What is bromhidrosis?
Bromhidrosis is foul-smelling body odor related to your sweat.
Perspiration itself actually has no odor. It’s only when sweat encounters bacteria on the skin that a smell can emerge. Other than body odor (BO), bromhidrosis is also known by other clinical terms, including osmidrosis and bromidrosis.
Bromhidrosis can often be treated or prevented through changes to your hygiene habits, though there are medical treatment options as well.
You have two types of sweat glands: apocrine and eccrine. Bromhidrosis is usually related to secretions by apocrine glands. But both types of sweat glands can lead to abnormal body odor.
Apocrine glands are located primarily in the underarm, groin, and breast areas. Sweat from the apocrine glands tends to be thicker than that produced by the eccrine glands. Apocrine sweat also contains chemicals called pheromones, which are hormones meant to have an effect on others. People and animals release pheromones to attract a mate, for example.
When apocrine sweat is released, it’s colorless and odorless. When bacteria on the body start to break down dried sweat, an offensive smell can result in people with bromhidrosis.
Apocrine glands don’t become active until puberty. That’s why BO isn’t usually an issue among young children.
Eccrine sweat glands are all over the body. Eccrine sweat is also odorless and colorless at first, though it does contain a mild salty solution. A bad smell can also develop when bacteria on the skin break down eccrine sweat. The smell of eccrine sweat can also reflect certain foods you may have eaten (such as garlic), alcohol you’ve consumed, or certain medications you’ve taken.
Bromhidrosis is easy to diagnose. Your doctor should be able to identify the condition based on your scent. You may have no discernible odor if you’re not sweating or recently showered. Your doctor may ask to see you after you’ve been exercising or may have you exercise on a treadmill, for example, at the appointment.
Your doctor will also review your medical history to look for possible underlying causes of your BO. Conditions such as diabetes and liver and kidney disease can contribute to an abnormally strong body odor.
The appropriate treatment approaches for bromhidrosis are based on the severity of the condition. In some cases, preventive measures are enough. In more serious cases, removal of the offending sweat glands may be the answer. Your treatment options include:
Botulinum toxin A (Botox), which works by blocking nerve impulses to the muscles, can be injected into the underarm to block nerve impulses to the sweat glands. The downside of Botox treatment is that it wears off after a while, so you may need it a few times a year. Botox is also used for sweaty hands and feet.
One way to cut down on apocrine sweat is to remove the sweat glands themselves. You may have heard about liposuction in relation to removing fat from your midsection or elsewhere in the body. Special tubes are carefully inserted into the body, and fat is extracted.
The same concept can be applied to sweat glands under your arms. A very small suction tube, called a cannula, is inserted just under the skin. It’s then grazed along the underside of your skin, removing sweat glands as it goes. This process may leave some glands in place that can continue to cause excessive sweating.
In some cases, early positive results of less sweating and odor are the result of damaged nerves. When the nerves stunned during liposuction repair themselves, the same problems can return.
There is some encouraging progress in the use of ultrasonic liposuction, which uses vibrating energy to better remove the targeted sweat glands.
A more invasive way of removing sweat glands or the nerves that trigger sweating is through surgery. A procedure called endoscopic sympathectomy uses small incisions and special tools to destroy the nerves in the chest that lead to the underarm sweat glands. The procedure is effective for 5 to 10 years.
Another minimally invasive treatment is called electrosurgery. It’s done with tiny insulated needles. Over a period of several treatments, a doctor can use the needles to remove the sweat glands.
A surgeon can also remove the sweat glands themselves through a more traditional operation. This starts with an incision in the underarm. It allows the surgeon to see clearly where the glands are located. This type of surgery is called a skin resection, and it does leave some scarring on the surface of your skin. It tends to be used with people who also have hidradenitis, a chronic skin condition that leaves you with lumps in the armpits and elsewhere in the body.
Before any invasive procedure is attempted, you should try some basic hygiene strategies. These can help reduce the number of bacteria interacting with your sweat. These life hacks for beating BO are a great place to start.
Because bromhidrosis is triggered by the action of bacteria on the skin, frequent washing may be enough to neutralize the bacteria. Washing at least daily with soap and water may help. If the smell is localized to the armpits, for example, you can focus your cleansing efforts there.
An antiseptic soap and antibacterial creams containing erythromycin and clindamycin may also help.
A strong deodorant or antiperspirant can play a key role in minimizing odor. Trimming the hair in your underarms is also recommended.
You should also wash your clothes regularly and remove clothes that are sweaty as soon as you can. While some clothes can be worn more than once before washing as a general rule, if you have bromhidrosis, you may need to wash after every wear. An undershirt may help keep odor from reaching your outer layers of clothing.
For some people, bromhidrosis means more than having BO. It can be a sign of another medical condition. These include:
- trichomycosis axillaris (an infection of the hair follicles under the arm)
- erythrasma (a superficial skin infection)
- intertrigo (skin rash)
- type 2 diabetes
Obesity can also be a contributing factor to bromhidrosis, too.
The bottom line
Some odor under the arms or from other sweaty parts of the body is normal, especially during puberty. Bathing regularly, using a deodorant or antiperspirant, and wearing clean clothes may be enough to neutralize minor BO. You should try those approaches first.
However, if the problem can’t be contained with hygiene, talk with your doctor about other treatment options. Consult a dermatologist to see if a skin condition may be making things worse. Bromhidrosis can be a difficult condition, but it’s treatable for many people.