish you all the best of luck.

H

Dutch says:

I have been diagnosed with Harlequin Syndrome last year.
About 20 years ago I had already been diagnosed with Holmes-Adie Syndrome.
Together (Holmes-Adie + Harlequin) : Ross Syndrome.

I have started a website to collect and share information about these related Syndromes : http://www.ross-syndrome.com

I have you have one of these Syndromes, please contact us through that website. Exchange of experiences may lead to better treatments for the problems that some people experience….

Emily Elert says:

Hi everyone, thanks for sharing your comments and your own stories about Harlequin Syndrome. To answer Faye’s question about other health effects: none of the doctors I spoke with while reporting this story, or any of the medical literature I read, suggested that Harlequin Syndrome presents a health hazard. The fact that you aren’t flushing doesn’t mean that the blood isn’t flowing– it just isn’t flooding full-force into those little capillaries near the surface of your skin, where it can cool down quickly. The biggest problem that people with Harlequin Syndrome seem to encounter is increased sweating and flushing in other parts of the body, which can be a real annoyance and sometimes a source of embarrassment.

On the other hand, as it says in the article, Harlequin Syndrome IS a result of nerve damage (usually doctors can’t say how the damage happened)– so it’s worth getting checked out by a neurologist to make sure there isn’t something causing that damage to your nerves, especially if your symptoms have come on suddenly.

Hope that helps!

Bonnie says:

Hallelujah! Someone out there like me….I was playing on a woman’s softball team at 29 and it was really hot. I took off my cap after the game and my sister asked me if I had looked in a mirror, wondering what she was talking about I immediately did and wow what a surprise. Red and white face, sweating on the red side and dry as a bone on the other. I went to an internist, family doctor, then a neurologist and none of them knew what it was. I am now 67 and of course still have it and have endured the embarrassment all these years. I began noticing a difference as I got older which is I get so sweaty and hot when I work outside even when it’s only about 75 outside. I definitely stay indoors in air conditioning when it gets really hot outside. I just cannot tolerate heat as well as others can. No one else in my large extended family has this. Glad to know I am not alone though!

Sue says:

I’ve noticed a slow onset of Harlequin over a number of years. Like most stories, noticed it after bike riding, mowing, etc. When asked, several of my doctors said that it sounded familiar, like something they’d read about in medical school, but no one could remember what it was called. So I stumbled on it by accident on the Web one day, picture and all. Relief to know I wasn’t the only one! Last year I had an MRI and other tests in that area and although my neck is pretty messed up, no one saw anything else unusual.

I agree with comment 7 above…at age 63, I’m starting to notice that it’s physically uncomfortable at times. Not a problem in the winter, but in warmer weather and after exercising, I need to apply a cold pack. It feels like a slight burn almost…cheek and neck mainly, on the left side. Yesterday I mowed and it was bad…today I’m deskbound and it’s bothering me again in a rather warm house. I’m not looking forward to it getting worse!

All of us really appreciate any developments in this field. Thanks, Emily!

bikram says:

I am 46 duing bikram yoga (hot room) for the first time. I start to feel the right side of my face red and burning hot and the left side of my face cool and totally white. Right through the middle of my forehead, nose and chin. OMG I am shocked. I feel like I have a block somewhere and I’m scared to do bikram again. Thanks for all the info!

Christopher says:

I also have what appears to be Harlequin syndrome. The left side of my forehead sweats profusely when I’m working in the yard, etc., but the right side remains dry. If I wear a ballcap, the left side is soaked, while the right is dry. I asked my doctor if she’d ever heard of anything like that. Although she did not reference Harlequin syndrome by name, she said it sounded like nerve damage. I think I can trace mine back to having a severe accident on a 3-wheeler when I was 15, which ultimately resulted in having a lobe of my right lung removed. I still have no feeling in parts of my chest and back where they cut through the nerves. In my case, I attribute it to that. I could be wrong, but it’s logical.

