The bromhidrosis is a chronic condition where the smell given off by the skin becomes unpleasant. When the smell is particularly intense or significantly interfere with social life, bromhidrosis assumes pathological aspects and requires specialist treatment. This disorder is largely linked to the secretion produced by the apocrine glands. It can be of constitutional character, or depends on skin alterations of certain regions (hands, toes) or the most superficial layers of the epidermis (as happens in certain bacterial or fungal infections). The bromhidrosis concerns all individuals in post-pubertal stage, but its incidence is still considered rare. Bromhidrosis indicates an intensification of physiological body odors. It can develop axillary, from the level of the soles of the feet or the scalp and is not necessarily associated with hyperhidrosis. Physiologically the body gives off a characteristic odour: this depends mainly on the type and quantity of bacterial flora, which metabolizes secreted substances from glands or cheratinocitaria junction (scalp = sweat and sebum; armpits = sweat; foot = sweat and keratin). Even the intervention of certain factors such as the presence of pathological conditions, hormonal changes in an individual, certain foods and taking certain drugs affect body odor.
TYPES Of GLANDS AND THEIR FUNCTIONS
Apocrine sweat glands
Apocrine glands are present only in some areas: their distribution is limited to armpits, breast areolas, perineal and inguinal region. Some apocrine elements are inperiorbital areas (eyelid margin) and periauricolar (external acoustic meatus).
Apocrine glands are small and inactive during childhood, do not play a role in thermoregulation, but are responsible for the characteristic feromonal smell (whose function is to stimulate sexual interest, particulariin animals). The glands produce, starting at puberty, a sweat apocrine white-yellowish, pungent and rich of various organic substances (carbohydrates, proteins, lipids) and inorganic materials (such as iron). Excessive production of this sweat can cause an unpleasant odor and create problems in interpersonal relationships. The emission of characteristic odor occurs as a result of bacterial decomposition of secreted, which take place on the surface of the skin. Some studies show that individuals with bromhidrosis have larger apocrine glands. The apocrine glands control seems to be regulated by the sympathetic system through peripheral mechanisms regulated by catecholamines. Though both types of bromhidrosis can occur in people of every race, gender and age, there are some differences between the two forms:
The apocrine bromhidrosis is the most widespread and should be distinguished from eccrine, less common form. The factors contributing to pathogenesis are different: the products of bacterial decomposition of sweat apocrine contain ammonia and short-chain fatty acids; their presence produces characteristic smells, strong and pungent.
The skin appears normal, but usually when the bromhidrosis is associated with concomitant dermatologic diseases such as Erythrasma (bacterial, infection due to Corynebacterium minutissimum, which proliferates in moist areas, such as skin folds). The apocrine bromhidrosis is more common in many Asian countries, often associated with a positive family history. Most cases affects predominantly males and occurs after puberty (depends on apocrine function), so it’s rare in elderly .
In some cases, eccrine secretions whitch is usually odorless can have invasive smell . The main cause of this form of bromhidrosis is the bacterial degradation of keratin in combination with eccrine sweat, which produces a bad smell. The ingestion of certain foods, such as garlic, onion, curry, alcohol, certain medications (e.g. penicillin and bromides) and toxins can cause bromhidrosis eccrine. Finally, this form of disturbance can be caused by metabolic causes (e.g. example: trimethylaminuria or fish-odor syndrome, which causes a defect in the degradation of trimethylamine, which is also released through sweating). The bromhidrosis eccrine occurs in people of all races and can occur at any age.
CAUSES OF BROMHIDROSIS
The main cause that leads to the production of smell associated with secretion of sweat, can be traced back to an anomaly for quantity and quality of this phenomenon. The sweat that reaches the skin surface is initially odorless: excessive secretion from eccrine glands or apocrine is attacked by indigenous bacteria that live on our skin, which produce certain substances “volatile” chemicals that can become, in some cases, smelly. For example, the maceration of keratin induced by the amount of excess sweat can produce an unpleasant odor.
- Factors such as inadequate hygiene, medical or dermatological conditions, Hyperhidrosis or excessive growth of cutaneous bacterial flora, can contribute to the onset of the disorder.
- Some conditions that favour the onset of bromhidrosis are: trimethylaminuria, phenylketonuria, kidney-liver, brucellosis etc.
- Coexistence of dermatosis that can contribute to odor: intertrigo, Mycosis etc.
- Pathological conditions which contribute to the occurrence of bromhidrosis: diabetes, obesity: overweight people tend to sweat more than a normal person. This arrangement translates into the ability to adopt unpleasant odor with perspiration.
- Food type: should be limited consumption of spicy foods, garlic, onions, alcohol and caffeine. Drinking lots of water helps to dilute the sweat and dampen the smell.
- Any drugs that the patient takes occasionally or on a regular basis.
- Familiarity: most patients family members suffer from bromhidrosis. A clinical study has an autosomal dominant pattern.
- Some medical tests link the source of odors with conditions such as gout, scurvy, typhus, or as a result of the extraction of metabolites in sweat.
BROMHIDROSIS DIAGNOSTIC TESTS
The bromhidrosis is a metabolic and functional disorder, not generally associated with any anatomical disorder. The skin appears normal, except in cases of concomitant dermatological disorders, such as Erythrasma, which manifests itself as a strong macular eruption (similar to a fungal disease) or axillary trichomychosis, a superficial bacterial infection that is located on the affected area ( organic formations visible on hair). There is no instrumental machines that measure human body odor, as have not yet been standardized specific tests of blood or sweat.
