Bromhidrosis refers to a medical condition where the body releases bad-smells plus sweat. When sweat comes into contact with bacteria on the skin that smells emerge. Other than body odor, bromhidrosis is also known by terms such as bromidrosis and osmidrosis. Body odor emanating from this medical condition can be treated or even prevented through maintenance of personal hygiene. Of course, there are options for medical treatment as well. Essentially, bromhidrosis is a condition in which a person’s body odor is not normal. This is because sweat contains acid which is broken down by bacteria on the skin. Sweat glands also play some role in this condition, according to some experts.
This is a condition in which body odor is not normal. Normally, there is no smell of sweating. But, if there are a layer of bacteria under the skin, then the sweat is broken into fatty acids and ammonia produces unpleasant and unfavorable odors. The situation may further be impacted by the consumption of certain foods such as spices, curry, and garlic. The conditions exacerbating bromhidrosis also include taking alcohol, excessive weight or specific conditions like liver, diabetes and kidney disease. The medical condition in itself a problem for those who suffer from it for it can severely restrict the quality of life of the person diagnosed with the condition. This medical condition is also more common in individuals who are well past their teens. Specific studies report that men experience more abnormal body odor conditions as against women, possibly on account of more physical activity.
How is Bromhidrosis Caused?
Table of Contents
Bromhidrosis is a condition linked with abnormal, foul or offensive body odor. It is determined by the secretion of the apocrine sweat gland, though other glands may also be important. Specifically, the sweat or sudoriferous glands are differentiated into two chiefly apocrine plus eccrine. There is additionally amount of crossover between the two.
Apocrine Glands
These are in limited areas and produce the pheromones associated with body scent. These glands are located under the arms, breast and groin regions. This sweat is odorless to start with. Within an hour, the bacteria in the skin break down the perspiration and produce a foul odor.
Eccrine Glands
These are located over the whole body. Eccrine glands produce the salty dilute solution associated with body sweat when the temperature rises. Eccrine glands secrete sweat that lacks odor but if bacteria get breaks down the sweat, it can start to smell. Various foods like garlic, curry or even alcohol and medication can impact the body in various ways.
Body odor is worse if more bacteria are there, or apocrine sweat glands are secreting a lot more.
So apocrine bromhidrosis is when the bacterial breakdown of apocrine sweat takes place. This is more so in the armpit area. Fatty acids plus ammonia are the chief byproducts and end results of bacterial breakdown. The smell emanating for BO sufferers is foul, sour, smelly and rancid.
Causes
So, basically, bromhidrosis results due to secretions of the apocrine glands, but even the eccrine gland generated sweat can be a reason for this medical condition.
Apocrine Sweat Glands
These glands produce sweat which is thicker and contains chemical pheromones which impact others. When this sweat is released, it lacks both color and odor. But when the bacteria in the body break down the dried sweat, the resulting foul smell can result in those suffering from this medical condition. Additionally, as apocrine glands become active at the point of puberty, body odor is generally not common among younger children.
Eccrine Sweat Glands
Eccrine sweat glands which are located and spread all over the body are also odor-free and colorless to start with. They do, however, contain a mildly salty solution. The bad smell also may develop when bacteria on the skin break down sweat secreted by this gland. The eccrine sweat smell may also result from eating certain kinds of food like garlic or consuming alcohol.
While bromhidrosis is common in puberty, it can also be aggravated and turn into a chronic and pathological condition. Furthermore, the odor can even interfere with the lifestyle of the person suffering from this medical condition. Apocrine body odor is the most well-known form of this medical condition, where axillary bacterial flora increases the unpleasant smell of the body odor, more so in the axillary region. The second is eccrine body odor, which does give a distinctive smell and depends on ingestion of certain foods or even alcohol and medication like penicillin. Additionally, there is a genetic predisposition to bromhidrosis.
While bromhidrosis occurs in people of different genders, ages, and races, certain differences are noted in the types of this medical condition.
While apocrine bromhidrosis is linked with a family history of this condition, this form of BO is not noted unless the patient has reached puberty. It is also more common in men and indicates a possibility of more apocrine gland activities. The skin also seems normal except in conditions where the BO medical condition is linked with skin troubles like erythrasma. Among the most regularly occurring bacteria found in the armpit and that are associated with offensive fatty acids are Corynebacterium species.