Jo-Anne says:

Hi. Glad I’m not the only one out there! Although I haven’t been diagnosed by a doctor, I can’t think of anything else it could be, with such striking symptoms! My face is fully halved down the middle – sweaty, red and hot on the right and cold, barely clammy and pale on the left. This was noticed by my mother who couldn’t stop staring at me after I had done a vigourous workout. I have another disease called sarcoidosis, an inflammatory disease for which I had a biopsy on one of my lymph nodes in my chest, cutting just under my Adam’s apple,3 months ago. Since my Harlequin symptoms have only just started appearing, I wonder if there was any nerve damage sustained during my operation or whether the anaesthetic had anything to do with that? I will have to see my doctor and find out!

Robin says:

I have this condition also after having surgery for a schwannomma which turned out to be a ganglioneuroma. The Dr. never mentioned this would happen before the surgery but after when I asked him about the not sweating, her said of course, I cut those nerves. I work out at Taekwondo and get very overheated on my right side as I dont sweat at all on the left side of my face, chest and left arm. I get the line down my face and the right side will be bright red, hot and sweaty. I end up explaining a lot. My kids make fun of me too.

Robin says:

Just went to the Smithsonian Air & Space museum and they have an infrared camera that shows your body heat on a monitor. Half my face and chest were red (hot) and half were blue (cool). Strange thing is, the side that feels hot, the side that can sweat was the cool side and the none sweating side was red. My hands were opposite. It was interesting to see it on the monitor.

Ellen Lensing Kitzman says:

I have this syndrome….I also have been diagnosed with Lupus. Is there any connection.

David Stinson says:

I have similar effects, but there are not quite as drastic as most. I usually will start feeling ‘chilly’ on the right side of my body, usually around the shoulder, arm and head. My hair will often be sweaty as does the upper right side of my body. One thing that I seem to also have is tingling around the right scapula area of my back, like spiders are crawling on it. I so far have not seen the red/white skin as most people that have posted on this side has, but is a wonder if it will come later in life. Has other people noticed mild symptoms?

Dawn says:

I’ve had this sympton from my early 20’s. I’ve asked my doctors about it, and they say don’t worry about it. I’m 40 now, and it still happens, and I still don’t worry about it.

Nancy says:

I have been telling my doctors (military/gov/free) about the 1/2 & 1/2 face etc.. and they all looked at me like I belonged in the nut house. I finally (after 13 years of telling Dr’s) found a Dr interested and sent him a picture and was just diagnosed 2 days ago at the age of 49. I use to play on a thirty and over soccer team and after one game a man asked me if I had been hit in the face with a ball! I have found if I wear one of those sweat headbands it is not as noticeable. I don’t know what injury I may have received that would have caused this syndrome.

Rachel says:

Well, I’m pretty sure I have this too! I’m a 26 y/o active female, healthy eater, and I have no known health problems aside from a heart murmur and a little bit of anxiety from time to time.

I first noticed my half white/half red face during gym class when I was in elementary school, and it’s happened from time to time since. I noticed it again today which is why I searched for it. Little did I know maybe I have a rare condition! I don’t sweat profusely and oftentimes I sweat on both sides of my body, but the half white/half red face is pretty noticeable and the main symptom.

When I was younger, I always noticed that I sweated sooooo much more from my right armpit (also the side of my face which gets red), and my mom is the same exact way only it’s the opposite armpit. Now that I’m well past puberty, I notice that I sweat a little more from my right armpit, but the difference is not as staggering as when I was younger.

Very strange.

manda says:

My nine month old daughter has ??? harlequin syndrome ,she was born with a very destinctive line right down the middle of her chest one side of her has dry raised skin and the other side is “normal” smooth skin .My GP has just referred her to the hospital , she does not have it on her face but does have it down her torso arm and leg ,her skin looks scolded and she does have odour from one armpit and not the other . The “dry” side is the sweaty side which seems weird no-one has mentioned their skin looks different so i wonder if this is because she was born with this ??? She is a beautiful healthy and well loved little girl and i’m sure she wont let this bother her !!!

Dani says:

Thank you for this article. About 3 years ago after working out I noticed I had a distinct line down my face, one side red and sweaty, the other pale and dry. The first doctor I went to made a joke out of it and blew me off. The next one (military) told me it was cosmetic and I would have to go to a dermatologist on my own. I finally found a dr who listened, and has me scheduled tomorrow for an MRI. He didn’t know what to call it, but now that I can put a name to it, hopefully we can make some progress. I appreciate all the posts – I thought I was the only one with this.

