What is Chromhidrosis?
Chromhidrosis is a rare condition where a person sweats in color. This unusual condition was first noticed by Yonge in 1709 and can be grouped into three types: Apocrine chromhidrosis, eccrine chromhidrosis, and pseudochromhidrosis.
Apocrine chromhidrosis takes place in areas of the body where there are apocrine glands, including the armpits, genital area, eyelids, ears, scalp, chest, and nipples. Normally, these glands produce a small amount of scent-free, oily fluid that travels into the hair. When this fluid reaches the surface of the skin, bacteria break it down, creating a natural body aroma.
Eccrine chromhidrosis can potentially occur anywhere on the body, except for areas like the ear canal, lips, and certain parts of the private areas. This is because eccrine glands, which are smaller than apocrine glands, are spread out across the skin. These glands produce a dilute sweat composed mostly of water and electrolytes, which they secrete directly onto the skin surface. Eccrine gland sweat helps control body temperature, protects the skin, and helps excrete electrolytes. They are distributed irregularly on the ridges of the skin on the fingertips, but there aren’t any within the skin grooves.
Pseudochromhidrosis is a situation where a person’s colorless sweat produced by eccrine glands mixes with other substances on the skin to produce colored sweat.
What Causes Chromhidrosis?
In 1954, scientists Walter Shelley and Harry Hurley found that a pigment called lipofuscin causes the discolored sweat seen in a condition called apocrine chromhidrosis. Lipofuscin is a yellow-brown pigment found in cells of various organs, not just in sweat glands. However, individuals with apocrine chromhidrosis tend to have more lipofuscin, or the lipofuscin is more oxidized, making it darker. The extent of lipofuscin oxidation can cause the sweat color to change from yellow to green, blue, black, or brown.
Apocrine sweat glands can be triggered by hot showers, friction on the skin, and emotional stimuli such as pain or anxiety, leading to the secretion of the colored sweat in apocrine chromhidrosis. Certain substances may also play a role in the condition, hinting at why some treatments have been effective for some people.
In contrast, a similar condition known as eccrine chromhidrosis, is often caused externally by the consumption of water-soluble dyes, heavy metals, food flavorings, or certain drugs. It can also be caused internally due to a high level of bilirubin, a substance produced by the liver, causing patients to sweat a green color in certain areas of the hand and foot.
Finally, pseudochromhidrosis is an outside process where clear sweat changes color after being exposed to certain influences such as drugs that affect the bacteria on the skin surface. The color-changing bacteria, and sometimes fungi or chemical agents, are the most common causes for this type of discolored sweat.
Risk Factors and Frequency for Chromhidrosis
Apocrine chromhidrosis is a condition that can start at any age, but it most often begins after puberty when the apocrine glands start to function. Although it’s a long-lasting condition, it can lessen as a person gets older and the apocrine glands become less active.
This disease does not favor any specific job, location, climate or season. It can affect anyone, regardless of their gender. There have been more reported cases of chromhidrosis in people with black skin, except for facial chromhidrosis which is more common in people with white skin. However, there have not been enough reported cases to draw definite conclusions.
Signs and Symptoms of Chromhidrosis
Chromhidrosis is a condition where patients experience coloured sweat, which may stain their clothes. In some cases, feelings of warmth or a prickly sensation may occur during emotional or physical stress before the coloured sweat appears. When assessing a person with this condition, it’s important to gather complete information about their history. This should also cover any new medications, supplements, or herbal treatments that they might have started before they began experiencing chromhidrosis.
- Coloured sweat, possibly staining clothing
- Warmth or a prickly sensation with emotional or physical stress
- Complete patient history, including new medications, supplements or herbal treatments
Testing for Chromhidrosis
Chromhidrosis is a condition usually diagnosed through an examination by a doctor, but further testing is sometimes needed if the type and cause aren’t clear at first. One method of testing involves using a Wood’s lamp, which will cause certain secretions from sweat glands to glow different colors, such as green, blue, or yellow. However, black and dark brown secretions typically don’t glow under this lamp.
