What is bromhidrosis

Bromhidrosis is also known as osmidrosis or bromidrosis, is a condition of abnormal or offensive body odor, to a large extent determined by apocrine sweat gland secretion, although other sources may play a role. Bromhidrosis refers to body odor that is sweat related. The common name for bromhidrosis is body odor or BO. Now, everyone has body odor. What defines bromhidrosis? Unfortunately, there is no smell-o-meter that defines bromhidrosis. It’s a combination of an individual’s own perception of his or her smell. In addition, a history of close contacts who may have also noticed significant body odor is also useful. Basically, bromhidrosis is diagnosed when a person’ own smell affects their self-esteem, quality of life, and social behavior.

There are two main types of sweat glands (sudoriferous glands): apocrine and eccrine. One type of sweat is produced by glands in your skin called eccrine glands. This type of sweat is designed mainly to keep you cool on a hot day during exercise.

The second type of sweat is made by specialized apocrine glands. These glands are located only in specific locations of the body such as the groin and armpits. Apocrine sweat has proteins in it. The bacteria that live on your skin then degrade these proteins, creating compounds that lead to body odor.

Eccrine glands

• Found over the entire body and produce a dilute salt solution in response to increased body temperature.
• Eccrine sweat is normally odorless but can start to smell if bacteria get a chance to break down the stale sweat. It can also assume an offensive odor after ingestion of various substances, including foods (e.g. garlic, curry), alcohol, or certain medications.

Apocrine glands

• Found in limited areas, most notably the underarms, breasts and groin region and produce a thick secretion that contains pheromones (“personal scent”).
• Apocrine sweat is odorless when it first appears on the skin but within an hour bacteria that normally live on the skin break down the sweat to produce an offensive body odour.
• Body odor is worse if there are more bacteria present or the level of apocrine sweat production is high.

Apocrine bromhidrosis is the most common type of bromhidrosis and results from the bacterial breakdown of apocrine sweat, essentially all within the armpit area. Fatty acids and ammonia are the major products of bacterial breakdown and the odour have been described as pungent, rancid, musty or “sour and sweet”.

Although both types of bromhidrosis may occur in people of all races, sex and age, some differences do exist between the two types.

What causes bromhidrosis?

Both eccrine and apocrine sweat can cause bromhidrosis. Most often, bromhidrosis is localized. What we mean is that the offensive odor can be pinpointed to a specific anatomical location (eg, feet, armpits, or groin). Sometimes, the entire body can also be affected. This is called generalized bromhidrosis.

Apocrine bromhidrosis

Apocrine bromhidrosis in the armpits in the most common site of bromhidrosis. The armpits are an area where a wide variety of bacteria live. For example, Corynebacterium is a type of bacteria is notorious for creating compounds that lead to body odor.

• Possibly associated with a positive family history
• Only occurs after puberty, as the apocrine glands are not active until puberty is reached
• More common in men than women, which may be a reflection of greater apocrine gland activity in men than in women
• Skin usually appears normal except when bromhidrosis is associated with concomitant skin condition such as erythrasma
• Corynebacterium species are the most common bacteria found in the armpit and have been shown to produce the offensively smelling fatty acids.

Eccrine bromhidrosis

Eccrine bromhidrosis most commonly occurs on the feet. The feet are particularly susceptible to this kind of sweat because with shoes and socks, the sweat has nowhere to evaporate. This can lead to a moist environment where skin bacteria can live and thrive. This overgrowth can lead to an unpleasant smell.

• Occurs in all races
• Bromhidrosis may rarely be caused by metabolic disorders: amino acid disturbances (trimethylaminuria [fish odor syndrome]), sweaty feet syndrome, odor of cat syndrome.
• Possibly caused by ingestion of certain foods or medications
• Bromhidrosis caused by bacterial degradation of the skin protein keratin may be associated with maceration and a thick mat of moist keratin present on the skin.
• The role of excessive eccrine secretion (hyperhidrosis) in causing bromhidrosis is unclear. It may promote the spread of apocrine sweat and cause further bacterial overgrowth and decomposition, or it may improve the symptoms of bromhidrosis by flushing away the more smelly apocrine sweat.
• One study found an increase in body odor in regular users of axillary antiperspirant due to a change in the axillary bacterial flora.

What increases the risk of bromhidrosis?