Christine says:

Hi – Oh, I feel good now. Have been diagnosed today after 2 years of trying to get someone to listen to me seriously. So glad that I’m not alone. Finally went to see a neurologist after an MRI and who has confirmed condition. I also have the onset of severe flushing on the left side of my face, red, sweating and hot, the other pale and dry after any exercise, I run 4 times a week, plus play badminton, after a shower, bath etc. This all started after a bout of either chest infection or trigeninal neuralgia, can’t remember as my friends were to shy to tell me!! Also, only sweat under left arm and not right. Have memory problems too, but hope this will get better. Neurologist want me to have a Lumbar Puncture, but we have agreed to re visit this in December. I’m running my second half marathon in October, and have always been active so not too worried, just feel weird. Nice to know that their are other people like me. We are not alone!

Tiffany says:

This must be what I have!!! I seem to have all these symptoms times three. If there is not a constant flow of air blowing directly on the right side of my face in temperatures over 60 degrees, I am literally dripping sweat. My hair is always wet on the right. I can’t wear shirts with collars, they get drenched. I wear black as black hides the wetness. I have to wear waterproof mascara and eyeliner, any other make up is out of the question because I am constantly wiping my face. It has gone way past annoying or a little embarassing. I get asked every single day, “are you ok?” It’s absolutely humiliating. I cant go out and enjoy social gatherings, I’m sitting in a corner wiping and fanning. This is ruining my life!

Sterling says:

I started training for a 5k about a month ago and noticed half my face turns red after running. I researched and came up with Harlequin Syndrome. I checked to see if I was also sweating on only the red side the next time I ran and I was. I don’t notice it anywhere else on my body.
I’ve had bad migraines for the past 10 years. When I told my husband about the cause of Harlequin Syndrome being a result of nerve damage, he ask if my migraines might also be associated with it since I tend to have them on only one side. Does anyone else have issues with migraines? I’m going to bring it up to my neurologist next time I see him.

Joseph DeAngelis says:

I am an avid runner and have completed 5 marathons in the past several years.
I first noticed the half red face after a hard workout. I also noticed an uneven pupil size. My family doctor referred me to a neurologist. After chest x-rays and an mri of the head and neck, the neurologist attributed the cause to migraines after no lesions were found. I can trigger a migraine from a hard workout. My migraines are strange, I feel “off” for several days after the workout and then the pain on one side will increase through about 3 days. Ibuprofen will head it off if I take at the first sign – sometimes several doses over two days. The most effective cure for my migraines is sleep. I also think it is interesting that my pupils are frequently different sizes without exercise and without a migraine.

Kevin says:

I have a newborn who is one week old. He has had several episodes where his left side is bright red and his right side is pale. There is a perfect line running down the middle of his body, separating the two halves when this happens. After doing research online I had come to the conclusion that it must be Harlequin syndrome. We called a pediatrician and were told that it was nothing to worry about since everything else was normal. Today he had an episode and the right side of his body was the red one. Is it possible for the effect to switch sides like this?

leanne says:

my granddaughter is 8 years old in 2007 her pulmonologist found a tumor in the right side of her chest. At first he thought the mass was in her lung but after the surgery to remove the tumor it was actually located onthe back side of her right lung and close to the spine. Since her surgery she also has experieced the half red and half pale face and chest as well as only sweating on the left side. her neurologist says that she has harlequins syndrome related to nerve damage from her surgery.In the past six months she has experienced vision problems as well as some memory issues we are hoping that they are not related to the nerve damage. She will be having another mri next week to see if we can determine which nerve root was involved and if in fact it is causing the memory issues. good luck to all

peter yorke says:

Hi all, mine is a bit different in that only my head is affected and it is set off by eating spicy food. At first it was thought to be harlequin syndrome, but after 3 years of tests the doctors feel it is to do with an operation I had on my heart aged 4.5 months old. Wishing you all the best.

