82: Bromhidrosis and Chromhidrosis Flashcards
What is bromhidrosis and how does it differ from osmidrosis?
Bromhidrosis is an offensive body odor that is excessive or particularly unpleasant, primarily arising from apocrine and eccrine glands, most often in the axillae. Osmidrosis implies an offensive odor, while bromhidrosis implies osmidrosis in the context of concomitant hyperhidrosis.
What are the common causes of bromhidrosis?
Common causes of bromhidrosis include bacterial action on apocrine secretions, hormonal factors, dietary influences, and genetic factors.
What are the typical treatment options for bromhidrosis?
Treatment options for bromhidrosis include frequent washing and use of deodorants or antiperspirants, removal of axillary hair, use of antibacterial soaps, injection of botulinum toxin A, surgical options, and CO2 laser ablation.
What is the epidemiology of bromhidrosis?
Bromhidrosis shows a male predominance after puberty, no seasonal or geographic predilection, increased severity in summer months or warm climates, and is usually an individual condition.
What are the differential diagnoses for bromhidrosis?
Differential diagnoses for bromhidrosis include eccrine bromhidrosis, fish odor syndrome, phenylketonuria, isovaleric acidemia, hyperhidrosis, and other metabolic disorders.
What is the characteristic location for eccrine bromhidrosis?
The plantar location is characteristic for eccrine bromhidrosis.
What bacterial species is most commonly associated with axillary bromhidrosis?
Corynebacterium species are most commonly associated with axillary bromhidrosis.
What is the biochemical mechanism of Corynebacterium species in bromhidrosis?
These bacteria transform nonodoriferous precursors in sweat into malodorous compounds through the action of zinc-dependent N-alpha-acyl-glutamine aminoacylase.
What genetic factor might predispose a patient to bromhidrosis?
A strong relationship exists between bromhidrosis and wet earwax, associated with the single nucleotide polymorphism rs17822931 of the ABCC11 gene.
What is the rationale behind advising a patient to remove axillary hair?
Removing axillary hair minimizes odor by preventing the accumulation of bacteria and sweat on the hair shafts.
What is the purpose of using aluminum chloride hexahydrate in bromhidrosis treatment?
Aluminum chloride hexahydrate acts as an antiperspirant, reducing sweat production and thereby minimizing odor.
Which foods should patients with bromhidrosis avoid?
Patients should avoid foods like garlic, curry, and alcohol, as these can contribute to eccrine bromhidrosis by introducing odoriferous compounds into sweat.
What are the potential risks of surgical removal of apocrine glands?
Surgical removal of apocrine glands may be associated with postoperative scars, prolonged healing times, and infection.
What inheritance pattern has been proposed for apocrine bromhidrosis?
An autosomal dominant inheritance pattern has been proposed for apocrine bromhidrosis.
What is the rationale behind advising the use of antibacterial soaps for bromhidrosis?
Antibacterial soaps reduce the bacterial flora responsible for transforming sweat components into malodorous compounds, thereby minimizing odor.
What is the purpose of using perfumes for bromhidrosis?
Perfumes can mask the unpleasant odor associated with bromhidrosis.
What metabolic condition can result in a fishy body odor?
Trimethylaminuria, also known as fish odor syndrome, can result in a fishy body odor.
What are the primary causes of bromhidrosis?
Bromhidrosis is primarily caused by excessive or particularly unpleasant body odor arising from apocrine and eccrine glands, often in the axillae.
How does the epidemiology of bromhidrosis differ between genders?
Bromhidrosis shows a male predominance, possibly due to greater apocrine gland activity in men.
What are the treatment options available for managing bromhidrosis?
Treatment options include frequent washing, deodorants, removal of axillary hair, antibacterial soaps, injection of botulinum toxin A, and surgical options.
What are common findings associated with chromhidrosis?
Common findings include warm sensation before secretion, triggers from emotional or physical stimuli, and staining of clothing.
What is the etiology of chromhidrosis?
The etiology includes lipofuscins produced in apocrine secretory cells, which are excreted to the skin surface.
What tests are used to diagnose chromhidrosis?
Tests include examination of secretions using a Wood light, manual expression of secretions, and bacterial cultures.
What are the treatment options for chromhidrosis?
Adequate therapy for chromhidrosis is lacking, but manual expression may provide temporary symptom relief.
What is the primary advantage of liposuction curettage for bromhidrosis?
Liposuction curettage is preferred due to fewer complications and its ability to liquefy fat and sweat glands.
What triggers colored sweating in chromhidrosis?
Triggers include emotional and physical stimuli.
What is the significance of yellow fluorescence under a Wood light in chromhidrosis?
It confirms the presence of lipofuscin granules in the sweat.
What is the underlying cause of pigmentation in chromhidrosis?
The pigmentation is caused by lipofuscin granules in a higher state of oxidation.
What diagnostic test can confirm the presence of chromhidrosis?
An examination using a Wood light produces characteristic yellow fluorescence.
What triggers the tingling sensation before sweating in chromhidrosis?
Triggers include emotional or physical stimuli.
What is the nature of secretions in chromhidrosis?
The secretions are odorless, dry quickly, and appear as dark flecks.
What therapeutic benefit does manual expression of colored secretions provide in chromhidrosis?
It may result in temporary improvement in symptoms for 48 to 72 hours.
What is the most common site for facial chromhidrosis?
Facial chromhidrosis commonly develops near the lower eyelid and malar cheeks.
What might be the reason if colored sweat does not fluoresce under a Wood light?
Black or brown pigments in chromhidrosis rarely autofluoresce.
What histological findings support the diagnosis of chromhidrosis?
Findings include eosinophilic cytoplasm and lipofuscin granules in apocrine sweat glands.
What diagnostic tool can confirm the presence of chromhidrosis through stained clothing?