Eccrine BO is, on the other hand, a form of bromhidrosis which occurs among different races. It is caused by metabolism issues and disorders like amino acid disturbance or fish odor syndrome also known as trimethylaminuria and even cat odor or smelly feet syndrome.
It is possibly the result of consumption of certain medicines or foods. Bromhidrosis associated with keratin (a skin protein) degradation by bacteria also results causes maceration and a thick moist keratin mat present on the skin. Eccrine secretion or hyperhidrosis and its role in BO is still being investigated. It could be that apocrine sweat may be promoted by eccrine sweat and additional bacterial overgrowth and degradation may result. Additionally, the apocrine sweat may actually be flushed away by the eccrine sweat systems, leading to faster recovery. When sweat mixed with the bacteria on the skin surface, it can also impact clothing and make it difficult to take the smell of sweat out of certain clothes. While a genetic predisposition and a certain age may be associated with this condition, so are these causative factors:
Foods
Known as trigger foods, these boost chemicals from the body, creating a strong odor. One the body has processed what it needs, it will send the leftovers to be excreted through (among other means) sweat. This escapes through the pores in the opening of the body as well as other waste excreting systems.
#1 Vegetables Rich in Sulfur
Vegetables which contain a huge amount of sulfide content can be a factor in causing BO. Sulfide is a naturally occurring organosulfur. While this form of natural sulfur is an essential ingredient, excessive amounts can lead to body odor. Sulfur is found in every single body cell. Excess sulfur may cause bad smells to emanate from the body. Foods in the Brassica and Allium genomes fit in this food category called organosulfur. Asparagus is presently the most common food known to impact ammonia emitted from the body. It leads to smelly sweat and urine secretions. Among the Brassica veggies come a profusion of commonly eaten vegetables comprising broccoli, cauliflower, and even cabbages. The Allium group of vegetables include onion, scallion, leek, shallot, chives, and garlic. Spicy foods which entail heavy garlic ingestion such as curry and spices may also result in BO. Foods such as these cause gas to release from the pores of the body. Drinking plenty of water while consuming such foods can eliminate the toxins from within the digestive system.
#2 Meat/Fish
Another reason for body odor is eating a lot of red meat. As red meats are tough to digest, the body works overtime to break it down. This causes an increase in the amount of sweat produced. While fish is a good choice instead, choline found in certain fish meat like tuna and salmon constitute part of the B-complex vitamins and such meat can cause the body to emit an odor.
#3 Fried/Greasy Foods
Another body odor cause is consumption of different types of fried and greasy food items. These can cause bacteria to breed in the mouth and on the skin. Oils in these maximally processed foods are associated with lack of effective digestion and lead to bromhidrosis.
#4 Heavily Processed Items
Processed foods also lack certain ingredients which make digestion difficult. Chlorophyll, which is found in plants, helps the body to digest chemicals and additives in processed foods completely and efficiently. These foods come with a high glycemic index and have a massive dose of carbs and sugar. So, they are hard to digest.The harder the body works, the more sweat there is and the kidneys may then weaken and fail.
#5 Beverages Like Alcohol and Coffee
BO is also caused by beverages like coffee and alcohol which take a long time to digest and excrete plenty of chemicals through sweat in the skin.While water and good hydration are essential for a sturdy regimen of hydration, especially during exercise, and when life stress is on the rise, these beverages like coffee and drinks like alcohol only serve to aggravate bromhidrosis.
#6 Excessive Stress and Strain
Yes, stress can cause body odor too. Being anxious and stressed out leads to a huge amount of a stress hormone called cortisol being released. It is known as one of the chief reasons for too much sweating. Sweating can, however, be less of an issue if the bacteria are living on the skin in smaller amounts. Remember that the bacterial components are the real cause of BO along with lack of proper kidney functionality.
#7 Medical Problems
Many medical conditions lead to smells and sweat. It is important to contact the doctor immediately if there is a strong smell emanating from sweat and other excretions. Even if a chronic or long-standing medical problem requires medication, one of the ways it can impact you is bromhidrosis. There are comprehensive side effects associated with these medicines. Consequently, one of the results is body odor. Certain medications can cause sulfur build-up around the teeth and gums. This substance has a smell like rotten eggs. Make sure the medicines you eat are compatible with each other or BO and halitosis can be a persistent problem.
