Clinical features:
(1) abnormal or excessive odor to the sweat
(2) It usually involves the apocrine glands in the axilla. It occasionally may affect eccrine glands, especially on plantar surfaces (plantar bromhidrosis).
(3) rare before puberty (when apocrine glands become functional) and tends to affect adolescents and young adults
(4) The odor may persist despite bathing and good hygiene.
(5) A severely affected patient may have significant psychological comorbidities, resulting in social isolation and embarrassment.
Risk factors for apocrine bromhidrosis:
(1) Black race
(2) summer or hot environmental temperatures
(3) poor hygiene
(4) infrequent changing of clothes
(5) racial and cultural norms (Asians are more alarmed by the odor)
Therapy can be challenging and may consist of:
(1) cleansing with antibacterial soap and application of topical antibiotics (such as clindamycin)
(2) application of deodorants or perfume to mask the odor
(3) topical aluminum chloride to reduce sweating
(4) surgical excision of apocrine glands from the axilla can reduce axillary bromhidrosis in resistant cases
(5) iontophoresis may reduce eccrine-related bromhidrosis
Differential diagnosis:
(1) trimethylaminuria (smells fishy)
(2) aminoaciduria
(3) failure to bathe
