eMedicine Specialties > Dermatology > Diseases of the Adnexa

Chromhidrosis

Author: June Kim, MD, Staff Physician, Department of Dermatology, University of New Mexico
Coauthor(s): Wingfield Rehmus, MD, MPH, Co-Director of Clinical Trials, Clinical Instructor, Department of Dermatology, Stanford University Medical Center; Nelly Rubeiz, MD, Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon
Contributor Information and Disclosures

Updated: Dec 9, 2008

Introduction

Background

Chromhidrosis is a rare condition characterized by the secretion of colored sweat. Two glands produce sweat: eccrine and apocrine glands. Eccrine glands secrete a clear, odorless fluid that serves to regulate body temperature. Apocrine glands secrete a thick, milky sweat that, once broken down by bacteria, is the main cause of body odor.

Chromhidrosis is apocrine in origin. Although apocrine glands are found in the genital, axillary, areolar, and facial skin, chromhidrosis is reported only on the face,1 axillae,2 and breast areola.3,4 Lipofuscin pigment is responsible for the colored sweat. This pigment is produced in the apocrine gland, and its various oxidative states account for the characteristic yellow, green, blue, or black secretions observed in apocrine chromhidrosis.

In contrast, eccrine chromhidrosis is rare and occurs with ingestion of certain dyes or drugs, and pseudochromhidrosis occurs when clear eccrine sweat becomes colored on the surface of the skin as a result of extrinsic dyes, paints, or chromogenic bacteria.

Approximately 10% of people without the disease have colored sweat that is regarded as acceptable and within the normal range.

Pathophysiology

Lipofuscin is a yellowish brown pigment that is normally found in the cytoplasm of relatively nondividing cells (eg, neurons). In chromhidrosis, lipofuscins are found in a higher-than-normal concentration or a higher-than-normal state of oxidation in apocrine glands. However, why some glands experience these changes is unclear. This increased level of oxidation results in the green, blue, and even black sweat seen in chromhidrosis.

The yellow, green, and blue apocrine secretions produce a yellow fluorescence under a Wood lamp (UV 360 nm), whereas the dark brown and black apocrine secretions seldom autofluoresce. Substance P is also postulated to be an important neurotransmitter in this process.

Pseudochromhidrosis is of an extrinsic etiology in which a chemical on the surface of the skin reacts with eccrine secretions and produces the color transformation.

Frequency

United States

Incidence statistics are not available; the disease is rare.

International

Incidence statistics are not available; the disease is rare.

Race

Apocrine chromhidrosis appears to be more common in blacks than in whites, but facial chromhidrosis is described only in whites.

Sex

No sexual predilection is reported.

Age

Chromhidrosis is noted after puberty, when the apocrine glands are activated.

Clinical

History

History taking should include a detailed investigation of the patient's environment and lifestyle to exclude exogenous causes.

Quantities of apocrine sweat are less than those of eccrine sweat.

  • Usually, patients report axillary staining of their undershirt and, less frequently, staining of the face or areola. Yellow is the most common color of axillary staining.
  • An aura of warmth or a prickly sensation prompted by emotional or physical stimuli may precede the onset of colored sweat.
  • Facial apocrine chromhidrosis is rarely described. It occurs most frequently on the cheeks and malar eminences. The secretion can often be expressed mechanically.

Physical

On careful inspection, the following signs can often be observed:

  • An odorless yellow, green, blue, brown, or black and turbid secretion that can be manually expressed from apocrine-bearing skin
  • Staining that is accentuated in the follicular orifices and pores
  • Glistening, adherent, deeply colored flecks that appear as the secretions dry

Causes

The increased numbers of lipofuscin pigments in the secretory apocrine cells are presumed to be the cause of apocrine chromhidrosis.

Several extrinsic causes of eccrine chromhidrosis and pseudochromhidrosis include chromogenic bacteria, especially Corynebacterium species, fungi, dyes, drugs, and chemical contactants.5,6,7,8

More on Chromhidrosis

Overview: Chromhidrosis
Differential Diagnoses & Workup: Chromhidrosis
Treatment & Medication: Chromhidrosis
Follow-up: Chromhidrosis
References
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References

  1. Barankin B, Alanen K, Ting PT, Sapijaszko MJ. Bilateral facial apocrine chromhidrosis. J Drugs Dermatol. Mar-Apr 2004;3(2):184-6. [Medline].

