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Chromhidrosis in Child
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Chromhidrosis in Child

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Contributors: Matilda Nicholas MD, PhD, Jeffrey D. Bernhard MD, Lowell A. Goldsmith MD, MPH
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Synopsis

Chromhidrosis, as the name implies, is the appearance of colored sweat on the skin. Pseudochromhidrosis also denotes colored sweat; the distinction between the two is the location at which coloration occurs. In chromhidrosis, the sweat becomes pigmented before secretion from the gland, whereas in pseudochromhidrosis the sweat becomes pigmented after secretion.

Chromhidrosis may be further divided into apocrine and the much less common eccrine form. Not surprisingly, apocrine chromhidrosis is limited to apocrine gland-bearing areas such as the axilla, face, and areola. Common colors include yellow, green, blue or black, and coloration is secondary to abnormal accumulation of lipofuscin within apocrine cells. Lipofuscin is a pigment that results from lysosomal digestion of lipids; why abnormal accumulation results in cases of chromhidrosis is not known. The oxidative state of lipofuscin determines the color observed. Typically the pigment displays fluorescence at 360 nm, providing a useful diagnostic clue. Eccrine chromhidrosis is secondary to accumulation of water-soluble dyes, which a patient either ingests or is otherwise exposed to, within eccrine glands. For example, red eccrine chromhidrosis secondary to consumption of snack food colored with a red dye has been reported.

Pseudochromhidrosis, on the other hand, is often secondary to microbial overgrowth on the skin and accompanying pigment accumulation, but may also be caused by other dyes coming into contact with the skin, such as from clothing. In a frightening "epidemic" of cutaneous red spots on airline flight attendants, the source of the red dye turned out to be red ink on the demo life-jackets. Bacterial species commonly implicated as causative agents include Corynebacterium, Pseudomonas, Bacillus, and Serratia species, all of which may produce pigment of various colors.

No particular sex, race, or age predilection has been described for these conditions, although in the literature, multiple instances of red pseudochromhidrosis responding to antibiotics have been reported in preteen girls. There is one case report of new-onset pseudochromhidrosis thought to be due to overgrowth of pigment-producing bacteria in a patient taking multiple antacid medications, but otherwise no predisposing medical history has been identified.

Codes

ICD10CM:
L75.1 – Chromhidrosis

SNOMEDCT:
26147006 – Chromhidrosis

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Differential Diagnosis & Pitfalls

Other causes of pigmentation of the skin must be considered and excluded, eg:
Staining of cloth coming into contact with the affected skin should not occur in these disorders. Skin biopsy should rule out ochronosis and minocycline hyperpigmentation, and laboratory workup should rule out hyperbilirubinemia. Additionally, fluorescence of pigmented sweat under Wood's lamp should not be observed for ochronosis, hyperbilirubinemia, or minocycline hyperpigmentation.

Pigmented sweat can be faked (dermatitis simulata or dermatitis factitia). In one report, an adolescent female had bright blue, diffuse, and streaky "sweat" that tellingly appeared in non-apocrine as well as apocrine areas. She refused to submit a swab for spectrophotometric analysis.

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Last Updated: 09/06/2017
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Chromhidrosis in Child
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