15 - 82 - BROMHIDROSIS AND CHROMHIDROSIS Flashcards
refers to an offensive or unpleasant body odor arising from apocrine or eccrine gland secretions
Bromhidrosis
best-characterized short-chain fatty acid causing odor
-3-methyl-2-hexenoic acid
Body odor
osmidrosis
The terminology in the literature is sometimes confusing, using osmidrosis to imply offensive odor, and bromhidrosis to imply osmidrosis in the setting of concomitant hyperhidrosis (excessive eccrine sweat gland secretion)
predominantly responsible for odor production
Apocrine secretion
odorous steroids
pheromones, among them 16-androstenes, 5α-androstenol, and 5α-androstenone, contribute to osmidrosis
Individuals with osmidrosis have increased levels of what enzyme in their apocrine glands
5α-reductase
- Because this enzyme catalyzes the conversion of testosterone to 5α-dihydrotestosterone, levels of 5α-dihydrotestosterone may be greater than testosterone in the skin of affected individuals
Bromhidrosis has been particularly associated with the action of what bacteria?
aerobic Corynebacterium species.
Axillary bacterial florae produce the distinctive axillary odor by transforming nonodoriferous precursors in sweat to what substance?
ammonia and short-chain, malodorous, volatile fatty acids
The most common of these are ε-3-methyl-2-hexenoic acid and (RS)-3-hydroxy-3-methlyhexanoic acid, which are released through the action of a specific zinc-dependent N-alpha-acyl-glutamine aminoacylase from Corynebacterium species
what location is characteristic for eccrine bromhidrosis?
plantar
Certain foods (garlic, curry, alcohol), drugs (bromides), toxins, or metabolic causes (disorders of amino acid metabolism) may result in eccrine bromhidrosis; the latter being fish odor syndrome (trimethylaminuria), phenylketonuria, cat syndrome, isovaleric acidemia, hypermethioninemia, and food, drug, toxin ingestion
most commonly affected site of bromhidrosis
axillae
although the genitals or plantar feet also may be affected
general measures for bromhidrosis
- Frequent washing of the axillae,
- use of a deodorant or antiperspirant (aluminum chloride hexahydrate), perfumes, and changing of soiled clothing can help.
- Removal of axillary hair may minimize odor by preventing bacteria and sweat accumulation on the hair shafts.
- Antibacterial soaps or topical antibacterial agents also may be beneficial
Nonsurgical and surgical therapy for bromhidrosis
- injection of botulinum toxin A has been reported to successfully treat genital and axillary bromhidrosis
* frequency-doubled, quality switched neodymium:yttrium-aluminum-garnet laser also has been reported to be an effective noninvasive therapy for axillary bromhidrosis
** Upper thoracic sympathectomy *has been successful in treating apocrine bromhidrosis either in isolation or in association with palmar hyperhidrosis - Surgical removal of the culprit apocrine glands can be achieved either by the removal of subcutaneous tissue in isolation or in combination with axillary skin
- CO2 laser ablation - surgical subcutaneous tissue removal
- Superficial liposuction, tumescent superficial liposuction with curettage, and ultrasound-assisted liposuction, as well as their combinations, have efficacy in the management of apocrine bromhidrosis
can be considered the primary choice among surgical procedures used to treat patients with bromhidrosis because of its fewer complications
Liposuction curettage
may be associated with intensification of bromhidrosis.
laser hair removal
Rare, chronic condition characterized by the secretion of colored sweat
CHROMHIDROSIS
- Onset of chromhidrosis is usually at puberty, at the time of increased apocrine gland activity.
- However, rare cases of onset in infancy have been reported.
- The disease persists throughout life, improving in the aged.
- It is reported most commonly in African Americans.
- Individuals with chromhidrosis often describe a sensation of **warmth, a prickling sensation, or tingling feeling before apocrine gland secretion. **
- Triggers for colored sweating are usually emotional or physical stimuli
most common sites from chromhidrosis
Axillary and facial involvement
Areola involvement has been reported.
Chromhidrosis is caused by an increased number of what granules in the luminal secretory cells of the apocrine glands?
lipofuscin granules
pigment responsible for causing apocrine chromhidrosis
lipofuscins that are produced in the apocrine secretory cells and excreted to the skin surface
- Lipofuscin is a golden-colored pigment that is not specific to apocrine glands.
- In chromhidrosis, the lipofuscin granules are in a higher state of oxidation, thereby imparting various colors of pigment, such as yellow, green, blue, or black.
- Higher states of oxidation produce darker colors
examination used to visualize chromhidrosis
- An examination of yellow, blue, or green secretions using a **Wood light (360 nm) **produces a characteristic yellow fluorescence.
- Black or brown pigment rarely autofluoresces.
- Secretions can be manually expressed if not present at the time of examination.
- Stained clothing may also fluoresce with Wood lamp examination.
- Apocrine glands can be stimulated to produce colored secretions by the injection of epinephrine or oxytocin.
refers to the development of colored sweat when surface compounds or molecules mix with sweat to produce pigment
Pseudoeccrine chromhidrosis
- A classic example of this type is the formation of blue sweat in copper workers.
- Extrinsic dyes, paints, fungi, and chromogenic bacteria (eg, Corynebacterium species) are other causes of pseudochromhidrosis
- For pseudochromhidrosis,** topical and oral erythromycin** seems to be the most effective treatment, both in unidentified and identified chromogenic bacteria cases.
topical cream that depletes and prevents reaccumulation of substance P levels in unmyelinated, slow-conducting type C sensory fibers
Capsaicin
- Case reports demonstrate the efficacy of capsaicin in the treatment of facial chromhidrosis
