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Pseudochromhidrosis

Pseudochromhidrosis is an extremely rare pathology of the eccrine sweat glands. Patients produce colorless sweat that subsequently becomes colored when being in contact with various external compounds, which leads to black, blue, pink, brown, yellow, or red discoloration of the skin. The diagnosis rests on a thorough patient history and a comprehensive laboratory workup.


Presentation

Pseudochromhidrosis is a rare phenomenon in clinical practice, with only a handful of cases described in the literature so far [1] [2] [3]. The coloration of the skin seen in these individuals stems from the initial production of uncolored sweat that interacts with various substances present on the skin [1] [4] [5]. Changes in sweat color have been associated with bacterial pathogens (Corynebacterium sp., Malassezia furfur, Bacillus sp., Serratia marcescens), fungi, drugs, chemical products (topiramate, gold salts, emollients, and tanning creme have been confirmed as causes), and clothing dyes [1] [2] [3] [4] [5]. Irritant contact dermatitis and subsequent use of systemic corticosteroids (that were assumed to aggravate the symptoms) are also noted as possible etiology [1]. Up to this point, patients have presented with red, black, blue, brown, yellow, and pink color sweat and virtually any site in the body can be affected [1] [2] [3] [4] [5]. Reports documented isolated coloration of the face, palms, toe webs, and toenails [1] [5], whereas generalized changes have also been observed [1] [2] [3] [4]. Age is not a relevant factor in the appearance of pseudochromhidrosis, as this condition is encountered in children, young adults, and the elderly [1] [2] [3] [4] [5]. Except for perioral irritation seen in one patient that suffered from the red coloring of the face, accompanying signs or color changes of other fluids or tissues (saliva, urine, blood, feces, etc.) are absent [1] [2] [3] [4] [5]. Because of the extrinsic nature of pseudochromhidrosis, it is self-limiting and resolves after elimination of the underlying cause.

