Bromhidrosis Workup

Updated: May 23, 2018
  • Author: Nathaniel Teegee, MD; Chief Editor: William D James, MD  more...
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Workup

Laboratory Studies

Typically, the olfactory perception of the diagnostician is the only clinical tool required for diagnosis. Chromatography or spectroscopy may help identify odor-producing chemicals; however, the specific identification of odoriferous molecules is largely of academic interest and lacks diagnostic or therapeutic importance. In addition, results of chromatography or spectroscopy do not help in differentiating normal odor from odor caused by bromhidrosis. Starch iodine test can demonstrate areas of excessive sweating but would not characterize the associated malodor.

If concomitant erythrasma, a chronic bacterial infection of Corynebacterium minutissimum is suspected, the skin has a characteristic coral-red fluorescence under Wood lamp examination, and a potassium hydroxide preparation is negative for hyphae.

Gram stain preparation shows bacteria within concretions from axillary hair in cases of trichomycosis axillaris.

If an underlying metabolic disorder is suspected as a cause of odor, specific testing of urine or sweat may be indicated to detect the aberrant amino acid product.

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Imaging Studies

No imaging studies are indicated for the evaluation of bromhidrosis.

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Other Tests

Skin biopsy is rarely indicated in bromhidrosis. However, skin biopsy may be used to evaluate apocrine glands if surgical treatment options are being considered.

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Histologic Findings

Evidence about histologic findings in patients with bromhidrosis is conflicting. Some research indicates that no histologic abnormalities are seen in the skin or glands of patients with apocrine bromhidrosis when compared with control subjects. A few studies have shown that the number and the size of apocrine glands is increased in bromhidrosis skin. This finding suggests increased apocrine sweating as a possible cause of this bothersome condition. [23]

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