Another test involves taking a skin biopsy to study under a microscope using a special stain. This helps to detect and measure a type of pigment called lipofuscins within sweat glands. Lab examination of secretions can also help in spotting this pigment.
Further tests may include analyzing samples from sweat, body oils, urine, skin scrapings, and even clothing using a device called a spectrophotometer. This can also aid in determining the diagnosis. Sometimes, skin cultures for bacteria and fungus might be performed to rule out pseudochromhidrosis, which is an external cause of colored sweat.
Other tests could be done to rule out various causes of skin color changes. These may include a complete blood cell count test to rule out any issues in the blood that might cause bleeding, and a urine test to check for a high level of homogentisic acid, which could be a sign of a metabolic disorder called alkaptonuria.
Treatment Options for Chromhidrosis
After figuring out the type of chromhidrosis (color sweat) and what might be causing it, treatment can start. The goal of treating apocrine chromhidrosis is either to trigger the apocrine glands to excrete their contents, which can give up to three days of relief, or to reduce sweating. Applying pressure can manually empty the sweat glands and improve appearance for 24 to 72 hours.
Capsaicin, a component usually found in hot peppers, can be applied once or twice daily to deplete substance P from the nerves and help with the condition. However, a common side effect is a burning sensation at the site of application. Other helpful treatments are topical aluminum chloride and botulinum toxin type A injections.
It’s important to remember that the condition often comes back when treatment stops.
The primary focus of eccrine chromhidrosis treatment is to either stop or swap out the cause.
For pseudochromhidrosis, antibiotics are often used to kill the bacteria causing the problem. However, it’s worth mentioning that these antibiotics may change the natural balance of our body’s microorganisms, allowing chromogenic (color-producing) organisms to take over. In such cases, consideration should be given to stopping these medications.
What else can Chromhidrosis be?
When trying to diagnose chromhidrosis — a condition where a person sweats colored sweat — doctors have to keep in mind many other possibilities. These include:
- Hematidrosis (bloody sweat) – a rare condition where the skin and mucous membranes can seep blood. This can happen anyplace on the body and can come with pain.
- Addison’s disease – an illness which hampers your adrenal glands from producing enough hormones.
- Hemochromatosis – a disease that causes your body to absorb too much iron.
- Hyperbilirubinemia – a condition characterized by excessive levels of bilirubin in the blood, a yellowish substance that is produced during the normal breakdown of red blood cells.
- Poisoning – a harmful effect on the body from the ingestion, inhalation, or absorption of a toxic substance.
- Alkaptonuria – a rare inherited condition where a person is deficient in homogentisic oxidase. This can result in one’s skin and urine darkening and lead to arthritis starting in early adulthood.
So, it’s critical for doctors to consider these ailments and further investigate during their diagnosis process.
What to expect with Chromhidrosis
Chromhidrosis is a harmless chronic condition that often improves over time. However, it can cause serious emotional effects, like anxiety or depression, and can also be embarrassing. People with this condition may find themselves needing to change their clothes frequently throughout the day.
Possible Complications When Diagnosed with Chromhidrosis
Chromhidrosis doesn’t directly cause any complications. However, it can have indirect effects due to psychological and social issues.
Preventing Chromhidrosis
It’s important to let patients know that apocrine chromhidrosis, a skin condition that changes the color of sweat, is not harmful but it is long-lasting. This condition could potentially last for several years or even forever. The treatments available only manage the symptoms and they may reappear if treatment stops. It can be helpful to explain to patients that stress and physical activity may make the condition more noticeable.
For those with eccrine chromhidrosis and pseudochromhidrosis, where the sweat or skin color also changes, it’s vital to inform them of the cause. They should be advised to avoid the cause where possible. In case the cause isn’t clear, keeping a record of the substances they ingest as well as any chemicals they come into contact with can be useful.