Studies on the sweat glands themselves suggest that more sweat glands and larger sweat glands are associated with bromhidrosis.

There are also several medical conditions that predispose individuals to bromhidrosis. Hyperhidrosis, or excess sweating, is one common cause. Diabetes and obesity are both risk factors as well. Moisture and a lack of sweat evaporation in skin fold areas both can lead to bromhidrosis. Kidney problems, liver failure, and even gout can also be associated with bromhidrosis. Rarer causes of bromhidrosis include some genetic and metabolic disease. Diet can also be an influence for some individuals. Generally, this leads to whole body bromhidrosis. Notorious culprits include onions, garlic, or curry.

Skin problems, most commonly localized infections, can also lead to localized bromhidrosis. These include intertrigo, pitted keratolysis, and erythrasma. This can happen on the armpits or feet. Topical or even oral antibiotics are needed to treat these conditions.

Finally, hygiene is important too. But, this doesn’t necessarily equate to the need for daily washing, even after working out. Excess washing can lead to irritated, “angry” skin. Excessive use of perfumes and colognes can even cause allergic contact dermatitis. More often, hygiene contributes to bromhidrosis in vulnerable populations such as the homeless.

Bromhidrosis symptoms

Bromhidrosis refers to body odor that is sweat related. The common name for bromhidrosis is body odor or BO.

How is bromhidrosis diagnosed?

The clinician’s perception of smell is the only tool needed to diagnose bromhidrosis. Taking a medical history may reveal diseases or conditions that contribute to the occurrence of bromhidrosis e.g. obesity, diabetes mellitus, and intertrigo.

One distinction your doctor must be aware of is the difference between the true bromhidrosis patient and the bromhidrosiphobic individual. Bromhidrosiphobic patients have a morbid dread of bodily odors, and their sensory delusions can be an early warning sign of schizophrenia.

Bromhidrosis treatment

The two main factors to consider when treating bromhidrosis are to:

1. Keep the number of naturally occurring skin bacteria to a minimum
2. Keep skin in the area, namely the armpit in apocrine bromhidrosis, as dry as possible.

Improved hygiene and topical therapy are the main treatment options for mild cases of bromhidrosis and may include the following:

• Washing the underarm at least twice daily with germicidal soap
• Regular shaving of underarm hair to prevent the accumulation of bacteria and sweat on hair shafts
• Prompt removal of sweaty clothing
• Try anti-odor anti-microbial socks and other garments impregnated with silver or copper
• Use of topical deodorants
• Treatment of coexisting skin conditions such as intertrigo, erythrasma and trichomycosis axillaris
• Electrolysis to remove hair shaft and follicle

If hyperhidrosis is a contributing factor, this needs to be treated first, usually with the use of antiperspirants.

The treatments described above do not offer a cure for bromhidrosis and results can often be short-lived and incomplete. A visit to a specialist physician may provide more permanent treatment options, and include:

• Removal of apocrine sweat glands by superficial liposuction
• Removal of apocrine sweat glands by surgical excision.

If hyperhidrosis is a contributing factor, this needs to be treated first, usually with the use of antiperspirants. If this fails and the hyperhidrosis is a problem in its own right, then the following options may be considered:

• Anticholinergic or beta-blocking drugs
• Iontophoresis
• Botulinum toxin injection
• Chemical or surgical sympathectomy
• Microwave treatment of axillary eccrine glands

These treatments may not help the bromhidrosis, however, as this condition is often independent of hyperhidrosis and, as mentioned above, may in some cases be lessened by associated hyperhidrosis.

Bromhidrosis natural treatment

What you can do:

• Treat any underlying medical condition or skin problem that may be leading to bromhidrosis. This may include visiting your dermatologist to ensure there is no skin infection that is the source of the bromhidrosis.
• Reduce sweating with over-the-counter antiperspirants; other prescription-strength treatments can often be helpful too.
• Hygiene is important by very specific to the individual. There is no “recipe,” because everyone’s sweat glands, sweat rate, and skin bacterial composition are different. If you find yourself washing or scrubbing multiple times a day, leading to skin irritation, definitely ask your doctor for help. Bromhidrosis is often in the eye (or nose) of the beholder.

There is an FDA-cleared medical device that can be used to treat bromhidrosis. The technology is called miraDry. This can be helpful to many patients but also comes as an out-of-pocket price.