82: Bromhidrosis and Chromhidrosis

Question 1

What is bromhidrosis and how does it differ from osmidrosis?

Answer 1

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.

Question 2

What are the common causes of bromhidrosis?

Answer 2

Common causes of bromhidrosis include bacterial action on apocrine secretions, hormonal factors, dietary influences, and genetic factors.

Question 3

What are the typical treatment options for bromhidrosis?

Answer 3

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.

Question 4

What is the epidemiology of bromhidrosis?

Answer 4

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.

Question 5

What are the differential diagnoses for bromhidrosis?

Answer 5

Differential diagnoses for bromhidrosis include eccrine bromhidrosis, fish odor syndrome, phenylketonuria, isovaleric acidemia, hyperhidrosis, and other metabolic disorders.

Question 6

What is the characteristic location for eccrine bromhidrosis?

Answer 6

The plantar location is characteristic for eccrine bromhidrosis.

Question 7

What bacterial species is most commonly associated with axillary bromhidrosis?

Answer 7

Corynebacterium species are most commonly associated with axillary bromhidrosis.

Question 8

What is the biochemical mechanism of Corynebacterium species in bromhidrosis?

Answer 8

These bacteria transform nonodoriferous precursors in sweat into malodorous compounds through the action of zinc-dependent N-alpha-acyl-glutamine aminoacylase.

Question 9

What genetic factor might predispose a patient to bromhidrosis?

Answer 9

A strong relationship exists between bromhidrosis and wet earwax, associated with the single nucleotide polymorphism rs17822931 of the ABCC11 gene.

Question 10

What is the rationale behind advising a patient to remove axillary hair?

Answer 10

Removing axillary hair minimizes odor by preventing the accumulation of bacteria and sweat on the hair shafts.

Question 11

What is the purpose of using aluminum chloride hexahydrate in bromhidrosis treatment?

Answer 11

Aluminum chloride hexahydrate acts as an antiperspirant, reducing sweat production and thereby minimizing odor.

Question 12

Which foods should patients with bromhidrosis avoid?

Answer 12

Patients should avoid foods like garlic, curry, and alcohol, as these can contribute to eccrine bromhidrosis by introducing odoriferous compounds into sweat.

Question 13

What are the potential risks of surgical removal of apocrine glands?

Answer 13

Surgical removal of apocrine glands may be associated with postoperative scars, prolonged healing times, and infection.

Question 14

What inheritance pattern has been proposed for apocrine bromhidrosis?

Answer 14

An autosomal dominant inheritance pattern has been proposed for apocrine bromhidrosis.

Question 15

What is the rationale behind advising the use of antibacterial soaps for bromhidrosis?

Answer 15

Antibacterial soaps reduce the bacterial flora responsible for transforming sweat components into malodorous compounds, thereby minimizing odor.

Question 16

What is the purpose of using perfumes for bromhidrosis?

Answer 16

Perfumes can mask the unpleasant odor associated with bromhidrosis.

Question 17

What metabolic condition can result in a fishy body odor?

Answer 17

Trimethylaminuria, also known as fish odor syndrome, can result in a fishy body odor.

Question 18

What are the primary causes of bromhidrosis?

Answer 18

Bromhidrosis is primarily caused by excessive or particularly unpleasant body odor arising from apocrine and eccrine glands, often in the axillae.

Question 19

How does the epidemiology of bromhidrosis differ between genders?

Answer 19

Bromhidrosis shows a male predominance, possibly due to greater apocrine gland activity in men.

Question 20

What are the treatment options available for managing bromhidrosis?

Answer 20

Treatment options include frequent washing, deodorants, removal of axillary hair, antibacterial soaps, injection of botulinum toxin A, and surgical options.

Question 21

What are common findings associated with chromhidrosis?

Answer 21

Common findings include warm sensation before secretion, triggers from emotional or physical stimuli, and staining of clothing.

Question 22

What is the etiology of chromhidrosis?

Answer 22

The etiology includes lipofuscins produced in apocrine secretory cells, which are excreted to the skin surface.

Question 23

What tests are used to diagnose chromhidrosis?

Answer 23

Tests include examination of secretions using a Wood light, manual expression of secretions, and bacterial cultures.

Question 24

What are the treatment options for chromhidrosis?

Answer 24

Adequate therapy for chromhidrosis is lacking, but manual expression may provide temporary symptom relief.

Question 25

What is the primary advantage of liposuction curettage for bromhidrosis?

Answer 25

Liposuction curettage is preferred due to fewer complications and its ability to liquefy fat and sweat glands.

Question 26

What triggers colored sweating in chromhidrosis?

Answer 26

Triggers include emotional and physical stimuli.

Question 27

What is the significance of yellow fluorescence under a Wood light in chromhidrosis?

Answer 27

It confirms the presence of lipofuscin granules in the sweat.

Question 28

What is the underlying cause of pigmentation in chromhidrosis?

Answer 28

The pigmentation is caused by lipofuscin granules in a higher state of oxidation.

Question 29

What diagnostic test can confirm the presence of chromhidrosis?

Answer 29

An examination using a Wood light produces characteristic yellow fluorescence.

Question 30

What triggers the tingling sensation before sweating in chromhidrosis?

Answer 30

Triggers include emotional or physical stimuli.

Question 31

What is the nature of secretions in chromhidrosis?

Answer 31

The secretions are odorless, dry quickly, and appear as dark flecks.

Question 32

What therapeutic benefit does manual expression of colored secretions provide in chromhidrosis?

Answer 32

It may result in temporary improvement in symptoms for 48 to 72 hours.

