Bromhidrosis is a distressing condition that can bring personal and social embarrassment. Also called “bromidrosis,” it is essentially a combination of excessive sweating and excessive odor from certain areas of the body.
The Body’s Sweat Glands
Eccrine glands, which are found on most of the skin surface, are responsible for temperature regulation. When body temperature rises, eccrine glands are stimulated to release a salty, odorless fluid directly onto the surface of the skin. As that fluid evaporates, the body cools down.
Apocrine glands, on the other hand, are mostly found in the scalp, armpits, groin, and breasts. They secrete an oily, odorless sweat into the tubule of the gland, which is then pushed to the skin surface during emotional stress. When the bacteria on the skin decompose this oily sweat, they release ammonia and fatty acids, which have strong odors.
Apo-eccrine glands are a third type of sweat glands that look like a combination of apocrine and eccrine glands. They appear during puberty and make up to 45% of al the sweat glands in the armpit. They can produce seven times as much sweat as eccrine glands.
What Causes or Worsens Body Odor
Most of the time, overactive sweat glands –especially apocrine glands, are the cause of body odor. As bacteria break more sweat down, they release a larger amount of smelly breakdown products. Other non-medical causes of body odor may include:
- improper hygiene
- Certain foods, such as curry spices, onions, and garlic;
- Alcohol
- Toxins
- Certain drugs, such as penicillin or bromides.
Body odor can also have direct medical causes, so it's important to be diagnosed. In addition, body odor develops when the following conditions are added to excessive sweating or bacterial overgrowth:
- Obesity
- Diabetes mellitus
- Intertrigo (a skin disease caused by bacteria, yeast or fungus)
- Trichomycosis axillaris (caused by bacterial overgrowth on hair shafts in the armpit)
- Erythrasma (a chronic bacterial infection of the major skin folds, mainly the armpit and groin areas)
Lifestyle and Over-the-Counter Remedies for Body Odor
Mild cases of bromhidrosis can usually be resolved with conservative measures. The goal here is to reduce the number of bacteria and maintain a dry environment in affected areas. The following measures can help:
- Hygienic measures. Properly washing the armpit and quickly removing sweaty clothes can help.
- Deodorants. They cover the odor but don’t stop perspiration. They help slow bacterial growth because they're often alcohol-based and make the skin acidic. They can be used for hands, feet, or underarms.
- Antiperspirants. They contain aluminum salts that temporarily block sweat production, so less sweat reaches the skin.
- Regular shaving of armpit hair. This helps prevent the accumulation of sweat and bacteria on the hair shafts.
- Electrolysis for hair removal. It also help minimize bacterial growth.
- Topical antibiotics and antiseptic soaps. They also to limit bacterial growth.
- Diet. Foods that contribute to body odor include curry spices, onions, garlic, and alcohol.
- Treatment of any coexisting skin conditions
Medical and Surgical Treatment of Bromhidrosis
More serious cases of body odor, medical options may include:
- Aluminum chloride (Drysol, Xerac). This is a prescription strength antiperspirant.
- Systemic anti-cholinergic drugs. They decrease sweating, but have adverse effects.
- Botulinum toxin A. Botox has been shown to decrease sweat production by denervating eccrine sweat glands.
Surgical treatment for bromhidrosis is not common in the U.S.. Current techniques are usually applied to the armpit, and not to the genital region. They include:
- Surgical removal of the apocrine glands. This is an open surgery to remove the type of glands that produce fatty sweat.
- Superficial liposuction curettage. This is less scarring than open surgery, but the problem is more likely to return.
- Ultrasound-assisted suction aspiration. The scars are as small as with curettage, but the risk of recurrence of the problem is smaller.
Weighing the Risks against the Benefits
Self-care and medical treatment are only temporarily effective. On the other hand, surgical treatment is often invasive, and carries a risk of complications. However, for the long-term management of serious cases of body odor, surgery may be the most satisfactory option.
Resources
References
eMedicine: Bromhidrosis; Wingfield Rehmus, MD, MPH, Katherine Brown, BA, and Nelly Rubeiz, MD
Etiology and management of Axillary Bromidrosis: A Brief Review; Guang-Yu Mao, Song-Lin Yang, and Jiang-Hong Zheng; International Journal of Dermatology, Oct 2008, Vol. 47 Issue 10
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