Bromhidrosis, also known as bromhidrosis, is a special form of hyperhidrosis, abnormal sweating. In bromhidrosis, affected individuals suffer from abnormally excessive sweat secretion.
What is bromhidrosis
The increased sweat secretion causes excessive secretion of sweat. Normally, the body produces a certain amount of sweat to regulate body temperature. Thus, when the ambient temperature is appropriately warm, large amounts of sweat are also physiological, but not so in bromhidrosis. Here, the sweat glands constantly produce an excess of sweat, which can quickly become a problem for those affected due to unpleasant body odor and constantly wet clothing. Medically, bromhidrosis is defined as a disease of the apocrine sweat glands. The horny layer of the skin is pathologically soaked by the constant overproduction of sweat, which, among other things, also results in an increase in germ flora. Sweat is normally odorless; only after decomposition by bacteria does the typical unpleasant odor of sweat develop. This smell spreads mainly on the body parts that have a high number of sweat glands, so armpits, groin region, feet but also skin folds.
Causes
Overlapping areas of skin affected by bromhidrosis are particularly prone to infection. The increased skin moisture leads to increased germ colonization by bromhidrosis in these areas of the skin. What leads to the constant overproduction of sweat in hyperhidrosis or bromhidrosis as a special form is not known. Dermatologists assume that it is a congenital metabolic disorder. The disease can already break out in childhood, but also in later adulthood, the time of onset seems to be directly related to the individual genetic disposition. Obesity also plays a role as a cofactor in all forms of hyperhidrosis. There are 2 forms of bromhidrosis, the apocrine and eccrine forms. The typical inherent odor of an individual is determined by the apocrine sweat glands. Increased secretion of eccrine sweat softens keratin, the bacterial decomposition of which produces a very unpleasant foul odor.
Symptoms, complaints and signs
Bromhidrosis is usually associated with increased sweat production. Affected individuals sweat even during mild physical exertion, and this leads to inflammation, emotional problems, and other discomfort. The condition places a strain on the skin and glands. Particularly in the case of prolonged or chronic illnesses, inflammation can occur under the armpits, on the legs and in the intimate area. Rubbing clothing and irritating skin care products intensify this effect and lead to increasing skin irritation in the long term. Pathogens can colonize the weakened skin, which can lead to infections, eczema and acne. Many affected people also suffer from pain and sore skin. If bromhidrosis is not treated, it has a negative effect on the mental state of the person affected. The increased perspiration is usually also associated with an intense odor – both of which restrict sufferers in social situations. Withdrawal from social life and the development of serious psychological complaints may occur. Externally, bromhidrosis can be recognized by the rapid formation of sweat. In individual cases, individual pores are inflamed or there is extensive redness under the armpits or in the genital area.
Diagnosis and course
The tentative diagnosis of any form of hyperhidrosis can already be made on the basis of the symptom of increased sweat production. The extent and degree of expression of the pathological sweating are then still the subject of further investigations. In the case of bromhidrosis as a particularly fulminant form of progression, sweat volume measurements can also be taken to confirm the diagnosis. These take place under controlled outpatient conditions at a dermatologist’s office or in a dermatology clinic. Fine fleece cloths are placed in the affected skin zones for a defined period of time and then weighed. In this way, the amount of sweat produced in 24 hours can be extrapolated very quickly. However, before the diagnosis of bromhidrosis is made, an accurate sweat analysis is also required to determine its chemical composition.If bacterially decomposed skin keratin is present in the sweat sample, the eccrine sweat glands are also affected and the suspected diagnosis of bromhidrosis is confirmed. In addition, to strengthen the diagnosis, individual sweat glands can be removed under local anesthesia and examined for fine tissue in the histology laboratory.
Complications
Bromhidrosis can cause various complications. For example, maceration, a watering down of the skin associated with permanent cell damage, often occurs. The heavy perspiration also increases the risk of fungal infections and itching. It is particularly common for bromhidrosis to result in athlete’s foot or jock itch, as well as warts and bacterial infections that can cause further illnesses. Moreover, the strong body odor and noticeable skin appearance can lead to social and emotional complications. Complications can also arise during the treatment of bromhidrosis. For example, when the sweat glands are aspirated, there is a risk of inflammation, infection, wound healing problems, and bleeding; in addition, nerves can be injured, resulting in permanent sensory disturbances. In rare cases, these nerve injuries result in Horner’s syndrome, a secondary disease of bromhidrosis, which is characterized by constricted pupils and drooping upper eyelids. As a result of treatment by endoscopic trasthoracic sympathectomy, severe night sweats may occur in the interim, often manifested in other parts of the body.