Question 33

What is the most common site for facial chromhidrosis?

Answer 33

Facial chromhidrosis commonly develops near the lower eyelid and malar cheeks.

Question 34

What might be the reason if colored sweat does not fluoresce under a Wood light?

Answer 34

Black or brown pigments in chromhidrosis rarely autofluoresce.

Question 35

What histological findings support the diagnosis of chromhidrosis?

Answer 35

Findings include eosinophilic cytoplasm and lipofuscin granules in apocrine sweat glands.

Question 36

What diagnostic tool can confirm the presence of chromhidrosis through stained clothing?

Answer 36

Stained clothing may fluoresce under a Wood lamp examination.

Question 37

What potential side effect should a patient be aware of when considering laser hair removal for bromhidrosis?

Answer 37

Laser hair removal has been associated with the intensification of bromhidrosis.

Question 38

What is the typical quantity of pigmented sweat produced in chromhidrosis?

Answer 38

The quantity is usually small, approximately 0.001 mL at each follicular orifice.

Question 39

Do rosis autofluoresce under a Wood light?

Answer 39

Rosis rarely autofluoresce under a Wood light.

Question 40

What histological findings support the diagnosis of chromhidrosis?

Answer 40

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.

Question 41

What are the primary surgical procedures used for treating bromhidrosis?

Answer 41

The primary surgical procedures for treating bromhidrosis include: 1. Superficial liposuction - Removes excess tissue and fat from the area. 2. Tumescent superficial liposuction with curettage - Involves injecting a solution to help liquefy fat and sweat glands before removal. 3. Ultrasound-assisted liposuction - Uses ultrasound to facilitate the liquefaction of fat and sweat glands for easier removal. 4. Liposuction curettage - A combination technique that is preferred due to fewer complications. 5. Laser hair removal - Although primarily for hair removal, it can intensify bromhidrosis symptoms. 6. Microwave-based devices - These are also used in the treatment process.

Question 42

What are the clinical findings associated with chromhidrosis?

Answer 42

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.

Question 43

What tests are used to diagnose chromhidrosis?

Answer 43

Tests for diagnosing chromhidrosis include: 1. Wood light examination - Yellow fluorescence indicates the presence of colored secretions. 2. Manual expression of secretions - Can confirm the presence of colored sweat if not visible during examination. 3. Stained clothing examination - May fluoresce under Wood lamp examination. 4. Injection of epinephrine or oxytocin - Stimulates apocrine glands to produce colored secretions. 5. Complete blood cell count - Excludes bleeding diathesis. 6. Homogentisic levels in urine - Excludes alkaptonuria. 7. Bacterial and fungal cultures - Exclude pseudoeccrine chromhidrosis. 8. Pathological examination - Reveals eosinophilic cytoplasm and increased lipofuscin granules in apocrine glands, which are positive on periodic acid-Schiff stains.

Question 44

What is the etiology of chromhidrosis?

Answer 44

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.

Question 45

What treatment has been found successful for facial chromhidrosis?

Answer 45

Botulinum toxin type A has been successful in one patient with facial chromhidrosis, sustained for 4 months.

Question 46

What is the role of capsaicin in the treatment of chromhidrosis?

Answer 46

Capsaicin is a topical cream that depletes and prevents reaccumulation of substance P levels in unmyelinated, slow-conducting type C sensory fibers.

Question 47

What is the most effective treatment for pseudochromhidrosis?

Answer 47

Topical and oral erythromycin seems to be the most effective treatment for pseudochromhidrosis.

Question 48

How does the prognosis of chromhidrosis change with age?

Answer 48

Chromhidrosis is a chronic disease that improves in old age as apocrine gland activity diminishes.

Question 49

What is a significant psychosocial impact associated with chromhidrosis?

Answer 49

Disease-associated morbidity is a result of psychosocial dysfunction experienced by affected individuals.

Question 50

What is the mechanism of action of capsaicin cream in treating facial chromhidrosis?

Answer 50

Capsaicin depletes and prevents the reaccumulation of substance P levels in unmyelinated, slow-conducting type C sensory fibers, reducing symptoms of chromhidrosis.

Question 51

What is the expected outcome of botulinum toxin injections for bromhidrosis?

Answer 51

Botulinum toxin type A injections can successfully treat bromhidrosis by reducing sweat production, with effects lasting up to 4 months.

Question 52

What is the mechanism of action of botulinum toxin in treating chromhidrosis?

Answer 52

Botulinum toxin reduces sweat production by inhibiting acetylcholine release at the neuromuscular junction, thereby alleviating symptoms of chromhidrosis.

Question 53

What is the expected duration of symptom relief from botulinum toxin injections for bromhidrosis?

Answer 53

Botulinum toxin type A injections can provide symptom relief for up to 4 months.

Question 54

What treatment has shown success in managing facial chromhidrosis?

Answer 54

Botulinum toxin type A has been successful in one patient with facial chromhidrosis, sustaining its effect for 4 months.

Question 55

What is the mechanism of action of capsaicin in treating bromhidrosis?

Answer 55

Capsaicin is a topical cream that depletes and prevents the reaccumulation of substance P levels in unmyelinated, slow-conducting type C sensory fibers.

Question 56

How does the prognosis of bromhidrosis change with age?

Answer 56

Bromhidrosis is a chronic disease that improves in old age as apocrine gland activity diminishes.

Question 57

What psychosocial impact is associated with bromhidrosis?

Answer 57

Disease-associated morbidity in bromhidrosis is a result of psychosocial dysfunction experienced by affected individuals.