chromhidrosis

Last reviewed 11/2021

Chromhidrosis

• an unusual disorder that usually occurs in puberty, when apocrine secretory function is activated
  • as apocrine glands regress with age, a parallel regression of the disease is often seen
  • majority of cases report in the literature, are confined to the face or axillae but areolar chromhidrosis has been reported
    
    
• Clinical features
  • sweat is a darker coloration like blue, yellow, green or black
  • lipofuscin is a yellow pigment that is not specific to apocrine glands. In apocrine chromhidrosis the lipofuscin is in higher concentration or in a higher state of oxidation than in normal secretions, adopting a darker coloration - reason for the development in only a few patients is unknown
    
• treatment
  • consult expert advice
  • treatment modalities used in this condition include topical capsaicin, topical alumium hydroxide based preparations and botulinum toxin A
    
    
    
• consider eccrine and pseudoeccrine chromohidrosis:
  • true eccrine chromhidrosis is a very rare condition, occurring through eccrine excretion of water-soluble agents like dyes and drugs
    • not associated with systemic disorders. Incidence is unknown, and there is paucity of reports on the etiology of eccrine chromhidrosis
    • tartrazine coating of bisacodyl is documented as the cause for true eccrine chromhidrosis resulting in yellow sweat (2)
    • pink sweat associated with food colourings
      • a case report described a 26-year-old female presented with marked pink staining of her uniform and lingerie (3)
        • extractions of clothing, skin surface samples, eccrine sebum, urine and a fast food product were spectrophotometrically analysed to identify the pink staining pigment. Three water-soluble colouring agents have been identified. An eccrine route of excretion probably produced chromhidrosis
          
          
  • pseudochromhidrosis is the result of colorless perspiration mixed with an external chromogen such as dyed clothing, colored chemicals, or microorganisms such as Piedraia or Cornynebacterium
    • red facial pseudochromatosis
      • a case report describes a 9-year-old girl with pseudochromhidrosis simulating apocrine chromhidrosis (4)
        • treatment with topical and systemic erythromycin resulted in complete clearance of the reddish discoloration of the face. No relapse or recurrence was observed over a 3-month period.

Notes:

• eccrine glands (sometimes called merocrine glands) are the major sweat glands of the human body, found in virtually all skin
• apocrine sweat glands are found only in certain locations of the body: the axillae (armpits), areola and nipples of the breast, ear canal, eyelids, wings of the nostril, perianal region, and some parts of the external genitalia

Reference:

• 1) Pérez Tato B et al. Facial and axillary apocrine chromhidrosis.Dermatol Online J. 2012 Mar 15;18(3):13
• 2) Krishnaram AS et al. An interesting case of bisacodyl (dulcolax)-induced chromhidrosis. Indian J Dermatol Venereol Leprol. 2012 Nov-Dec;78(6):756-8. doi: 10.4103/0378-6323.102382
• 3) Cilliers J, de Beer C. The case of the red lingerie - chromhidrosis revisited. Dermatology. 1999;199(2):149-52.
• 4) Thami GP, Kanwar AJ. Red facial pseudochromhidrosis.Br J Dermatol. 2000 Jun;142(6):1219-20.