Stained clothing may fluoresce under a Wood lamp examination.
What potential side effect should a patient be aware of when considering laser hair removal for bromhidrosis?
Laser hair removal has been associated with the intensification of bromhidrosis.
What is the typical quantity of pigmented sweat produced in chromhidrosis?
The quantity is usually small, approximately 0.001 mL at each follicular orifice.
Do rosis autofluoresce under a Wood light?
Rosis rarely autofluoresce under a Wood light.
What histological findings support the diagnosis of chromhidrosis?
Histological findings include luminal cells of the apocrine sweat glands with eosinophilic cytoplasm, a large nucleus, and lipofuscin granules that are periodic acid–Schiff–positive and diastase-resistant.
What are the primary surgical procedures used for treating bromhidrosis?
The primary surgical procedures for treating bromhidrosis include:
- Superficial liposuction - Removes excess tissue and fat from the area.
- Tumescent superficial liposuction with curettage - Involves injecting a solution to help liquefy fat and sweat glands before removal.
- Ultrasound-assisted liposuction - Uses ultrasound to facilitate the liquefaction of fat and sweat glands for easier removal.
- Liposuction curettage - A combination technique that is preferred due to fewer complications.
- Laser hair removal - Although primarily for hair removal, it can intensify bromhidrosis symptoms.
- Microwave-based devices - These are also used in the treatment process.
What are the clinical findings associated with chromhidrosis?
Clinical findings of chromhidrosis include:
- Warm, prickling sensation or tingling feeling before apocrine gland secretion.
- Triggers for colored sweating include emotional or physical stimuli.
- Staining of undershirts and handkerchiefs is common.
- Colored sweat can appear in the axillae, face, or mammary areolae, with colors ranging from yellow to blue, green, brown, or black.
- Quantity of pigmented sweat produced is usually small (approximately 0.001 mL at each follicular orifice).
- Droplets are odorless and dry quickly, while dried secretions appear as dark flecks in affected areas.
- Facial chromhidrosis often develops near the lower eyelid and may affect the malar cheeks and forehead.
What tests are used to diagnose chromhidrosis?
Tests for diagnosing chromhidrosis include:
- Wood light examination - Yellow fluorescence indicates the presence of colored secretions.
- Manual expression of secretions - Can confirm the presence of colored sweat if not visible during examination.
- Stained clothing examination - May fluoresce under Wood lamp examination.
- Injection of epinephrine or oxytocin - Stimulates apocrine glands to produce colored secretions.
- Complete blood cell count - Excludes bleeding diathesis.
- Homogentisic levels in urine - Excludes alkaptonuria.
- Bacterial and fungal cultures - Exclude pseudoeccrine chromhidrosis.
- Pathological examination - Reveals eosinophilic cytoplasm and increased lipofuscin granules in apocrine glands, which are positive on periodic acid-Schiff stains.
What is the etiology of chromhidrosis?
The etiology of chromhidrosis involves:
- Lipofuscins (golden color) produced in apocrine secretory cells, which are excreted to the skin surface.
- In chromhidrosis, lipofuscin granules undergo higher oxidation states, resulting in various colors of pigment (yellow, green, blue, or black).
- Higher oxidation states produce darker colors.
- Nerve endings with receptors for substance P around eccrine sweat glands suggest that this vasodilator may influence sweat production and chromhidrosis.
- True eccrine chromhidrosis is rare and occurs when water-soluble pigments are excreted from eccrine glands after ingesting certain dyes or drugs, such as quinine or cranberry juice.
What treatment has been found successful for facial chromhidrosis?
Botulinum toxin type A has been successful in one patient with facial chromhidrosis, sustained for 4 months.
What is the role of capsaicin in the treatment of chromhidrosis?
Capsaicin is a topical cream that depletes and prevents reaccumulation of substance P levels in unmyelinated, slow-conducting type C sensory fibers.
What is the most effective treatment for pseudochromhidrosis?
Topical and oral erythromycin seems to be the most effective treatment for pseudochromhidrosis.
How does the prognosis of chromhidrosis change with age?
Chromhidrosis is a chronic disease that improves in old age as apocrine gland activity diminishes.
What is a significant psychosocial impact associated with chromhidrosis?
Disease-associated morbidity is a result of psychosocial dysfunction experienced by affected individuals.
What is the mechanism of action of capsaicin cream in treating facial chromhidrosis?
Capsaicin depletes and prevents the reaccumulation of substance P levels in unmyelinated, slow-conducting type C sensory fibers, reducing symptoms of chromhidrosis.
What is the expected outcome of botulinum toxin injections for bromhidrosis?
Botulinum toxin type A injections can successfully treat bromhidrosis by reducing sweat production, with effects lasting up to 4 months.
What is the mechanism of action of botulinum toxin in treating chromhidrosis?
Botulinum toxin reduces sweat production by inhibiting acetylcholine release at the neuromuscular junction, thereby alleviating symptoms of chromhidrosis.
What is the expected duration of symptom relief from botulinum toxin injections for bromhidrosis?
Botulinum toxin type A injections can provide symptom relief for up to 4 months.
What treatment has shown success in managing facial chromhidrosis?
Botulinum toxin type A has been successful in one patient with facial chromhidrosis, sustaining its effect for 4 months.
What is the mechanism of action of capsaicin in treating bromhidrosis?
Capsaicin is a topical cream that depletes and prevents the reaccumulation of substance P levels in unmyelinated, slow-conducting type C sensory fibers.
How does the prognosis of bromhidrosis change with age?
Bromhidrosis is a chronic disease that improves in old age as apocrine gland activity diminishes.
What psychosocial impact is associated with bromhidrosis?
Disease-associated morbidity in bromhidrosis is a result of psychosocial dysfunction experienced by affected individuals.