The first medical examination is entrusted to subjective perception of smell (for this it is important not to cover the natural body odor so and not to invalidate the test). In addition, in order to highlight an alteration of bacterial flora you can collect a sample of sweat for microbiological examination, and/or inspect the skin surface with a Wood’s lamp, which provides information on the presence of bacteria (Corynebacterium) or particular substances.
How to handel the bromhidros
The most effective solution for preventing this condition is to try to reduce the sweat at a normal level: there are several treatment options that enable you to manage the bromhidrosis.
Proper management of bromhidrosis is important to distinguish the subjective evaluation of odor from the skin disorder real: those who mask body odor should understand that the symptoms will not be eliminated until the basic conditions are treated.
The moisture management and thorough cleansing often are not sufficient; then, you must:
Check out the factors that favor bacterial proliferation: underarm hair removal, choice of socks&footwear breathable,etc. Use products that inhibit bacterial overgrowth.
Keep your skin dry zone (such as the armpit in apocrine bromhidrosis).Hygiene and topical therapy are the main treatment options for mild cases of bromhidrosis and may include the following actions: washing underarm hair at least twice a day with germicidal soap;regular epilation of hairs to prevent buildup of bacteria and sweat on the hair shaft or electrolysis to remove the follicle; prompt removal of sweaty clothing;use of topical deodorants;
Treatments of dermatological diseases that coexist (fungal or bacterial infections favorite alteration of the skin).These treatments do not offer a definitive cure for the bromhidrosis and the results can be partial. A visit to the doctor can provide permanent treatment options including surgeries like removal of apocrine sweat glands by surgical excision or superficial liposuction
If Hyperhidrosis is a condition for the bromhidrosis, it would be useful to treat early in the primary cause of excessive sweating.
Therefore there can be considered the following treatment options:
- use of anti-perspiring
- anticholinergics or beta blockers drugs
- injection of botulinum toxin;
- surgery (surgical sympathectomy, superficial liposuction …).
If bromhidrosis is caused by concomitant diseases, treatment must be aimed at resolving the pathological condition causing discomfort for secundary effect.
Some examples: it is important to identify and treat skin diseases that coexist as Intertrigo, Erythrasma and axillary trichomycosis;
follow a specific therapy in diseases of the endocrine system;
for obesity is suggested a weight loss, etc.
Bromhidrosis: symptomatic therapy
Before proceeding with the approach of clinical-therapeutic methods, suitable to solve definitely the bromhidrosis, it is important to consider the degree of impairment of the quality of life, as well as the patient’s expectations and objectives of treatment.
Hygiene and antibacterial agents
First therapeutic measures are aimed at controlle the proliferation of bacterial flora and to keep the skin dry.
Improvement of hygiene is very useful in case of apocrine and bromhidrosis implies: appropriate skin cleansing, the removal of sweaty clothing sweaty and use of topical deodorant (covering the odor that can be associated with an active that limits bacterial growth). The bromhidrosis often resolves with a thorough cleaning: generally, are effective daily baths with a liquid soap containing triclosan, or chlorhexidine, farnesol (antibacterial agents) and the application of preparations containing aluminum chloride (common in creme antiperspiranti). Some antiseptic soaps can be used in order to prevent bacterial growth and get relief from the smell.Shaving hair regularly prevents perspiration build up of bacteria on the hair shaft. Even using electrolysis hair removal might be considered in order to minimize bacterial growth.The use of topical antibiotics such as clindamycin and erythromycin, can produce clinical benefit by limiting the growth of bacteria that contributes to decomposition of apocrine secretions (free fatty acids from the smell).
Topical antibiotics should only be used when other antiseptics are not effective, because they are associated with greater risk of bacterial resistance.A solution to bromhidrosis may be offered also by systemic anticholinergic drugs, which may decrease sweating (act on nerves of the sympathetic nervous system and inhibits perspiration by blocking the transmitter acetylcholine), but are not commonly used for significant adverse effects that can induce (blurred vision, constipation, difficulty in urination, dry mouth, etc.).There are also special tampons clothing and stockings with ions or silver wires, which deliver a short time to protect against bad odours. For example, the anti-sweating shirts allow you to fight the formation of unsightly stains on clothing next to the use of aluminium chloride and tampons for your underarms. Special garments to resort to temporary assistance and natural excessive sweating, allowing you to not resort to drugs or surgery.
Anti-perspering agents products, mostly based on aluminum salts (to varying concentrations), are capable to drastically inhibit sweating and can be applied externally on the skin. These topical substances include as main ingredients some metal compounds such as aluminum hydroxide or aluminium sulfate, all of whom have an astringent action going to interfere with the secretion of the sweat glands. Unlike deodorants, anti-perspiring inhibit the production of sweat, as well as prevent unpleasant smells.
Their use can reduce the intensity of bromhidrosis promoting a feeling of dry skin, improving the status of skin moisture and limiting the maceration of keratin.
The application of anti-perspering products can cause some side effects like the onset of skin irritation and yellowish staining of tissues.
The iontophoresis therapy blocks the production of sweat and it is particularly effective for bromhidrosis eccrine This non-invasive method is performed by administering a gradient of electrical current through the skin. The small electric shock is transmitted by conduction to the specific area under tap water. Typically, iontophoresis is suitable for the treatment of armpits skin, the palm of the hand and of the foot. The principle of ionophoresis can also be used to facilitate the channelling of transcutaneous drugs. The goal is to get locally high concentration of medicine.
The success of this therapy, applied to bromhidrosis, depends on the type of device used, the dose of electricity administered and the duration of treatment: it is effective only if it includes a session of time (20-40 minutes per day) and should be considered only if sweating is associated with the issuance of a very strong smell.