What Is Chromhidrosis?

Overview

Chromhidrosis is a chronic disorder of the sweat glands that results in the secretion of coloured sweat that may be yellow, brown, green, blue or black. This colouration may be minimally noticeable and is commonly located in areas such as the face, underarms and areola, although other body parts may also be affected.¹

This condition is related to lipofuscin, a pigment produced in the sweat glands.² In people with chromhidrosis, lipofuscin exists in higher concentrations or is abnormally over-oxidised, leading to the production of coloured sweat.³

 Depending on the underlying cause of the chromhidrosis, individuals can be placed into one of the following subcategories:

• Apocrine chromhidrosis⁴ – chromhidrosis affects body areas containing apocrine sweat glands (e.g., torso, face, scalp and areola).
• Eccrine chromhidrosis – chromhidrosis impacts almost every area of the body, as it affects eccrine sweat glands, which are widely distrusted across the body.
• Pseudochromhidrosis – Colourless eccrine sweat is transformed into colour sweat when mixed with certain dyes/chemical or pigment-producing bacteria.

Editor’s Note: It would be beneficial to add an illustration that shows the difference between apocrine and eccrine glands. For example, https://www.freepik.com/free-vector/human-skin-anatomy-infographics-poster-with-cross-section-hair-follicle-vessels-flat-vector-illustration_38754041.htm 

 Irrespective of the subdivision, those affected all experience chromhidrosis, however, the type of chromhidrosis has to be considered when creating the treatment plan to make it as effective and specific to the patient as possible.

 Whilst physiologically harmless, chromhidrosis has substantial psychological effects given that it can cause embarrassment, distress and anxiety for those affected, thus making treatment for this condition vital. 

Causes of chromhidrosis

Fundamentally, the colouring of sweat arises as a result of lipofuscin, a pigment produced in the sweat glands. Lipofuscin is a yellow-brown pigment found in cells across various organs, not just in sweat glands.²  

Apocrine glands, which can be found in the skin, breasts, ear and eyelids, for example, are implicated in the production of pheromonal body odour, otherwise known as sweat.⁵  

While it is normal for these glands to contain lipofuscin granules, in people with chromhidrosis, lipofuscin is present in higher concentrations or is abnormally over-oxidised.⁶  Over-oxidisation of the lipofuscin can be triggered⁷ by:

• Exposure to emotional stimuli (e.g., pain, anxiety, sexual arousal).
• Hot showers and baths.
• Skin rubbing together or general friction.

In apocrine chromhidrosis, the greater the oxidisation, the darker the lipofuscin colour, so sweat can manifest in a variety of colours. 

On the other hand, in eccrine chromhidrosis, the colouring of sweat occurs exogenously (i.e., outside of the body). This results from contact with or consumption of: 

• Water-soluble dyes (e.g., tartrazine, a common food colouring agent)
• Certain food colouring or artificial flavourings
• Heavy metals (e.g., copper)
• Certain drugs or medications (e.g., bisacodyl,⁸ quinines, levodopa and rifampin)

Finally, in pseudochromhidrosis, which is a more common form of chromhidrosis, colouration of the sweat also occurs outside of the body.In this case, however, sweat produced by the eccrine glands develops its altered colour when exposed to drugs and compounds that specifically alter the microorganisms present on the skin’s surface.³

These compounds include a variety of chemicals and dyes, as well as pigments produced by certain types of bacteria.

Signs and symptoms of chromhidrosis

The most noticeable symptom of chromhidrosis is coloured sweat. This sweat may be a variety of colours, including black, brown, blue, green and yellow; however, the exact colour and vividness of the sweat varies depending on the individual. The sweat may or may not stain one’s clothing and may be restricted to certain areas of the body or not, depending on the individual.

Those suffering from this condition can also experience a feeling of warmth, or a prickly sensation with the anticipation of emotional or physical stress caused by the appearance of coloured sweat.

As a regressive, benign and chronic condition, chromhidrosis is of no immediate detrimental effect on the physiology of an individual; however, patients with this condition are more likely to experience psychological distress. Notably, the condition can lead to significant anxiety, depression, or embarrassment, particularly regarding the frequent need to change clothes throughout the day .

Other signs and symptoms attached to chromhidrosis include:

• Persistent anxiousness, sadness, or general low mood
• Weight loss, lack of appetite, or overeating
• Suicidal thoughts or ideation
• Trouble concentrating, decision-making or recalling information
• Inability to feel pleasure (i.e. anhedonia) and lack of interest in previously enjoyable activities
• Increased fatigue or decreased energy
• Insomnia

Management and treatment for chromhidrosis

The optimal treatment plan for chromhidrosis is dependent on the type of chromhidrosis the patient presents as it is based on the underlying cause of this condition.

For patients with apocrine chromhidrosis, treatment methods focus on reducing perspiration (i.e., the amount of sweat secreted by the body), or on inducing the secretion of sweat to empty the glands. Specific treatment options include:

• Applying manual pressure to empty the apocrine glands, resulting in improved sweat appearance for up to 72 hours⁹
• Applying capsaicin cream daily, which may, however, create a burning sensation at the site of application
• Applying topical aluminium chloride
• Receiving injections of botulinum toxin type A (i.e., botox injections)

It should be noted that the condition will recur if therapy is stopped.

For eccrine chromhidrosis, treatment methods revolve around eliminating the causative agent, commonly by reducing contact with the dyes, chemicals and heavy metals responsible.

Finally, treatment methods for pseudochromhidrosis involve topical or systemic antimicrobial medication to eradicate the perpetrating microorganism. Alternatively, stopping any additional medication that may be implicated in the condition helps to rebalance the skin’s natural population of bacteria.

FAQs

How is chromhidrosis diagnosed?

In order to diagnose this condition, doctors perform a physical examination and administer a questionnaire regarding when and where the coloured sweat appears. This enables the doctor to get a more comprehensive image of the individual’s condition and better understand how to implement an effective and feasible treatment plan. 

Furthermore, the doctor may require additional tests or examinations to rule out other potential causes for the coloured sweat to ensure that chromhidrosis is accurately diagnosed.

Who isat risk of chromhidrosis?

Whilst apocrine chromhidrosis can appear at any age or point in life, it often manifests post-puberty when the apocrine secretory function begins. The disease is chronic in nature, yet with age, it may regress thanks to diminished apocrine secretion.

Currently, there is no link between chromhidrosis and gender, geographical location, weather or season. In terms of race, however, the conditions appear to be more common in those of African descent.

When should I see a doctor?

Typically, regular sweat is clear or slightly cloudy in colour. Therefore, if you notice any colouration of yoursweat, then youshould consult yourdoctor or anotherhealthcare professional.

If you have chromhidrosis and experience emotionally or physically distressing symptoms,then you should get in contact with you doctor to get the support you need.

Summary

Chromhidrosis is a chronic condition of the sweat glands that results in the secretion of coloured sweat that may be yellow, brown, green, blue or black. This colouration may be minimally noticeable and is commonly located in areas such as the face, underarms and areola, although other body parts may also be affected.

Affected individuals may experience one of three types of chromhidrosis: apocrine chromhidrosis, eccrine chromhidrosis or pseudochromhidrosis. The type of chromhidrosis experienced has significant implications for the treatment plan as treatment focused on suppressing the cause of the condition, which is directly linked to the type of chromhidrosis .

The condition itself poses no physiological threat to affected individuals however, there may be substantial psychological distress caused as a result of embarrassment or emotional distress. As such, it is vital that affected individuals consult their doctor and establish an effective and feasible treatment plan that works for them.