When should you see a doctor?
If bromhidrosis is a new occurrence, a doctor should definitely be consulted to determine the cause. There may be a disease behind the increased sweat production. However, it may also be the after-effect of drug treatment. If bromhidrosis is not limited by hygienic measures, many patients will consult a doctor anyway to get rid of the foul-smelling sweat odor. Often, psychological problems also arise as a result of bromhidrosis, which can then only be treated with the help of a psychologist. Without professional psychological help, bromhidrosis often leads quickly to social isolation. In addition to psychological problems, other complications of bromhidrosis can also occur, which make the consultation of a doctor urgently necessary. This is especially true in the case of excruciating itching, persistent skin and athlete’s foot infections or wart formation. If the doctor cannot find a cause for the increased sweating, the patient must be referred to a dermatologist. The dermatologist then tries to limit the proliferation of fungi and bacteria through various measures. Sometimes, however, even this is not enough. In particularly severe cases, the doctor will have to decide to surgically remove the sweat glands. This is an operation that may only be performed by experienced doctors, because there is a risk that nerve endings may also be injured with the consequence of permanent sensory disturbances.
Treatment and therapy
The cause of abnormal sweating are still in the dark, so a causal, i.e. cause-related therapy of any form of hyperhidrosis is not possible. However, a treatment concept has been established that has also found its way into a guideline concept of the Society of Dermatology. Commercially available deodorants have no effect on bromhidrosis as a severe form of hyperhidrosis. However, it has been shown that medical metal-containing antiperspirants have an antibacterial effect in addition to the antihidrotic effect. Due to the increased content of aluminum chloride, these deodorant preparations require a prescription, and the treatment results are promising, especially for hyperhidrosis axillaris. However, in bromhidrosis, other areas of the body and additionally the skin folds are typically affected by the increased uncontrolled sweating. In addition, aluminum as a heavy metal is suspected of being able to overcome the skin barrier and trigger severe side effects, including the development of tumors, when used in increased doses and continuously. Permanent hair removal with laser treatment does not lead to reduced sweating, but the consequences of bacterial sweat decomposition can at least be mitigated.In the case of a fully developed clinical picture of bromhidrosis, the only last resort is surgery. This is an operation under general anesthesia, during which large parts of the sweat glands in the armpit or other areas of the skin are removed.
Outlook and prognosis
Bromhidrosis must be treated in all cases. There is no other way for this disease to progress positively or to heal itself. As a rule, even ordinary deodorants do not help with this disease. In severe cases, those affected are dependent on the removal of the sweat glands under the armpits or in other regions. This is the only way to completely stop the abnormal sweating. If surgery is not desired, the affected person can also use various deodorants that have a high content of metals. Although these can reduce sweating, they are carcinogenic and can have other serious side effects. For this reason, these care products should not be used over a long period of time. Without treatment, bromhidrosis leads to very heavy sweating and thus to various restrictions in the patient’s daily life. If the sweat glands have been removed, the symptoms do not recur. In some cases, hair removal can also have a positive effect on the course of the disease, as it can prevent bacterial infections. The sweat formation remains nevertheless.
Prevention
Bromhidrosis, as an inborn error of metabolism, cannot be directly prevented. However, sufferers of any form of hyperhidrosis can take a variety of measures to prevent excessive sweating and unpleasant body odor. The composition of sweat depends to a large extent on the diet. Sweat-inducing and odor-active foods such as pepper or garlic should be avoided. By providing breathable textile protection, suitable clothing can be a decisive factor in preventing excessive sweat production. Finally, effective body cleansing and hygiene with skin-friendly, ph-neutral detergents are also important for prevention.
What you can do yourself
In the case of bromhidrosis, the dermatologist in charge can prescribe medical antiperspirants and give further tips for self-help. Depending on the severity of the condition, it is sometimes possible to sufficiently curb the condition by changing your lifestyle. For example, sweating can at least be reduced by eating a healthy, balanced diet free of spicy, irritating or odor-active foods such as pepper or garlic. Exercise also helps to regulate perspiration. Wearing loose, breathable clothing and avoiding excessive sunlight or heat also helps as a preventive measure. Finally, comprehensive body hygiene and care with skin-friendly care products is also useful. Accompanying these measures, it can sometimes be useful to share the condition with other sufferers. Attending a support group or participating in Internet forums are good ways to make daily life with bromhidrosis easier. In the long term, other measures such as permanent hair removal can be considered. Although this will not reduce perspiration, it may limit the resulting odor. The above measures should always be carried out in consultation with the attending physician.
