History

Patients present with particularly offensive body odor that most commonly originates from the axillary region. However, the condition may also occur as genital or plantar bromhidrosis. The odor has been described as pungent, rancid, musty, or sour in character.

Physical Examination

Bromhidrosis is a metabolic and functional disease not typically associated with any anatomic disturbance. Therefore, results of physical examination of patients with axillary bromhidrosis are usually unremarkable. The skin appears normal, except when bromhidrosis is associated with concomitant skin conditions such as erythrasma, in which case a sharply marginated erythematous macular rash is seen, or trichomycosis axillaris, in which case concretions are visible on the hairs in the affected area.

In contrast, individuals with eccrine bromhidrosis caused by bacterial degradation of keratin may have maceration and a thick mat of moist keratin on examination. This finding is most common on the plantar and intertriginous surfaces.

Several case reports in children have described a nasal foreign body as a cause of generalized bromhidrosis.^{[17, 18, 19, 20, 21]}Therefore, examiners should conduct thorough visualization and palpation of nasal passages in pediatric patients.

Differential Diagnoses

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Nestor MS, Park H. Safety and Efficacy of Micro-focused Ultrasound Plus Visualization for the Treatment of Axillary Hyperhidrosis. J Clin Aesthet Dermatol. 2014 Apr. 7 (4):14-21. [QxMD MEDLINE Link].
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Lee KG, Kim SA, Yi SM, Kim JH, Kim IH. Subdermal Coagulation Treatment of Axillary Bromhidrosis by 1,444 nm Nd:YAG Laser: A Comparison with Surgical Treatment. Ann Dermatol. 2014 Feb. 26(1):99-102. [QxMD MEDLINE Link].
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Author

Nathaniel Teegee, MD Resident Physician, Department of Dermatology, University of British Columbia Faculty of Medicine, Canada

Nathaniel Teegee, MD is a member of the following medical societies: American Society of Dermatology, Canadian Dermatology Association, College of Physicians and Surgeons of British Columbia, Doctors of BC

Disclosure: Nothing to disclose.

Coauthor(s)

Wingfield Rehmus, MD, MPH Dermatologist, BC Children's Hospital, Vancouver, British Columbia

Wingfield Rehmus, MD, MPH is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie; Valeant Canada<br/> Received honoraria from Valeant Canada for advisory board; Received honoraria from Pierre Fabre for advisory board; Received honoraria from Mustella for advisory board; Received honoraria from Abbvie for advisory board.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Acknowledgements

Katherine Brown Stanford University School of Medicine

Katherine Brown, is a member of the following medical societies: American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Carol E Cheng, MD Attending Physician, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School

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

Disclosure: Nothing to disclose.

Shereen S Timani, MD Staff Physician, Department of Dermatology, American University of Beirut, Lebanon

Disclosure: Nothing to disclose.