#8 Nutritional Deficiency
In a world where nutrition is given low priority and frozen/processed foods take precedence, getting the required vitamins and minerals from food taken is often impossible. When there is a vitamin or mineral deficiency from food intake, it is essential to make up for it or bromhidrosis can result. Consider the nutrients like magnesium, for instance. These aid in the removal of bromhidrosis. So try to include items like oatmeal, raw nuts, almond and cashew nuts or even dark chocolate and get your daily dose of magnesium.
#9 Other Factors
Some of the most common causes of BO include excessive sweat secretion and lack of bodily hygiene. Other conditions associated with bromhidrosis include dermatological problems and excessive weight.Then, another factor that can cause BO is endocrine disorders like diabetes or inflammation in the skin folds or intertrigo. Some of the other medical conditions associated with BO include trichomycosis axillaris or axilla hair shafts being infested with body odor-emitting bacteria that break down sweat or erythrasma where skin that is chronically infected on being rubbed together emits an odor. Other areas of the body may also be colonized with different types of bacteria such as Sphingomonas paucimobilis. Laser hair removal can also trigger body odor. So can metabolic disorders like PKU, fish odor syndrome, sweaty feet, and odor of cat syndrome. In younger patients, nasal foreign bodies can also cause a body smell. Apart from this toxic additives and even medicines like penicillin can lead to BO, apart from metabolites secretion due to conditions like typhoid, scurvy, and gout.
Diagnosis
In the case of those with bromhidrosis, it is vital to consult a doctor or hospital for medical care. While the condition in itself may not be life-threatening, it can reduce the quality of life of the sufferer. Complaints need to be reported in detail as easy diagnosis results. The history of the disease is also important to trace, especially if you are suffering from allied liver, diabetes and kidney diseases.
Symptoms
Bromhidrosis is associated with stinging, musty, sharp sweat smells. If there is too much sweat, it interferes with every day life. Apart from the foul stench, there are axillae the BO emanates. Extremities like legs and genital area can also be impacted. Common conditions of bromhidrosis are associated with smells that are pungent, rancid, acrid or musty. Skin appears normal excelt in eccrine bromhidrosis where skin maceration occurs when keratin and/or body protein is eaten up by bacteria. There’s also a thick moist keratin layer that can be seen and observed.When the skin is constantly rubbed, there are issues as well such as the formation of calluses.
Treatment
The treating doctor has to record the body odor to make a clear diagnosis of bromhidrosis. Additionally, a medical history may reveal diseases or disorders that are associated with this medical condition like diabetes and obesity. The distinction between real BO sufferers and those who are phobic is important. Bromidrosiphobia is often associated with early warning signs of schizophrenia.
This BO linked disorder is easy to diagnose as the doctor can identify the condition in association with the scent. Bear in mind that if you’ve just had a shower or not sweating, the condition may be harder to diagnose. Therefore, the doctor may require you to come to him post an exercise or a sweat-inducing workout, so that he can detect whether you have that condition. Additionally, the treating doctor will review medical history to study possible BO causes whereby conditions like diabetes, liver or kidney disease may also be triggering BO.
The desired treatment approaches for bromhidrosis are associated with the condition’s severity. In some cases, it is enough to implement measures to prevent body odor. In the more serious cases, the sweat glands may even be operated on.
#1 Botox
Botulinum toxin A or Botox blocks nerve impulses to the muscles and it can be injected into the underarm to block the impulses to the sweat glands. The problem with botox treatment is it wears off once a certain period of time elapses. So, it may be needed for multiple treatments. Botox can also be used for sweating hands and feet.
#2 Liposuction Procedures
Another way to cut down on the apocrine sweat is the removal of sweat glands. Liposuction is a common procedure for removing fat from the belly or other fatty places in the body. Specifically, special tubes are carefully inserted into the body and fat is extracted. This concept can also be applied to sweat glands beneath the arms or in the underarm area. Small tubes for suction called cannula are inserted beneath the skin. The tubes are then grazing the skin’s underside, removing sweat glands as one progresses. This process leads to less sweat as a result of the impact on the glands. Early positive outcomes such as less sweating and lack of odor happen. When the nerves that are stunned during liposuction recover, however, the problem returns. Therefore, this is also not a permanent cure. On the other hand, ultrasonic liposuction can be used to vibrate the energy and target the sweat glands.