Mallory says:

I was told I had Harlequin Syndrome but a doctor about 6 months ago. I feel like mine is a little different. I first thought maybe it was from stress, but then I realized whenever I had an episode, I wasn’t stressed. I don’t get real read, but the right side of my face, neck, and upper shoulder sweat profusely. I could be doing absolutely nothing and it hits me. I don’t notice it anymore if I am working out or doing nothing. I’ll go a few months without an episode and then one day it will hit me. For the past few days I’ve had a lease 3 or 4 episodes a day. I wish there was something we could do for this. Not only is it embarrassing, but its completely uncomfortable.

Lynda says:

wow, glad to hear i’m not the only one!!! this condition is really annoying and can be embarassing. i wonder if anyone has looked into Horners Syndrome? sound similar, is there a difference? just curious… also, i tend to feel sore and numb on my left side (which is the side that is red and sweaty). it has progressed all the way down to my feet over the past couple of years. i don’t recall any traumas in my past, so am i to assume i may have an undiagnosed condition? i have had an mri and was unfounded. reply if you have any info. thanks and good luck.

Martha says:

Hello,
I have a rare disease known as Adies Tonic Pupils in both my eyes, however medical research indicates it is most common to have it only in one eye. I just happen to have it in both eyes. I’ve had it for over 30 years now and I am 53 years old. I work for a pediatric neurology clinic and what I learned about my disease from one of the Neurologist was quite surprising. As he learned of me having Aide’s Tonic Pupil, he mentioned, “oh so you don’t sweat much”? My response was “your right, I don’t”. It’s been for sometime now (years) that I’ve known that I usually do not sweat like most people do when I exercise or run. I’m not saying I don’t sweat, I just don’t sweat as easily or quickly like most people do. I’m planning to run a half marathon soon. I’m self training for it but, everytime I do my run I can’t help but to feel alarmed as half of my face (left side) turns deep red and it actually sweats, but my right side is dry and looks normal, with no sweat. I’m wondering if my disease which is a neurological disorder sometimes caused by trauma to the head or from having high fevers isn’t the culprit,

Harry says:

Hey all, After seeing all kinds of specialists over the years to find an answer to my problem, (which is exactly as most of you describe) I was referred to a neuroligist who diognosed me with harlequin syndrome, my doctor suggested i have a nerve cut within my sympathetic nerve area.. I did not do this as im aware that the nerve system is a very delicate and best left alone.
I have continued to suffer from this condition and until the end of 2009 i worked nights so it didnt seem so bad, i have now moved on to a daytime position working outdoors and i cannot handle the intense heat i feel on the right side of my face and neck, I resort to drink at least 5 litres of water to try and help dehydration but sometimes need to retreat and get out of the sun because it will get to a point where i am completely lathargic and dizzy.

Is there a medication to help with this condition ??

James says:

I have it too! But, it just started a few weeks ago. My symptoms started with pain in the left jaw area and a sore left eye with a slightly droopy lid and discoloration. The head pain is gone, but the eye remains the same. Then, after working out not too long ago, I noticed the Harleguin Syndrome. I don’t care about the red-face. My concern is with my eye. All tests have come back negative including an eye exam. Can anyone help me? Every day it looks and feels like somebody poked me in my eye. It’s a real bummer.

phyllis beauvais says:

Dutch, who posted above on April 28th, has started a face book page titled: Ross, Harlequin, Holmes-Adie and Horner’s syndrome.
We are looking for members to share symptoms.
Please check us out.

Karen says:

I’ve have had the same problem. When I workout out or get too hot. I have a perfect line down my face splitting the left side to the right side. The left side is red and soaking wet as the right side is white and dry. No one doctor included could tell me why. I figure it must have be caused by two concussions I received when younger. Must of did some damage to the nerves. I’m now 47 and hope no problems stem from this in the future a bit concerned..

