You are in: eMedicine Specialties > Dermatology > DISEASES OF THE ADNEXA ChromhidrosisArticle Last Updated: Sep 12, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: June Kim, MD, Staff Physician, Department of Dermatology, University of New Mexico June Kim is a member of the following medical societies: American Medical Association and American Medical Women's Association Coauthor(s): Wingfield Rehmus, MD, MPH, Co-Director of Clinical Trials, Clinical Instructor, Department of Dermatology, Stanford University Medical Center; Nelly Rubeiz, MD, Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon Editors: Günter Burg, MD, Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center; Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center Author and Editor Disclosure Synonyms and related keywords: pseudochromhidrosis, chromidrosis, colored sweat, discolored sweat, pigmented sweat, yellow sweat, green sweat, blue sweat, black sweat, lipofuscin, Corynebacterium bacteria INTRODUCTIONSection 2 of 10
  BackgroundChromhidrosis is a rare condition characterized by the secretion of colored sweat. Two glands produce sweat: eccrine and apocrine glands. Eccrine glands secrete a clear, odorless fluid that serves to regulate body temperature. Apocrine glands secrete a thick, milky sweat that, once broken down by bacteria, is the main cause of body odor. Chromhidrosis is apocrine in origin. Although apocrine glands are found in the genital, axillary, areolar, and facial skin, chromhidrosis is reported only on the face, axillae, and breast areola. Lipofuscin pigment is responsible for the colored sweat. This pigment is produced in the apocrine gland, and its various oxidative states account for the characteristic yellow, green, blue, or black secretions observed in apocrine chromhidrosis. In contrast, eccrine chromhidrosis is rare and occurs with ingestion of certain dyes or drugs, and pseudochromhidrosis occurs when clear eccrine sweat becomes colored on the surface of the skin as a result of extrinsic dyes, paints, or chromogenic bacteria. Approximately 10% of people without the disease have colored sweat that is regarded as acceptable and within the normal range. PathophysiologyLipofuscin is a yellowish brown pigment that is normally found in the cytoplasm of relatively nondividing cells (eg, neurons). In chromhidrosis, lipofuscins are found in a higher-than-normal concentration or a higher-than-normal state of oxidation in apocrine glands. However, why some glands experience these changes is unclear. This increased level of oxidation results in the green, blue, and even black sweat seen in chromhidrosis. The yellow, green, and blue apocrine secretions produce a yellow fluorescence under a Wood lamp (UV 360 nm), whereas the dark brown and black apocrine secretions seldom autofluoresce. Substance P is also postulated to be an important neurotransmitter in this process. Pseudochromhidrosis is of an extrinsic etiology in which a chemical on the surface of the skin reacts with eccrine secretions and produces the color transformation. FrequencyUnited StatesIncidence statistics are not available; the disease is rare. InternationalIncidence statistics are not available; the disease is rare. RaceApocrine chromhidrosis appears to be more common in blacks than in whites, but facial chromhidrosis is described only in whites. SexNo sexual predilection is reported. AgeChromhidrosis is noted after puberty, when the apocrine glands are activated. CLINICALSection 3 of 10
HistoryHistory taking should include a detailed investigation of the patient's environment and lifestyle to exclude exogenous causes. Quantities of apocrine sweat are less than those of eccrine sweat.
PhysicalOn careful inspection, the following signs can often be observed:
CausesThe increased numbers of lipofuscin pigments in the secretory apocrine cells are presumed to be the cause of apocrine chromhidrosis. Several extrinsic causes of eccrine chromhidrosis and pseudochromhidrosis include chromogenic bacteria, especially Corynebacterium species, fungi, dyes, and chemical contactants. DIFFERENTIALSSection 4 of 10
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| Drug Name | Capsaicin (Dolorac, Zostrix) |
|---|---|
| Description | Derived from plants of Solanaceae family. May render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons. Use 0.025% cream. |
| Adult Dose | Apply to affected area bid; not to exceed 4 applications/d |
| Pediatric Dose | Administer as in adults |
| Contraindications | Documented hypersensitivity; broken or irritated skin |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Causes significant irritation and a burning sensation during first few days of use; for external use only; avoid contact with eyes; do not use tight bandage; discontinue use if condition worsens or symptoms persist for 14-28 d. |
These agents inhibit the transmission of nerve impulses at the neuromuscular junction of skeletal muscle and/or autonomic ganglia.
| Drug Name | Botulinum toxin A (BOTOX®) |
|---|---|
| Description | Prevents calcium-dependent release of acetylcholine and produces a state of denervation at the neuromuscular junction and postganglionic sympathetic cholinergic nerves in the sweat glands. |
| Adult Dose | Facial chromhidrosis: 3-5 U spaced approximately 1 cm apart over affected area; total of 10-15 U into each side of face |
| Pediatric Dose | Not established |
| Contraindications | Documented hypersensitivity |
| Interactions | Aminoglycosides or drugs that interfere with neuromuscular transmission may potentiate effects |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Do not exceed recommended dosages and frequencies of administration; presence of antibodies to botulinum toxin type A may reduce effects of therapy; mild transient weakness and muscle weakness at toxin-treated sites may occur but resolve within 2-5 wk |
The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Shereen Timani, MD, to the development and writing of this article.
Article Last Updated: Sep 12, 2006