#3 Surgical Processes
Yet a highly invasive means of removing the sweat glands or nerves associated with excessive perspiration is via surgery. The process is known as endoscopic sympathectomy, whereby tiny incisions and specific tools are employed to damage nerves in the chest linked with underarm-based sweat glands. The procedure has a lifespan of 5-10 years, which is higher than the earlier two methods discussed.
#4 Electrosurgery
Another treatment that is minimally invasive is known as electrosurgery. It is carried out with small insulated needles. Over a period of consecutive treatments, doctors can use the needles for removing the sweat glands. A surgeon can remove sweat glands through a conventional operation as well. It begins with an incision in the underarm. Surgeons can, therefore, see where the glands are clearly located. This kind of surgery is known as a skin resection. It causes some scarring on the skin’s surface, though.
Before invasive procedures are attempted, basic hygiene strategies need to be carried out. This helps to reduce the bacteria interacting with the sweat. As bromhidrosis is triggered when bacteria reacts with the skin, frequent washing can be an effective means of neutralization of the bacteria.
#5 Maintain Hygiene
Washing with a soap and some water daily can also ward off BO. If the smell is localized at the armpits, focus your cleaning efforts there. An antiseptic soap and antibacterial cream containing erythromycin and clindamycin can also help. Strong deodorant can also ward off body odor. It is also advisable to remove underarm hair or trim it for hygiene and odor-free armpits.
Another important step is to regularly wash clothes and remove sweaty ones. When some clothes can be worn more than once, if bromhidrosis is a problem, washing after every wear may be needed. Undershirts and inner-wear can also keep stench at bay.
Complications
Bear in mind that bromhidrosis may be the sign of another medical condition like trichomycosis axillaris and erythrasma as well as intertrigo or type 2 diabetes. Another contributing factor is obesity. Each of these medical conditions must be treated to keep the BO at bay.
Factors to Consider for Treatment
The key factors to consider while treating bromhidrosis include keeping skin bacteria to the minimum and keeping the skin in the armpit region where the sweat glands are located as dry as can be.
Hygiene Factors
Improved hygiene and topical applications are the main ways to treat mild BO. Washing the underarm twice daily with germicidal soap works. So does shaving of underarm fuzz so that bacteria and sweat do not aggregate on the hair shafts. Quick removal of sweat filled clothing is also important. Try anti-microbial socks and other garments with copper or silver for the best results. Using topical does is also important. Treatment of prevalent skin conditions like trichomycosis axillaris, erythrasma and intertrigo are important. Electrolysis is also a good way out for removing hair shafts and follicles.
Adequate washing of the axillary region, removal of sweaty clothes sans delay and use of deodorant and hygiene changes can benefit you. Use electrolysis or regular shaving of hair in the axilla to remain odor-free
Hyperhidrosis
In case hyperhidrosis is a reason for BO, antiperspirants may be used. Remember that hygiene factors only come into play for mild BO treatment and temporary solutions. Visiting specialist physicians provides long-term treatment options such as removal of sweat glands by surgery or superficial liposuction. For treating hyperhidrosis, and associated BO, anticholinergic or beta blockers drugs, iontophoresis, chemical or surgical sympathectomy, microwave cures for eccrine axillary glands or botulinum/botox toxic injection.
Medicines and Soaps
Topical antibiotics for combating increased bacteria include erythromycin while clindamycin is another option. Other treatments include antiseptic soap on a regular basis to prevent bacteria growth in the axillary region. Treatment of associated medical conditions includes erythrasma, intertrigo, diabetes, trichomycosis axillaris can help. Then people with BO can also try antiperspirants with aluminum chloride in case of hyperhidrosis and BO. Iontophoresis for bromhidrosis from the eccrine sweat glands causes weak electrical currents to pass through the skin. Systemic anticholinergic agents are also used.
Non-Surgical
The laser can be used for destroying apocrine glands. Then Botox is a good bet for those sweating heavily. Dietary changes can also help whereby the BO patient should give alcohol, coffee, garlic, onion etc a wide berth.
Surgical
The surgical removal of apocrine glands involves cutting layers of the skin and removal of the glands. This surgical approach is used for severe cases. For removing apocrine glands, CO2 lasers may be used. Then there is upper thoracic sympathectomy, ultrasound assisted suction aspiration and superficial liposuction curettage. This involves cutting out the sweat glands. Excision is not recommended. The other options are superficial liposuction and gland removal with a cartilage shaver.