Tracey says:

My son, who is now 9 years old was diagnosed with this as a baby. We were told it was to do with the development on his face ane blood vessels etc and that he would grow out of it. His eye was also smaller on the same side but has since “caught up”. However he does have some learning difficulties, he is very clever academically, but socially and hygeine wise he is like a 5 year old. The trouble is now, his friends have started to laugh at him and he is becoming very withdrawn and not wanting to do anything incase he goes “different colours”. Asking for help is like getting blood out of a stone…..any one else having similar problems/advice?x

Bob Dranberg says:

I have not been officially diagnosed yet I did have a head injury while in the military in 1986 at the time it seemed minor. But a few years later the condition got to a point where people would notice it and i started to worry. I was seeing a dermatologist in the navy and he had no answers. I was also seeing a psycologist and they had no answers. My family doctor was confused as was my back surgeon who has one of the countries top brain surgeons in his practice. My condition is similiar uncomfortable profuse sweating and distinct line on left side of face the overheating is overwhelming. anyone who touches me comments on how hot my body feels. you can feel the heat in my chair after i have sat in one. I too have the spicy food condition but what is odd is that only my right side sweats with spicy food. so the condition switches. which makes no sense if it is a damaged nerve causing one side to not sweat. I am overweight, my blood pressure is elevated, by cholesterol is high as is my sugar all of these are able to be treated with meds. the one thing that is not is my extreme high triglycerides. If I go on an extreme diet I may get my tri’s down to 1000 normally they are 2500 to 4500. I do not drink hard liquor and drink anywhere from 0 to 5 beers a week. so alcohol is not a factor. anyone know a doctor who specializes in this or if you are a doctor who wants to do a case study. I would appreciate any help that could fix or reduce symtems. I have an appointment with family doctor June 28th I will show him this info so he might be able to get me to the right place. I am on facebook if anyone has anything on this please send it as message and not as wall post.

M.P. says:

Holy crap this is so crazy I starting noticing this 4 years ago, after several months of intense training and dieting for a fitness competition…. I’ve asked a few people over the years and finally went to a Dr. about it this week – she had no clue what it was. Then tonight my roommate accidentally discovered this webpage. I’m glad to know it’s benign :) Thanks!!

A.Orell says:

Well, I think all this posts answered a lot of questions that I have about myself since I was a little kid. I’m 39 years old, and my mom says that when I was born she noticed that my right arm was cooler than the other, and while I was growing up I sweat half of my head only (the left side). I remembered playing soccer when I was in elementary school, and my classmates used to looked at me surprised with that weird look, asking me what’s going on with me. Over the years I asked doctors about my condition but nobody seemed to have an answer. The Symptoms are almost the same as everybody else in this posts. But there is something else, when I see oranges, lemons and other citric fruits, the right side of my head (the one with no sweat) feels like is going to start to sweat. That’s really weird. Another thing, because I’m getting old,the same side with no sweat in my head got more gray hair than the other side, and is dryer too. ,,I’m not the only one!! it feels like a relief, or something like that.

JJ.Madd says:

A few weeks ago, I went for a jog outside and noticed that the left side of my face was red. I figured that was the side facing the sun. Today, after running on the treadmill inside the same thing happened and I realized it wasn’t the sun. Interesting, I haven’t had any surgeries recently but had a minor one in the past. I too was in the military, which i found interesting that a couple people who posted were also in the military, but nothing happened there. I will call the doctor just to play it safe and get checked out.

Judy says:

I have had this condition for at least 15 years when I noticed it after running (ie 1/2 face sweating and turning red). I have had really bad magraine headaches for the past 10 years (pretty much on the left hand side) Nothing bad showed up on MRI. I am wondering if it there is a connection.

John M. says:

In 1995,during the time I was a professional house painter,an accident occurred where I fell from the house roof[approx.25ft-30ft.] onto an asphalt driveway.Although I was really lucky not to break any major bones[I had hairline fractures in the calcaneous bone in both legs],I did endure moderate to severe neck pain[whiplash] from the fall.Since that day I only sweat on the left side of my face-profusely! The right side is totally dry at the same time! Also I had severe restriction of movement in my neck,lack of focus and I developed a “lazy eye” on the left side. Drs. said I have herniated disc in the C-4/C-5 area and recommended surgery.However my concern was taking a risk of being permanently parylized-and so I opted out of surgery. The neurosurgeon said that if I could live with the pain, then he wouldn’t operate.He mentioned that if I decided to have it later, the longer I wait the less posibility of a favorable outcome.I guess it wasn’t a life or death thing cause I’m still here!I felt the same way a lot of these people did in that I thought I had something new or without a name.

