Thank you for the timely article titled “Preventing heat-related illness: Identifying workers at risk of heat stress due to hotter days in the context of climate change” by May, Janke, and Maruti [BCMJ 2024;66:179-180]. We would like to comment on the description of heatstroke signs, specifically the description of the skin as being dry and nonsweating. While such presentation is typical for classic heatstroke, which occurs in the elderly, small children, and some deconditioned individuals, it is not typical for exertional stroke, where metabolic heat generation plays a role. This type of heatstroke can be seen in those who perform physical work in hot environments. Exertional heatstroke may present with wet and sweating skin. Epstein and Yanovich[1] describe the two types of heatstroke well. Importantly, listing dry skin without sweating at the beginning of the description of signs and symptoms is misleading, as it may lead to delayed early identification of exertional heatstroke. We suggest it is important to inform clinicians and the public not to rely on dry skin and the absence of sweating as important signs of heatstroke.
—Marina Afanasyeva, MD, MPH, PhD, FRCPC
Toronto, ON
—Nikhil Rajaram, MD, FCFP, MPH, FRCPC
Toronto, ON

This letter was submitted in response to “Preventing heat-related illness: Identifying workers at risk of heat stress due to hotter days in the context of climate change.” [11]

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [12].

References

1.    Epstein Y, Yanovich R. Heatstroke. N Engl J Med 2019;380:2449-2459.