Bromhidrosis

Bromhidrosis is a condition wherein the individual has abnormal or offensive body odour. The usual term is body odor or BO.^[1] The condition may  significantly interfere with the life of the affected person.^[2]

Epidemiology

Bromhidrosis is believed to be more common in dark-skinned ethnic groups than in others. Bromhidrosis has gender predilection for males. Axillary bromhidrosis is common after puberty while eccrine bromhidrosis is more common during childhood. ^[2]

Types

Bromhidrosis is generally divided into two types as sweat glands are. Apocrine type is determined by apocrine glands which are found in limited areas such as  the underarms, breasts and groin region and produce a thick secretion that contains pheromones or personal scent. Since apocrine glands are not active until puberty is reached, apocrine bromhidrosis only occurs after puberty. On the other hand, eccrine type is determined by eccrine glands which are found over the entire body and produce a dilute salt solution in response to increased body temperature. ^[1]

Causes

More often than not, overactive sweat glands particularly apocrine glands, are the cause of body odor. As bacteria break more sweat down, smelly  breakdown products are released. Nonmedical causes of body odor include improper hygiene, foods like curry spices, onions, and garlic, alcohol, toxins and certain drugs such as penicillin or bromides. Body odor may also develop due to some medical conditions like obesity, diabetes mellitus, intertrigo, trichomycosis axillaris and erythrasma. ^[3]

Presentation

Patients have particularly offensive body odor that often originates from the axillary region. In some cases, genital or plantar bromhidrosis are the concern.  The odor may be described as pungent, rancid, musty, or sour in character. ^[2]           

Diagnosis

The clinician's perception of smell is the most important tool coupled with adequate medical history of the patient taking note of the conditions that may contribute to bromhidrosis such as obesity. The true bromhidrosis patient and the bromhidrosiphobic individual must be properly differentiated since bromhidrosiphobic patients only have sensory delusions of body odor. ^[1]

Treatment

Main considerations are to keep the number of naturally occurring skin bacteria to a minimum and to keep the skin area as dry as possible.^[1] Lifestyle changes are important especially hygienic measures. Deodorants and antiperspirant often help. Patients must regularly shave armpit hair and avoid foods that contribute to body odor like curry spices and garlic.  Topical antibiotics and antiseptic soaps also limit bacterial growth.^[3] If hyperhidrosis is a contributing factor, the patient may be given anticholinergic or beta-blocking drug, botulinum toxin injection or iontophoresis. Permanent treatment may also be done like removal of the sweat glands.^[1]

References:

1. http://dermnetnz.org/hair-nails-sweat/bromhidrosis.html
2. http://emedicine.medscape.com/article/1072342-overview
3. http://suite101.com/article/understanding-body-odor-a156370