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Apocrine chromhidrosis

Author: Dr Duncan Lyons, Resident Medical Officer, Gold Coast University Hospital, Gold Coast, Queensland, Australia. Medical Editor: Dr Helen Gordon, Dermatology Registrar, Auckland, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. July 2020.


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What is apocrine chromhidrosis?

Apocrine chromhidrosis is the production of coloured sweat from the apocrine sweat glands.

Apocrine chromhidrosis

Who gets apocrine chromhidrosis?

Apocrine chromhidrosis is rare. It usually starts after puberty once the apocrine glands have matured. Chromhidrosis occurs in both sexes [1].

What causes apocrine chromhidrosis?

Apocrine chromhidrosis is usually due to lipofuscin granules in the apocrine sweat glands. It is thought that lipofuscin is produced from the oxidation of unsaturated fatty acids within the gland. It is unknown why this happens.

What are the clinical features of apocrine chromhidrosis?

Apocrine chromhidrosis presents with coloured sweat localised to the distribution of the apocrine glands in the axillae, on the face (particularly the cheeks), breast areolae, and anogenital regions.

Sweat may be coloured blue, black, green, brown, or yellow, depending on the oxidation state of the lipofuscin staining the skin and clothing [1,2].

The secretion of coloured sweat can be preceded by a prickly sensation or warmth on the affected skin [2].

What is the differential diagnosis of apocrine chromhidrosis?

Apocrine chromhidrosis can resemble pseudochromhidrosis and eccrine chromhidrosis.

Pseudochromhidrosis

Pseudochromhidrosis is sweat coloured after it has been secreted. It is more common than chromhidrosis.

Eccrine chromhidrosis

Eccrine chromhidrosis is the production of coloured sweat from the eccrine sweat glands. It is more widespread than apocrine chromhidrosis as eccrine glands are widely distributed over the body and concentrated on the palms and soles.

How is apocrine chromhidrosis diagnosed?

Apocrine chromhidrosis is often diagnosed clinically. The following may be used to confirm the diagnosis [1].

  • Expression of sweat from the affected site may reveal coloured sweat that quickly dries.
  • Exposure to a Wood lamp may show yellow fluorescence.
  • A skin biopsy confirms the diagnosis if lipofuscin pigment granules are found within the apocrine glands.

Other tests may include:

  • A skin scraping and culture to exclude the chromogenic bacteria of pseudochromhidrosis
  • Liver function and kidney function tests to exclude hyperbilirubinaemia and uraemia.

What is the treatment of apocrine chromhidrosis?

Treatments that have had some success in apocrine chromhidrosis include:

  • Topical capsaicin cream, which reduces substance P (a neurotransmitter important in the production of sweat in apocrine sweat glands)
  • Botulinum toxin type A injections.

What is the outcome for apocrine chromhidrosis?

Apocrine chromhidrosis is a benign chronic condition. It slowly regresses with advancing age as the apocrine glands gradually return to their original state [3,4].

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References

  1. Chromhidrosis: Uptodate (for subscribers). Available at: www.uptodate.com/contents/chromhidrosis/print [accessed 16 July 2020]
  2. Marks J. Treatment of apocrine chromhidrosis with topical capsaicin. J Am Acad Dermatol 1989; 21: 418–20. DOI: 10.1016/s0190-9622(89)80050-7. PubMed
  3. Griffith J. Isolated areolar apocrine chromhidrosis. Paediatrics 2005; 115: 239–41. DOI: 10.1542/peds.2004-1561. PubMed
  4. Saff D, Owens R, Kahn T. Apocrine Chromhidrosis involving the areolae in a 15-year-old amateur figure skater. Padiatr Dermatol 1995; 12: 48–50. DOI: doi.org/10.1111/j.1525-1470.1995.tb00124.x. Journal

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