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.

Imaging Studies

No imaging studies are indicated for the evaluation of bromhidrosis.

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.

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]

Treatment & Management

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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.