BROMHIDROSIS

Dermatologists or other physicians who are aware of the benefit and eventual cure of apocrine bromhidrosis by electrolysis will prefer to send the patients for "electrolysis therapy" - a sure fire cure involving the permanent removal of all axillary hair and destruction of the hair follicles.

If you have ever known someone with Bromhidrosis you'll understand why the literal translation is "stinking sweat." And you'll also be aware that no matter how much deodorant, antiperspirant or perfume they use, these individuals are foul-smelling most of the time. They could bathe 10 times a day and still be offensive to those around them. The syndrome effects every aspect of their lives; school, work, friendships, romance, sporting activities, even shopping.

Electologist's can help these individuals. We can make a significant difference in their lives. Lets embark on a learning journey of the human sudoriferous glands.

Sudoriferous (sweat) glands are the glands that produce our sweat. There are two kinds eccrine, and apocrine and they are an extraordinary study in contrast, from almost any way you look at it.

The eccrine glands, found all over the body in almost countless quantities, are totally unrelated to hair and other glandular appendages. They exist alone, and produce a simple, watery solution in seemingly unlimited quantities. Pure eccrine sweat is normally odorless and will remain so indefinitely unless it is contaminated by other secretions, epidermal scales, or skin debris. (The glands may also excrete ordoriferous material following the ingestion of onions, garlic, or certain drugs.)

The comparably large apocrine glands are found in limited areas, most notably the underarms and ano-genital skin, where they secrete (in remarkably small quantities) their sweat into the hair follicle. These glands are of interest essentially because of the discomfort or unpleasantness their secretory product can cause. They have no known physiologic importance as we live today (their role of "scent glands" being lost long ago in our evolutionary past).

Despite their physiologic worthlessness, the apocrine glands cannot be ignored, especially by electrologists. There are several distinctive dermatologic disorders involving the glands. In addition, control of the pervasive odor of apocrine sweat is regarded by most of modern society as a daily necessity. North Americans alone spend over 300 million dollars annually on the purchase of axillary deodorants and antiperspirants.

The ability to produce an unpleasant odor is without doubt the best known property of human apocrine sweat. It is by far the most odorogenic cutaneous secretion. In the normal, healthy, post-pubertal individual, it is the major odor source of the body.

APOCRINE BROMHIDROSIS

Strictly defined, bromhidrosis (or osmidrosis, as it is sometimes called), is a condition in which an excessive odor, usually offensive, emenates from the skin. Apocrine bromhidrosis is, of course, more specific. It results from bacterial alterations of apocrine sweat, essentially all within the axilla.

Apocrine bromhidrosis occurs in all races, but there are some variations in racial incidence. Individual's of African ancestry apocrine glands are the largest and most active. Asian's have the smallest and least active glands. Beyond that, variations in the occurrence of bromhidrosis are pretty much unexplained individual differences in the composition of apocrine sweat, or differences in hygienic routine. The hygienic routine (or lack of) probably explains why there is a greater frequency of the problem in males, who are usually (though not always) less fastidious than females.

Apocrine bromhidrosis never occurs before puberty, because the particular glands involved are not active in the pre-pubescent individual. It is also less likely in the elderly.

Apocrine sweat is sterile and odorless when it first appears on the skin surface. However, within an hour bacteria degrades the sweat to the point where the classic acrid odor is detectable. Fatty acids and ammonia ("diaper pail") are the major odoriferous products of this bacterial decomposition. Thus, a variety of odors - musty, rancid, fecal, sour and sweet' may be detected: reflecting, of course , the differences in chemical makeup of each individual's axillary sweat. Hair and clothing, also provide additional lodgings for the retention of the odorogenic sweat, and this contributes greatly to the odor-producing problem.

The axilla is really the only area from which the distinctive apocrine odor is produced. Even though the bacterial environment is present in other apocrine areas, they seem to produce very slight amounts of apocrine sweat, which is why these areas don¹t cause the same problem. In fact, most of the apocrine glands in areas other than the axilla are functionless.

Apocrine sweat is the only natural product of the body which, when decomposed with bacteria, gives rise to the classic apocrine odor. Nothing in the world can be substituted for apocrine sweat and result in the same odor ‹ not sebum, hair, eccrine sweat, keratin scales, or any combination of these. In fact, this odor can be so pervasive and prominent, that despite its origination from the axilla only, it has been given the common designation of ³body odor.²

The diagnosis of apocrine bromhidrosis, can be easily made if the examiner has normal olfaction. There is, though, one very important distinction that must be made between the true bromhidrosis patient and the bromhidrosiphobic individual: the latter being people who have a morbid dread of bodily odors and unreal images about what they smell, or in this case, what they think they smell. This sensory delusion can be an early warning sign of schizophrenia. Olfactory hallucinations may also be a sign of neurological disease.

By and large, people with apocrine bromhidrosis are not careless in their personal hygiene. They regularly cleanse their axilla (sometimes several times a day), usually with a germicidal soap. This accomplishes two things: the removal of the apocrine sweat, and temporary inhibition of the axillary bacteria.

Shaving the axillary hair (men and women) is an absolute necessity for all patients with apocrine bromhidrosis, in order to prevent the accumulation of sweat and bacteria on the hair shafts. As well as shaving, I advise my patients to carry alcohol pads for regular between-showers clean-ups.

Regular use of an axillary deodorant, several times daily, will help to suppress axillary bacteria. Contrary to what we might expect, the metallic aluminum, zirconium, or zinc salts in most over the counter anti-perspirants have no antiperspirant action on the apocrine glands, but they do work well on eccrine glands, and the antibacterial agents in the deodorants are effective on both glands.

Another obvious means of suppressing axillary odor involves the use of perfumes to cover up or mask the offensive odor. But it must be remembered that perfumes carry the risk of allergic sensitization. Most axillary deodorants contain perfumes, too, and for those patients who find this a problem, there now a few perfume-free preparations on the market.

Topical antibiotics such as neomycin or gentamicin creams are effective axillary deodorants, but they also carry the risk of allergic contact sensitization, especially with neomycin.

Topical antioxidants, especially vitamin E, may offer some help. Most doctors will try one or a combination of approaches in treating apocrine bromhidrosis before referring the patient to an electrologist. if all else fails, some dermatologists will try surgical extirpation of the apocrine glands ‹ in other words, complete removal of the apocrine glands. This requires numerous incisions, with resulting scar tissue, and to my mind this is like taking a sledge hammer to drive home a small nail: it¹s about the nearest thing to "overkill" that I can imagine.

Cost is a consideration, of course. Health insurance should cover the procedure, but with some rare exceptions it probably doesn't. They consider the procedure cosmetic in nature and refuse to pay.

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Mary Albrecht, RE
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