Bromhidrosis is a chronic condition in which the intensified body odor becomes unpleasant. When this odor is particularly intense or significantly interferes with a person’s social life, Bromhidrosis assumes pathological aspects and requires medical treatment.
This disorder is largely related to the secretions produced by the apocrine sweat glands. It can depend on the skin alterations of certain regions (hands, toes) or the most superficial layers of the epidermis (bacterial or fungal infections). Bromhidrosis affects all individuals in the postpubertal stages of their lives and indicates an intensification of the physiological body odors that are caused by the skin glands excretions or bacterial activity.
The apocrine sweat glands are usually located in the axillary (armpit) region, but they can also be found in the areola, anogenital region, or around the navel. The strong odor depends on the type and quantity of the bacterial flora, which metabolizes the secreted substances from the glands. In addition, certain factors like pathological conditions, hormonal changes, certain foods or drugs also affect the body odor.
Types of glands and their functions
Apocrine sweat glands
Apocrine sweat glands are present only in some areas: their distribution is limited to armpits, breast areolas, perineal, and inguinal region. Some apocrine elements are located in the periorbital areas (eyelid margin) and preauricular sinus (“Ear pit”).
Apocrine glands are small and inactive during childhood and they do not play a role in the thermoregulation. However, they are responsible for the characteristic pheromonal smell, which stimulates sexual interest, especially in animals. In puberty, the apocrine sweat glands start producing a white-yellowish, pungent, and rich organic (carbohydrates, proteins, lipids) and inorganic substances (iron).
The excessive production of these substances can cause an unpleasant odor and create problems in interpersonal relationships. The production of the characteristic odor occurs as a result of a bacterial decomposition of the secreted substances, which takes place on the surface of the skin. Some studies show that individuals with Bromhidrosis have larger apocrine glands.
The control of the apocrine glands seems to be regulated by the peripheral mechanisms of the sympathetic nervous system. Even though the two types of Bromhidrosis can occur to people of every race, gender, and age, there are some differences between them.
The Apocrine Bromhidrosis is the most widespread and should be distinguished from the eccrine Bromhidrosis. The factors contributing to the pathogenesis are different. In most cases, the products of a bacterial decomposition of the apocrine sweat glands contain ammonia and short-chain fatty acids, and their presence produces the characteristic pungent odor.
Bromhidrosis is usually associated with the concomitant dermatologic diseases such as Erythrasma (bacterial infection which proliferates in moist areas, like skin folds). The apocrine Bromhidrosis is more common in many Asian countries and it is often associated with a positive family history. It mostly affects the postpubertal male population and it is very rare among the elderly.
In some cases, the eccrine sweat glands secretions can have a very invasive odor. The main cause of this form of Bromhidrosis is the bacterial degradation of keratin, which produces an unpleasant odor when combined with the eccrine sweat. The ingestion of certain foods, such as garlic, onion, curry, alcohol, certain medications (e.g. penicillin and bromides), and toxins can cause the eccrine Bromhidrosis.
Finally, it can also be caused by certain metabolic disorders (e.g. trimethylaminuria or fish-odor syndrome, which causes a defect in the degradation of trimethylamine, an organic compound released through sweating). The eccrine Bromhidrosis occurs to persons of all races and ages.
Causes of Bromhidrosis
The main cause that leads to the secretion of sweat can be traced back to an anomaly which is responsible for both the quantity and the quality of this phenomenon. The sweat that reaches the skin surface is initially odorless: excessive secretion from the eccrine or apocrine sweat glands is attacked by the indigenous bacteria that live on our skin. These bacteria then produce the malodorous “volatile” chemicals. For example, the degradation of keratin induced by the excessive amount of sweat can produce an unpleasant odor.
Some conditions and factors that encourage the onset of Bromhidrosis are: diabetes, obesity, inappropriate clothing, inadequate hygiene, rash, Erythrasma (superficial skin disease), Hyperhidrosis, etc. In order to control or eliminate the occurrence of Bromhidrosis, you should limit the consumption of spicy foods like garlic, onions, alcohol, and caffeine. Drinking lots of water also helps to dilute the sweat and dampen the unpleasant odor. Medications that can be taken occasionally or on regular basis can also help with Bromhidrosis.
Studies suggest that Bromhidrosis is also caused by a genetic trait and most persons can be predisposed to body odor, especially when a family of bacterial skin flora and Hyperhidrosis (excessive sweating) exists.
Finally, some medical tests link the source of body odors with the medical 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 that is not generally associated with any anatomical disorder. The skin appears normal, except in the 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 in the affected area (organic formations visible on hair). At the moment, there are no instrumental machines that can measure the intensity of the human body odor.
The first medical examination represents a subjective perception of body odor and it is important for recognizing your natural body odor. Furthermore, you can collect a sample of your sweat for the microbiological examination and inspect the skin surface with a Wood’s lamp (also known as the black light), which will detect the presence of bacteria and similar substances.
How to deal with Bromhidrosis
The most effective solution for preventing this condition is to reduce the sweating to a normal level. Several treatment options for managing the Bromhidrosis exist.