Physician
  • For this reason, the physician must conduct a thorough investigation in the presence of skin discoloration.[symptoma.com]
  • He had consulted many physicians before reaching us. He was on a glutenfree diet. There was no icterus, peripheral oedema or organomegaly.[tropicalgastro.com]
  • The tools the physician needs are readily available and include a magnifying glass, glass slide (for diascopy), flashlight, alcohol pad to remove scale or makeup, scalpel, and at times a Wood’s lamp. Universal precautions should always be used.[accesspharmacy.mhmedical.com]
  • DISCLAIMER: The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician.[doctorslounge.com]
  • Great article from DermReview.com on Chromhidrosis June Kim, MD, Staff Physician, Department of Dermatology, University of New Mexico. "[Chromhidrosis]".[wikidoc.org]
Keratosis
  • […] in skin properties 395 Chapter 45 The menopause skin and cosmetology 405 Chapter 46 Mesotherapy 410 Chapter 47 Microneedles and cosmetics 417 Chapter 48 Photodynamic therapy in dermatology 422 Chapter 49 Topical 5fluorouracil formulations in actinic keratosis[books.google.com]
  • hyperkeratosis ( Seborrheic keratosis, Callus ) · other epidermal thickening ( Ichthyosis acquisita, Palmoplantar keratoderma ) skin ulcer ( Pyoderma gangrenosum, Bedsore ) Cutaneous Markers of Internal Malignancy ( Florid cutaneous papillomatosis,[wikidoc.org]
Hyperkeratosis
  • […] full-thickness epidermis and papillary dermis, reticular dermis, or subcutis Lichenification : thickening of the epidermis and accentuation of natural skin lines Atrophy : thinning of the epidermis Scale : flaking caused by accumulation of stratum corneum (hyperkeratosis[accesspharmacy.mhmedical.com]
  • Radiodermatitis · Erythema ab igne Pigmentation disorder hypopigmentation ( Albinism, Vitiligo ) · hyperpigmentation ( Melasma, Freckle, Café au lait spot, Lentigo / Liver spot, Acanthosis nigricans, Acral acanthotic anomaly ) Other skin keratosis / hyperkeratosis[wikidoc.org]
Alopecia
  • Chapter 56 An easy method to assess the antioxidative capacity of topical formulations 503 Chapter 57 The antioxidative capacity of topical emulsion on ultraviolet exposure 505 Chapter 58 Treatment and noninvasive clinical assessment of androgenetic alopecia[books.google.com]
  • L66.9 Cicatricial alopecia, unspecified L67 Hair color and hair shaft abnormalities L67.0 Trichorrhexis nodosa L67.1 Variations in hair color L67.8 Other hair color and hair shaft abnormalities L67.9 Hair color and hair shaft abnormality, unspecified[icd10data.com]
Urticaria
  • He is also the editor of Cosmeceuticals and Active Cosmetics 3E, Handbook of Systemic Drug Treatment in Dermatology 2E, Contact Urticaria Syndrome, Handbook of Cosmetic Science and Technology 4E, Dermatotoxicology 8E, and Topical Nail Products and Ungual[books.google.com]
  • Dermatographic urticaria · Cold urticaria · Cholinergic urticaria Erythema Erythema multiforme / drug eruptions : Stevens-Johnson syndrome · Toxic epidermal necrolysis · Erythema nodosum Other erythema : Erythema annulare centrifugum · Erythema marginatum[wikidoc.org]
Eczema
  • Paronychia ) · Acute lymphadenitis · Pilonidal cyst · Pimple ( Pustule ) Bullous disorders acantholysis ( Pemphigus, Transient acantholytic dermatosis ) · Pemphigoid ( Bullous, Cicatricial, Gestational ) · Dermatitis herpetiformis Inflammatory Dermatitis and eczema[wikidoc.org]
  • She had also passed the soap on to her mother, who had developed some blue spots on her hands and fingers that came and went, especially when she was having a flare of her eczema.[well.blogs.nytimes.com]
Irritability
  • Irritant contact dermatitis and subsequent use of systemic corticosteroids (that were assumed to aggravate the symptoms) are also noted as possible etiology.[symptoma.com]
  • Other symptoms of these workers included headaches, eye irritation, fever, respiratory tract problems and chronic fatigue syndrome. None of these symptoms could be conclusively linked to the PCP exposure specifically.[livestrong.com]
  • ; may use if benefits outweigh risk to fetus Precautions Causes significant irritation and a burning sensation during first few days of use; for external use only; avoid contact with eyes; do not use tight bandage; discontinue use if condition worsens[dermaamin.com]
Confusion
  • Started some research last night to see if link to Stelara but getting confused by medical jargon. Anyone else experienced this? It may be totally unrelated but I haven't changed anything else diet or medical related. Each of us are different.[inspire.com]
  • Abstract Favorites PDF Get Content & Permissions Open Translation and validation of the Tibetan confusion assessment method for the intensive care unit Danzeng, Qu-Zhen; Cui, Na; Wang, Hao; More Chinese Medical Journal. 132(10):1154-1158, May 20, 2019[cmj.org]

Workup

Because of the rare occurrence of pseudochromhidrosis, clinicians will unlikely encounter this disorder. For this reason, the physician must conduct a thorough investigation in the presence of skin discoloration. Firstly, a detailed patient history is necessary to cover the recent use of pharmacological agents and changes in treatment for pre-existing disorders. Clothing marks are sometimes reported by patients, which may be a useful clue toward the diagnosis [1] [3] [4]. The physical examination is crucial for determining the exact area(s) of skin changes and follow-up laboratory studies need to be conducted. Exams like a complete blood count (CBC), basic biochemistry and urinalysis should be included in the initial workup [1]. The role of microbial agents in the development of pseudochromhidrosis necessitates the use of skin cultures (for both bacteria and fungi), with a goal of identifying the underlying cause [1] [3]. In some cases, however, a favorable response to antimicrobial therapy has been confirmed in the absence of a positive culture [3]. A skin biopsy can be used as a definitive diagnostic method, showing dilated apocrine acini with a colored secretion [1] [4].

