The Case of the Orange Sweat Chromhidrosis

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The Case of the Orange Sweat Chromhidrosis

• Kristen Wyrick, Capt USAF MC
• David Grant Medical Center
• Travis AFB CA

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IntroductionChromhidrosis

• A rare apocrine gland disorder
• Produces pigmented sweat
• Usually found in the axillae, face or areola
• More common in African Americans
• Unknown etiology

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Case PresentationChief Complaint

• 44yo healthy female
• Orange stained skin, clothes and nails
• Symptoms for one year
• Concentrated across chest
• Asked about the use of self-tanners

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Case PresentationChromhidrosis
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Case PresentationChromhidrosis
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Case PresentationMedical History

• PMH
• Br Cancer Gene-1 Positive
• Benign liver cysts
• PSH
• TAH/BSO (prophylactic)
• Meds
• Multivitamin
• Topical Testosterone cream
• Vaginal Estrogen cream
• Hormones started 6 mo after onset of symptoms

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Case PresentationMedical History

• No dietary cause
• No occupational cause
• Non-smoker, Non-drinker
• Family History
• Negative for any like symptoms/ diseases

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Case PresentationPhysical Exam

• Vital signs normal
• BMI 22
• Skin
• Bronzing of the chest and face
• Nails stained orange around cuticle
• Intradermal Nevi
• No evidence of sun damage
• Benign exam otherwise

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Case PresentationLab work

• CBC
• ADH
• Cortisol
• Homogentisic Acid
• Punch Biopsy
• No apocrine glands present
• Eccrine glands flourescent cytoplasmic granules
• Rare Gram Positive Cocci

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Case PresentationPunch biopsy site
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Case PresentationTreatment

• Multivitamin Stopped
• Well water was tested by the county
• Capsaisin cream offered
• 10 day course of Augmentin
• Botulinum toxin not offered due to large affected
  surface area

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DiscussionBackground

• First case- 1709 by Yonge
• Review- 1954 by Shelley and Hurley
• Apocrine gland
• Oxidised lipofuscins
• Most cases- black/blue pigments
• Limited research on etiology
• Not associated with systemic disorders

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DiscussionLiterature
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DiscussionChromhidrosis

• True Chromhidrosis
• Apocrine Gland- colored lipofuscin granules
• Eccrine Gland- water soluble pigments
• Pseudochromhidrosis
• Sweat becomes colored at the skin surface
• Ochronosis-Alkaptonuria
• Genetic disorder HGAO enzyme missing

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DiscussionDifferential Diagnosis

• Hyperbilirubinemia
• Pseudomonas infection
• Bleeding diathesis
• Alkaptonuria
• Poisoning
• Addisons Disease
• Hemochromatosis

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DiscussionChromhidrosis

• Associated with an aura
• Warmth or prickling sensation
• Prompted by emotional or physical excitation
• Diagnosis
• Woods Lamp
• Induce colored sweat with pharmacologic
  stimulation
• Biopsy specimen
• Oxidized lipofuscin granules present

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DiscussionTreatment

• Avoid external causes when identified
• Treat infections
• Capsaicin cream
• Botulinum Toxin A injection
• Reassurance

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DiscussionFollow-up

• Antibiotics did not improve her symptoms
• Declined request for second biopsy
• Continues to have stained clothing nails
• Patient appreciative of the diagnosis and
  information on the disease

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ConclusionChromhidrosis

• First Case reported
• Orange colored secretions
• Post-menopausal female
• Unknown incidence and etiology
• May consider capsaicin cream or botox
• Reassure patients
• Benign condition
• Spontaneous regression

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References

• 1. Shelley WB, Hurley HJ. Localized
  chromhidrosis a survey. Arch Dermatol.
  195469449-471.
• 2. Cilliers J, de Beer C. The Case of the Red
  Lingerie-Chromhidrosis Revisited. Dermatology.
  1999199149-152.
• 3. Kim J. Chromhidrosis. Emedicine From WebMD.
  Available at http//www.emedicine.com/derm/topic5
  96.htm. Accessed December 15, 2006.
• 4. Griffith JR. Isolated Areolar Apocrine
  Chromhidrosis. Pediatrics. 2005 Feb115 239-241.
• 5. Mali-Gerrits MM, van de Kerkhof PC, Mier PD,
  Happle R. Axillary apocrine chromhidrosis. Arch
  Dermatol. 1988 Apr124(4)494-496
• 6. Thami GP, Kanwar AJ. Red facial
  pseudochromhidrosis. Br J Dermatol. 2000 Jun
  142(6)1219-1220.
• 7. Barankin B, Alanen K, Ting PT, Sapijaszko MJ.
  Bilateral facial apocrine chromhidrosis. J Drugs
  Dermatol. 2004 Mar-Apr3(2)184-186.
• 8. Saff DM, Owens R, Kahn TA. Apocrine
  chromhidrosis involving the areolae in a
  15-year-old amateur figure skater. Pediatr
  Dermatol. 1995 Mar12(1)48-50.
• 9. Daos MS, Dicken CH. Disorders of the apocrine
  sweat glands. In Fitzpatricks Dermatology in
  General Medicine. 6th ed. New York, NY
  McGraw-Hill 2003 708-709
• 10. Hurley HJ, Witkowski J. Dye clearance and
  eccrine sweat secretion in human skin. J Invest
  Dermatol. 196136259-272
• 11. Cox NH, Popple AW, Large DM.
  Autofluorescence of clothing as an adjunct in the
  diagnosis of apocrine chromhidrosis. Arch
  Dermatol. 1992 Feb128(2)275-276.
• 12. Marks JG. Treatment of apocrine
  chromhidrosis with topical capsaicin. J Am Acad
  Dermatol. 198921(2)418-420.
• 13. Rumsfield JA, West DP. Topical Capsaicin in
  Dermatologic and Peripheral Pain Disorders. DICP,
  Annals of Pharmacotherapy. 199125381-387.
• 14. Matarasso SL. Treatment of facial
  chromhidrosis with botulinum toxin type A. J Am
  Acad Dermatol. 2005 Jan52(1)89-91.
• 15. Wu JM, Mamelak AJ, Nussbaum R, McElgunn PS.
  Botulinum toxin a in the treatment of
  chromhidrosis. Dermatol Surg. 2005 Aug31(8 Pt
  1)963-965.

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Questions?