Bromhidrosis is a condition of abnormal or offensive body odour from the sweat. Sweat glands are divided into eccrine and apocrine sweat glands.

Eccrine Sweat Glands & Bromhidrosis

Eccrine glands are located at the dermis, and found over the entire body, but are richest on the palms and soles. They produce a dilute salt solution in response to increased body temperature, and serve primarily to regulate body temperature and excrete waste products.

Eccrine bromhidrosis occurs in all races, sex and age groups. Eccrine sweat is normally odourless but can start to smell if bacteria get a chance to break down the stale sweat.

Excessive eccrine sweating (hyperhidrosis) leads to a sweaty wet environment that encourages the growth of some organisms, for example fungi, which will break down the skin protein and cause some smelly skin conditions. Various substances, including foods (e.g. garlic, curry), alcohol, or certain medications, find their ways into the sweat after ingestion and can lead to an offensive odour.

Apocrine Sweat Glands & Bromhidrosis

Most cases of bromhidrosis are due to apocrine gland secretion.

Apocrine glands are much bigger, and found only in the underarms, breasts and groin regions. They produce a thick secretion rich in fatty acid. Apocrine sweat is odourless when it first appears, but within an hour the fatty acid is broken down by bacteria on the skin, and produces a strong offensive odour like rotten meat

Apocrine bromhidrosis is more common in men than women, and in dark-skinned ethnic groups who have larger and more active apocrine glands. There may be a positive family history. It only occurs after puberty when the apocrine glands become active.

Management & Treatments

Use of topical deodorants may help to cover the offensive odour. Simply maintaining personal hygiene is a good way to improve bromhidrosis. The main issues are dryness and reduction of bacteria.

The skin, particularly the armpits, should be kept as dry as possible. Hair removal can be considered, as it will prevent accumulation of bacteria and sweat on hair shafts. Laser hair removal is better as it will remove the hair shafts in the follicles too.

A dry skin condition will reduce the growth of bacteria. Washing the underarm at least twice daily with germicidal soap will keep the number of naturally occurring skin bacteria to a minimum.

In more severe cases, when it is suspected to have heavy growth of bacteria, or when there are coexisting skin conditions, such as intertrigo or erythrasma, antibiotics cream or even a short course of oral antibiotics (for example Erythromycin) is a good regime.

If hyperhidrosis is a contributing factor, this needs to be treated. It is described in details in the previous section. In brief, the treatments include:

• anti-perspirants
• anti-cholinergic or beta-blocking drugs
• tap water iontophoresis
• botulinum toxin injection
• surgical sympathectomy
• surgical excision of apocrine sweat glands