Bromhidrosis

Bromhidrosis is also known as body odor and it is a common modification in individuals who have just gone through puberty. However, in some cases it can turn into a pathological and chronic condition, as the body odor becomes excessive and it interferes with the life of the person suffering from it. When an excessive and unpleasant odor is emanated from the skin, that person tends to refrain from certain activities and the quality of life is significantly impaired.

There are two main types of bromhidrosis. The first is the apocrine body odor, which is also the most common form. This appears when the sweat glands function excessively, leading to a characteristic body odor. To that excessive function is added an increase in the axillary bacterial flora, increasing the unpleasantness of the body odor (especially in the axillary region). The second is the eccrine body odor, which comes from the eccrine glands. These glands do not give out any odor in normal situations, but they can give a distinctive odor if a person consumes certain types of food (garlic for example), takes medication (penicillin) or drinks alcohol. Also, it seems that there is a genetic predisposition to bromhidrosis.

Bromhidrosis Symptoms

These are the most common symptoms of bromhidrosis:

• Excessive, unpleasant body odor
• Primary area from where the body odor comes: axillae
• Other areas affected: soles of the feet, genital area
• The odor can be described differently from one patient to the other. However, the most common words used for the description of BO were: pungent, acrid, musty or rancid.
• Skin looks normal in the affected areas. Exception: association with other skin conditions (erythrasma, trichomycosis axillaris).
• In case of eccrine bromhidrosis, the following modifications may occur on the skin in the affected areas:

• Skin maceration (the keratin is consumed by bacteria)
• Thick mat of moist keratin (physical examination will reveal it)
• Modifications appear on the soles of the feet and in areas where the skin rubs together.

What Causes Bromhidrosis?

These are the most common causes that lead to the appearance of bromhidrosis:

• Excessive secretion of apocrine or eccrine glands – the foul odor comes from the bacteria that actually feed on the keratin.
• Inadequate bodily hygiene.
• Dermatological conditions (two basic mechanisms can lead to bromhidrosis, meaning excessive sweating and bacteria overgrowth)
  • Excessive weight
  • Endocrine dysfunction – diabetes
  • Skin folds inflammation (intertrigo)
  • Trichomycosis axillaris (the hair shafts in the axilla are colonized superficially with bacteria)
  • Erythrasma (the areas where the skin rubs together become chronically infected)
  • Colonization of other parts of the body with different bacteria, including Sphingomonas paucimobilis.
• Laser hair removal (potential adverse effect)
• Metabolic disorders (in eccrine bromhidrosis):
  • Phenylketonuria
  • Fish odor syndrome
  • Sweaty feet syndrome
  • Odor of cat syndrome
• In children – nasal foreign body.
• Ingestion of certain foods (garlic)
• Taking specific medication (penicillin)
• Alcohol consumption
• Toxic materials
• Metabolite excretion in sweat (gout, scurvy, typhoid)

Treatment

These are the most common courses of treatment undertaken for bromhidrosis:

Change in hygiene habits:

• Adequate washing of the axillary region
• Removing sweaty clothing without delay. Also, try to refrain from wearing the same clothes for several days in a row.
• Use of deodorant to reduce the foul odor and bacteria count
• These hygiene changes are especially effective in the case of apocrine bromhidrosis

Reducing the bacteria count in the affected area by:

• Regular shaving of the hair in the axilla
• Using special methods for the removal of the hair in the axilla (such as electrolysis)

Topical antibiotics for cases of increased bacterial count (these inhibit the actual bacterial growth):

• Clindamycin
• Erythromycin

Other treatments include:

• Antiseptic soap – this should be used on a regular basis in order to prevent the bacterial growth in the axillary region and not only.
• Treatment of associated medical conditions (diabetes, intertrigo, trichomycosis axillaris, erythrasma etc.)
• Antiperspirants with aluminum chloride – these are recommended in cases of bromhidrosis accompanied by hyperhidrosis
• Iontophoresis for eccrine bromhidrosis (a weak electrical current passes through the skin)
• Systemic anticholinergic agents (not the primary course of treatment because of the potential adverse effects)

Non-surgical treatments:

• Laser (for the destruction of apocrine glands)
• Botulinum toxin (recommended for eccrine bromhidrosis and in cases where the body odor is accompanied by excessive sweating)

Surgical treatments:

• Surgical removal of apocrine glands (there are different surgical approaches and they may involve cutting into several layers of the skin). The surgical approach depends on the severity of the condition and the intensity of the body odor.
• Carbon dioxide laser is used for the removal of apocrine gland residue
• Superficial liposuction curettage
• Ultrasound-assisted suction aspiration
• Upper thoracic sympathectomy

Diet changes:

• Eliminating certain foods from the diet or reducing the daily consumption (garlic, onion, spices)
• Reducing the daily intake of alcohol.