- Author: June Kim, MD; Chief Editor: Dirk M Elston, MD more...
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, axillae, 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 chromhidrosis have colored sweat that is regarded as acceptable and within the normal range.
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.
Incidence statistics are not available; chromhidrosis is rare.
Apocrine chromhidrosis appears to be more common in blacks than in whites, but facial chromhidrosis is described only in whites.
No sexual predilection is reported for chromhidrosis.
Chromhidrosis is noted after puberty, when the apocrine glands are activated. However, rare cases in infants have been reported.[5, 6]
Chromhidrosis persists throughout life, but slow regression of the disease is noted, as apocrine glands regress with time. The prognosis for chromhidrosis is good if an extrinsic cause can be identified and addressed appropriately.
Barankin B, Alanen K, Ting PT, Sapijaszko MJ. Bilateral facial apocrine chromhidrosis. J Drugs Dermatol. 2004 Mar-Apr. 3(2):184-6. [Medline].
Mali-Gerrits MM, van de Kerkhof PC, Mier PD, Happle R. Axillary apocrine chromhidrosis. Arch Dermatol. 1988 Apr. 124(4):494-6. [Medline].
Griffith JR. Isolated areolar apocrine chromhidrosis. Pediatrics. 2005 Feb. 115(2):e239-41. [Medline].
Saff DM, Owens R, Kahn TA. Apocrine chromhidrosis involving the areolae in a 15-year-old amateur figure skater. Pediatr Dermatol. 1995 Mar. 12(1):48-50. [Medline].
Carman KB, Aydogdu SD, Sabuncu I, Yarar C, Yakut A, Oztelcan B. Infant with chromhidrosis. Pediatr Int. 2011 Apr. 53(2):283-4. [Medline].
Yöntem A, Kör D, Hızlı Karabacak B, Karakaş M, Önenli Mungan N. Blue-colored sweating: four infants with apocrine chromhidrosis. Turk J Pediatr. 2015 May-Jun. 57 (3):290-3. [Medline].
Polat M, Dikilitas M, Gozubuyukogullari A, Alli N. Apocrine chromhidrosis. Clin Exp Dermatol. 2009 Oct. 34(7):e373-4. [Medline].
Wang A, Wysong A, Nord KM, Egbert BM, Kosek J. Chromhidrosis: A Rare Diagnosis Requiring Clinicopathologic Correlation. Am J Dermatopathol. 2013 Mar 14. [Medline].
Gaffney DC, Cooper HL. Coloured sweat in two brothers: First report of familial chromhidrosis. Australas J Dermatol. 2016 Feb. 57 (1):e23-5. [Medline].
Singal A, Thami GP. Red pseudochromhidrosis of the neck. Clin Exp Dermatol. 2004 Sep. 29(5):548-9. [Medline].
Thami GP, Kanwar AJ. Red facial pseudochromhidrosis. Br J Dermatol. 2000 Jun. 142(6):1219-20. [Medline].
Yoshida R, Kobayashi S, Amagai M, Tanaka M. Brown palm pseudochromhidrosis. Contact Dermatitis. 2002 Apr. 46(4):237-8. [Medline].
Hill S, Duffill M, Lamont D, Rademaker M, Yung A. Pseudochromhidrosis: blue discolouration of the head and neck. Australas J Dermatol. 2007 Nov. 48(4):239-41. [Medline].
Krishnaram AS, Bharathi S, Krishnan S. An interesting case of bisacodyl (dulcolax)-induced chromhidrosis. Indian J Dermatol Venereol Leprol. 2012 Nov-Dec. 78(6):756-8. [Medline].
Allegue F, Hermo JA, Fachal C, Alfonsín N. Localized green pigmentation in a patient with hyperbilirubinemia. J Am Acad Dermatol. 1996 Jul. 35(1):108-9. [Medline].
Kanzaki T, Tsuda J. Bile pigment deposition at sweat pores of patients with liver disease. J Am Acad Dermatol. 1992 Apr. 26(4):655-6. [Medline].
Keum DI, Hong H, Lee SH, Ahn SK. Eccrine Chromhidrosis Resembling Clinical Features of Pompholyx with Bile-Like Greenish Pigmentation on the Right Palm and Soles. Ann Dermatol. 2015 Aug. 27 (4):482-3. [Medline].
So JK, Romero L. Eccrine chromhidrosis secondary to hyperbilirubinemia. Dermatol Online J. 2014 Dec 14. 21 (3):[Medline].
Albers SE, Brozena SJ, Glass LF, Fenske NA. Alkaptonuria and ochronosis: case report and review. J Am Acad Dermatol. 1992 Oct. 27(4):609-14. [Medline].
Cox NH, Popple AW, Large DM. Autofluorescence of clothing as an adjunct in the diagnosis of apocrine chromhidrosis. Arch Dermatol. 1992 Feb. 128(2):275-6. [Medline].
Pérez-Tato B, Zamora-Martínez E, Sánchez-Albisua B, Pérez-González YC, Polimón-Olabarrieta I, Marinero-Escobedo S, et al. Facial and axillary apocrine chromhidrosis. Dermatol Online J. 2012 Mar 15. 18(3):13. [Medline].
Beer K, Oakley H. Axillary chromhidrosis: report of a case, review of the literature and treatment considerations. J Cosmet Dermatol. 2010 Dec. 9(4):318-20. [Medline].
Matarasso SL. Treatment of facial chromhidrosis with botulinum toxin type A. J Am Acad Dermatol. 2005 Jan. 52(1):89-91. [Medline].
Wu JM, Mamelak AJ, Nussbaum R, McElgunn PS. Botulinum toxin a in the treatment of chromhidrosis. Dermatol Surg. 2005 Aug. 31(8 Pt 1):963-5. [Medline].
Marks JG Jr. Treatment of apocrine chromhidrosis with topical capsaicin. J Am Acad Dermatol. 1989 Aug. 21(2 Pt 2):418-20. [Medline].
Rumsfield JA, West DP. Topical capsaicin in dermatologic and peripheral pain disorders. DICP. 1991 Apr. 25(4):381-7. [Medline].
Daoud MS, Dicken CH. Disorders of the apocrine sweat glands. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003. 708-9.
Shelley WD, Hurley HJ Jr. Localized chromhidrosis: a survey. Arch Dermatol Syphilol. 1954. 69:449-71.