  2. Mali-Gerrits MM, van de Kerkhof PC, Mier PD, Happle R. Axillary apocrine chromhidrosis. Arch Dermatol. Apr 1988;124(4):494-6. [Medline].

  3. Griffith JR. Isolated areolar apocrine chromhidrosis. Pediatrics. Feb 2005;115(2):e239-41. [Medline].

  4. Saff DM, Owens R, Kahn TA. Apocrine chromhidrosis involving the areolae in a 15-year-old amateur figure skater. Pediatr Dermatol. Mar 1995;12(1):48-50. [Medline].

  5. Singal A, Thami GP. Red pseudochromhidrosis of the neck. Clin Exp Dermatol. Sep 2004;29(5):548-9. [Medline].

  6. Thami GP, Kanwar AJ. Red facial pseudochromhidrosis. Br J Dermatol. Jun 2000;142(6):1219-20. [Medline].

  7. Yoshida R, Kobayashi S, Amagai M, Tanaka M. Brown palm pseudochromhidrosis. Contact Dermatitis. Apr 2002;46(4):237-8. [Medline].

  8. Hill S, Duffill M, Lamont D, Rademaker M, Yung A. Pseudochromhidrosis: blue discolouration of the head and neck. Australas J Dermatol. Nov 2007;48(4):239-41. [Medline].

  9. Allegue F, Hermo JA, Fachal C, Alfonsín N. Localized green pigmentation in a patient with hyperbilirubinemia. J Am Acad Dermatol. Jul 1996;35(1):108-9. [Medline].

  10. Kanzaki T, Tsuda J. Bile pigment deposition at sweat pores of patients with liver disease. J Am Acad Dermatol. Apr 1992;26(4):655-6. [Medline].

  11. Albers SE, Brozena SJ, Glass LF, Fenske NA. Alkaptonuria and ochronosis: case report and review. J Am Acad Dermatol. Oct 1992;27(4):609-14. [Medline].

  12. Cox NH, Popple AW, Large DM. Autofluorescence of clothing as an adjunct in the diagnosis of apocrine chromhidrosis. Arch Dermatol. Feb 1992;128(2):275-6. [Medline].

  13. Matarasso SL. Treatment of facial chromhidrosis with botulinum toxin type A. J Am Acad Dermatol. Jan 2005;52(1):89-91. [Medline].

  14. Wu JM, Mamelak AJ, Nussbaum R, McElgunn PS. Botulinum toxin a in the treatment of chromhidrosis. Dermatol Surg. Aug 2005;31(8 Pt 1):963-5. [Medline].

  15. Marks JG Jr. Treatment of apocrine chromhidrosis with topical capsaicin. J Am Acad Dermatol. Aug 1989;21(2 Pt 2):418-20. [Medline].

  16. Rumsfield JA, West DP. Topical capsaicin in dermatologic and peripheral pain disorders. DICP. Apr 1991;25(4):381-7. [Medline].

  17. Cilliers J, de Beer C. The case of the red lingerie - chromhidrosis revisited. Dermatology. 1999;199(2):149-52. [Medline].

  18. Daoud MS, Dicken CH. Disorders of the apocrine sweat glands. In: Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003:708-9.

  19. Shelley WD, Hurley HJ Jr. Localized chromhidrosis: a survey. Arch Dermatol Syphilol. 1954;69:449-71.

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Further Reading

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Keywords

chromhidrosis, pseudochromhidrosis, chromidrosis, colored sweat, discolored sweat, pigmented sweat, yellow sweat, green sweat, blue sweat, black sweat, lipofuscin, Corynebacterium bacteria

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Contributor Information and Disclosures

Author

June Kim, MD, Staff Physician, Department of Dermatology, University of New Mexico
June Kim, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Wingfield Rehmus, MD, MPH, Co-Director of Clinical Trials, Clinical Instructor, Department of Dermatology, Stanford University Medical Center
Wingfield Rehmus, MD, MPH is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Nelly Rubeiz, MD, Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon
Nelly Rubeiz, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Günter Burg, MD, Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland
Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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