The most obvious symptom of chromidrosis is sweating colored sweat. Although the condition is harmless and painless, it is obviously very distressing to people and causes them severe anxiety and stress.
- Patients with chromidrosis may also feel a prickly or warm sensation because mild sweat discoloration may or may not appear on the skin.
- Patients with chromidrosis present with colored sweat, with or without staining of their clothing.
- Sweating is worse in the armpits and around the nipples and face.
- Symptoms worsen when patients are stressed or excited.
- The sweat color may be yellow (commonest), green, blue, brown or black.
What is chromidrosis?
Chromidrosis is a rare, but chronic condition that causes a person to have colorful sweat. There are two types of chromidrosis that are differentiated based on which sweat glands are affected.
- It is caused by the presence of a pigment called lipofuscin (a yellowish-brown pigment) in the sweat glands.
- How the lipofuscin pigment makes its way from the body cells to sweat is a mystery. Essentially, this pigment makes its way into the apocrine glands (sweat glands) where it oxidizes (which can give it a different color) and is then secreted out in the sweat.
- Depending on the oxidization level, it can cause black, blue, green, brown, red and yellow sweat.
- Apocrine chromidrosis may appear at any age, but usually appears after puberty when the apocrine secretory function begins. The disease is considered chronic. However, it may regress with age as apocrine secretion diminishes.
- Apocrine chromidrosis displays no occupational or geographical predisposition and is not influenced by climatic or seasonal variation.
- It is caused by the ingestion of chemicals, or drugs, which then find their way into the eccrine glands and where they are excreted with sweat.
- Cases of red, yellow and blue excretions have been documented.
- This type is treatable by identifying the color-causing agent and removing exposure to it.
- It occurs when sweat becomes colored upon coming in contact with something on the surface of the skin.
- Pseudochromidrosis results from the interaction of colorless eccrine sweat with extrinsic dyes, paints and certain bacteria, subsequently causing colored sweat. This is the more common type of the condition and it is the one most easily treated by identifying what is causing the sweat to become colored on the skin and removing exposure to it.
What are the possible causes of chromidrosis?
In patients with chromidrosis, lipofuscins are found in a higher-than-normal concentration or a higher-than-normal state of oxidation in the apocrine glands. However, why some glands experience these changes is unclear. This increased level of oxidation results in green, blue and even black sweat seen in chromidrosis.
- The greater the extent of lipofuscin oxidation, the darker the lipofuscin color.
- Apocrine glands are provoked by hot showers and baths. Also, by rubbing the skin and emotional stimuli such as pain, sexual arousal or anxiety, which leads to the secretion of colored sweat.
- Eccrine chromidrosis is most often caused exogenously when clear sweat becomes colored due to the ingestion of water-soluble dyes such as tartrazine; heavy metals such as copper; coloring and flavoring substances in food products and drugs such as quinines, levodopa, tartrazine-coated bisacodyl and rifampin.
- Sometimes, it is also seen in patients with high levels of bilirubin or those with jaundice.
What are the possible treatment options for patients with chromidrosis?
There is no permanent cure. However, few treatment options may help in limiting the symptoms.
- The treatment of apocrine chromidrosis aims at either inducing apocrine secretion, thereby emptying the glands resulting in a temporary symptom-free period for up to three days, or reducing perspiration.
- Manual pressure can express apocrine gland contents resulting in an improved appearance for 24 to 72 hours.
- Capsaicin, applied once or twice daily, depletes the neurons and can improve the appearance in some patients.
- Topical aluminum chloride and injections of botulinum toxin type A have also reportedly shown benefit in patients.
- Recent reports demonstrated improvement of facial and axillary chromidrosis with Botox injections.
- The treatment of eccrine chromidrosis revolves around stopping or replacing the causative agent.
- Discontinuation of certain medications, dyes and chemicals should be a consideration in a few situations.
- In pseudochromidrosis, topical or systemic antimicrobials are often used to treat the germ causing discolored sweat.
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