The subjective comparison of the normal body odor and the intensified body odor is crucial for the proper Bromhidrosis management: persons who are trying to mask their body odor with various cosmetic products should understand that the symptoms will not be eliminated until the basic conditions and causes are cured.
Furthermore, if the moisture management and thorough cleansing are not sufficient, you should start paying special attention to the factors that encourage the bacterial proliferation: underarm hair removal, wearing breathable of socks and footwear, using the products that inhibit the bacterial overgrowth, etc.
Good hygiene and topical therapy are the main treatment options for mild cases of Bromhidrosis and may include the following actions: washing the underarm area at least twice a day with germicidal soap; regular removal of hairs to prevent the sweat and bacteria buildups; electrolysis to remove the hair follicles; prompt removal of sweaty clothing; and the use of topical deodorants.
The treatments of the coexistent dermatological diseases do not offer a definitive cure for Bromhidrosis and the results can be partial. A visit to the doctor can provide certain permanent treatment options, such as the removal of the apocrine sweat glands by surgical excision or superficial liposuction. If Hyperhidrosis is a pre-existing condition for the Bromhidrosis, it would be useful to treat it as soon as the excessive sweating occurs.
The following options should be considered in the treatment of Bromhidrosis:
- Use of antiperspirants
- Use of anticholinergics or beta blockers
- Injection of botulinum toxin (Botox)
- Surgery (surgical sympathectomy, superficial liposuction …).
If Bromhidrosis is caused by a concomitant disease, its treatment must be aimed at resolving the secondary pathological condition that causes discomfort.
Examples of treatment:
- Identify and treat skin diseases that coexist with Bromhidrosis, such as Intertrigo (rash), Erythrasma, and axillary trichomychosis;
- Follow a specific therapy in the diseases of the endocrine system;
- Lose weight if you are obese.
Bromhidrosis: symptomatic therapy
Before proceeding with the clinical-therapeutic method approach, it is important to consider the degree to which a patient’s quality of life has been impaired, as well as the patient’s expectations and treatment objectives.
Hygiene and antibacterial agents
The first therapeutical measures are aimed at controlling the proliferation of bacterial flora and keeping the skin dry.
The hygiene improvement is very useful in the treatment of Bromhidrosis and it includes appropriate skin cleansing, fast removal of sweaty clothing, and the use of a topical deodorant (limits bacterial growth).
Bromhidrosis can often be resolved with a thorough cleaning routine: daily baths with a liquid soap containing the antibacterial agents (triclosan, chlorhexidine, or farnesol) and the application of products containing aluminum chloride (common in antiperspirant creams). Various antiseptic soaps can be used in order to prevent bacterial growth and alleviate the odor.
Regular shaving prevents the perspiration bacteria build up on the hair shaft. Even using the electrolysis hair removal can be considered in order to minimize the bacterial growth. The use of topical antibiotics, such as klindamicin and erythromycin, can limit the growth of bacteria that contributes to the decomposition of the apocrine secretions (free fatty acids).
Topical antibiotics should only be used when other antiseptics are not effective, because they are associated with a greater risk of bacterial resistance. A solution to Bromhidrosis may also be offered through the systemic anticholinergic drugs, which may decrease sweating by acting on nerves of the sympathetic nervous system and inhibiting the perspiration by blocking the transmitter acetylcholine, but are not commonly used because of their numerous undesirable side effects (blurred vision, constipation, difficulty in urination, dry mouth, etc.).
Moreover, special tampon clothing with ions or silver wires that can offer a temporary odor relief is available. For example, the anti-sweating shirts allow you to fight the formation of the unsightly sweat stains thanks to the aluminum chloride and underarm tampons. Wearing these special garments will provide you with a temporary relief from the excessive sweating and perhaps eliminate the need for drugs or surgery.
Anti-perspiring products, mostly based on aluminum salts, have the power to drastically inhibit sweating and can be applied externally on the skin. These topical substances include the main ingredients of some metal compounds, such as the aluminum-hydroxide or aluminum-sulfate, whose astringent action interferes with the secretion of the sweat glands.
Unlike deodorants, antiperspirants inhibit the production of sweat and prevent the unpleasant odors.
The use of antiperspirants can significantly reduce the intensity of Bromhidrosis, while promoting a feeling of dry skin, improving the status of skin moisture, and limiting the degradation of keratin.
The application of antiperspirants 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 in the treatment of the eccrine Bromhidrosis. This non-invasive method is performed by administering a gradient of the electrical current through the skin. A small electric shock is transmitted by placing the specific area under tap water. Typically, iontophoresis is suitable for the treatment of armpit skin, hand palms, and feet. The principle of iontophoresis can also be used to facilitate the absorption of transcutaneous drugs into the skin.
The success of this therapy in the treatment of bromhidrosis depends on the type of device being used, the dose of electricity administered, and the duration of the treatment: it is effective if it includes daily 20-40 minute sessions and it should only be considered if the excessive sweating is associated with a very strong and unpleasant odor.