Susan M H says:

I was diagnosed with Harlequin Syndrome 4 years ago when I was 46. I have very severe headached behind my left eye and back of my head about once a month. I am convinced this is connected to my condition. Recently I have had a problem touching cold things as my fingers start to go red and itch. I recently saw a neurologist who thinks this could be connected to Harlequin. Does anyone else have this condition?

Daniel says:

Hello everyone,

My mother recently had a pretty big surgery to remove the lung cancer from her chest. During the process I think some nerve damage occurred and she now has the symptoms of what can only be Harlequin’s Syndrome where she sweats only on half of her face and upper body.

For those out there that has had a major surgery cause their Harlequin’s, does anybody know if this is something temporary after a major surgery and will get better over time or if it’s permanent?

Thanks Dan

Margaret F H says:

I have had this condition including Horner’s Syndrome for over 35 years ever since having thoracic surgery for the removable of a ganglioneuroma (benign tumor growing between my heart and spine). The doctor mentioned I would experience the Harlequin Syndrome because in order to reach the tumor the nerves that result in sweating or crying were cut (sympathetic nervous system). The only real inconvenience is in very hot weather which I can avoid by staying in air-conditioning. Swimming is my choice of exercise. Since I have had this condition for so long, I have noticed one side of my face is dryer thus more wrinkles (mostly noticable only to me). Also, my hair is thinner on dry side which I’m sure is due to not being normally hydrated. If these Sympathetic Nerves are severed, the condition is usually permanent. Best to ask your surgeon about this possibility. On a lighter note, I only use Right Guard.

VIDAL says:

Bonjour,
je suis atteint aussi d’un syndrome d’harlequin depuis 2004, diagnostiqué en juin 2006. Mes sympthomes sont une hyper transpiration sur le côté droit de mon tronc, tout le reste est sans sueur, provoquant une hyperthermie execive lors de forte chaleur ou d’une activité physique intensive ou ma température corporelle peut atteindre près de 40°0. Cela provoque une gène sociale de l’excés de sueur sur le côté droit du tronc et des coups de chaleur lorsque la température dépasse 24°0. Si quelqu’un a des solutions thérapeutiques suite à ses sympthomes je suis à leurs dispositions.
Cordialement.

Wendy E says:

I’m so relieved to find out I’m not the only one. I also sweat profusely on my torso and legs. I have to buy clothes that are patterned and synthetic so as not to show the sweating. My doctor ignored it when I mentioned it, but will now mention it again. I had major chest surgery 30 years ago, and found it interesting that others have mentioned chest problems. Thank you for this site!

Duncan M says:

I have had Harlequins for as long as I can remember (from birth). I have had no real side effects except, of course, the high levels of sweating on one side when exercising. I also have the associated Horner’s syndrome but again no side effects. For those who do a lot of exercise just two observations. Firstly make sure you keep your electrolyte levels high as I have noticed I sweat out salts at a faster rate than is average, in turn affecting performance for endurance based sessions. Secondly keep applying the sun cream – because you sweat off the sun protection at a faster rate you can end up with a darker tan on one side of the face! Reading some of the posts there may be different degrees of effect (and discomfort) for those who have had the impact event in adulthood against those in childhood – perhaps the body has had time to adapt better in the latter cases? Best wishes Duncan

Sandy says:

I am a 40 year old healthy female. I’ve notice years back that only half my body sweats. My right side after a work out or when ever I sweat, right side of my head, face, torso, butt and legs, (right side of my head my hair gets totally wet after a work out but my left side is totally dry, so is the rest of my body) half is sweaty, it looks like a line in the middle of my face, I also have notice thats is getting worse, is this normal?

Natasha says:

Hi, i have congential horners Syndrome and i found a wonderful support group on facebook for people just like us : Ross, Harlequin, Holmes-Adie and Horner’s Syndrome…have a look:)

Rick says:

Hello everyone, I have had harlequin all my life (21 year) without horners syndrome, major injuries or tumors that caused it. Just born with it. It only shows after a hard work-out, when the difference between the 2 sides gets accentuated. Ive never been ashamed of it, and neither should you! It is part of who you are, accept it ;) If it is not caused by a disease suddenly later in life, then im sure it is harmless, and I find it just a funny side-effect which shows real hard work regarding myself. For those of you who suddenly got this effect, I suggest to go and see a doctor, as there might be a certain cause to it.

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