Malassezia Furfur
  • The diagnosis was made on the basis of clinico-histological features and growth of Malassezia furfur, and Bacillus species, not Bacillus cereus, in the absence of lipofuscin.[ncbi.nlm.nih.gov]
  • ., Malassezia furfur, Bacillus sp., Serratia marcescens), fungi, drugs, chemical products (topiramate, gold salts, emollients, and tanning creme have been confirmed as causes), and clothing dyes.[symptoma.com]

Treatment

  • This article provides a literature review of the various etiology, investigation, treatment, and prognosis.[ncbi.nlm.nih.gov]
  • Abstract A 57-year-old man is presented with blue pseudochromhidrosis affecting the face and neck following combination treatment with lansoprazole, a proton pump inhibitor, and ranitidine, a type two histamine receptor antagonist.[ncbi.nlm.nih.gov]
  • Treatment options for chromhidrosis is limited. Capsaicin depletes the neurons of substance P and has been found to be beneficial in the treatment of these patients. The other options are topical clindamycin and topical aluminum chloride.[tropicalgastro.com]
  • Chapter 40 Keratolytic treatment of acne 352 Chapter 41 Cosmetics for men 365 Chapter 42 Ethnic cosmetics 379 Chapter 43 Ethnic variation in hair 386 Chapter 44 Ethnic differences in skin properties 395 Chapter 45 The menopause skin and cosmetology 405[books.google.com]
  • Treatment with topical and systemic erythromycin resulted in complete clearance of the reddish discoloration of the face. No relapse or recurrence was observed over a 3-month period.[ncbi.nlm.nih.gov]

Prognosis

  • This article provides a literature review of the various etiology, investigation, treatment, and prognosis.[ncbi.nlm.nih.gov]

Etiology

  • This article provides a literature review of the various etiology, investigation, treatment, and prognosis.[ncbi.nlm.nih.gov]
  • Irritant contact dermatitis and subsequent use of systemic corticosteroids (that were assumed to aggravate the symptoms) are also noted as possible etiology.[symptoma.com]
  • Etiology is unknown till date. Stress may be a precipitating factor. Record : found Abstract : not found Article : not found Red pseudochromhidrosis of the neck.[scienceopen.com]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Pseudochromhidrosis is of an extrinsic etiology in which a chemical on the surface of the skin reacts with eccrine secretions and produces the color transformation. Frequency: In the US: Incidence statistics are not available; the disease is rare.[wikidoc.org]

Epidemiology

  • Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty[mdedge.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of apocrine chromhidrosis is unclear, but it is postulated that oxidized lipofuscin is the responsible pigment. Eccrine chromohidrosis is due to water-soluble pigments being excreted via the eccrine glands.[lifeinthefastlane.com]
  • Pathophysiology: Lipofuscin is a yellowish brown pigment that is normally found in the cytoplasm of relatively nondividing cells (eg, neurons).[wikidoc.org]
  • Pathophysiology: An increased synthesis of tyrosine, heme, and melanin has been implicated in the pathogenesis of apocrine chromhidrosis.[medhelp.org]
  • Pathophysiology Lipofuscin is a yellowish brown pigment that is normally found in the cytoplasm of relatively nondividing cells (eg, neurons).[dermaamin.com]

Prevention

  • Medication The goals of pharmacotherapy for chromhidrosis are to reduce morbidity and to prevent complications. Counterirritants Counterirritants may be used to treat chromhidrosis.[dermaamin.com]
  • Ear wax is thought to prevent foreign material from entering your ears, including insects. Chromhidrosis is apocrine in origin.[welltellme.com]
  • Assessment of the effectiveness of application antiseptics in prevention of foot skin inflammation. N Dermatol Online. 2011;2:21-4. 6. Al Aboud K. The selection of the types of shoes and its impact on the skin of the feet.[odermatol.com]

References

Article

  1. Koley S, Mandal RK. Red and Black Pseudochromhidrosis. Indian J Dermatol. 2016;61(4):454-457.
  2. Castela E, Thomas P, Bronsard V, Lacour JP, Ortonne JP, Passeron T. Blue pseudochromhidrosis secondary to topiramate treatment. Acta Derm Venereol. 2009;89:538–539.
  3. Nair PA, Kota RKS, Surti NK, Diwan NG, Gandhi SS. Yellow pseudochromhidrosis in a young female. Indian Dermatol Online J. 2017;8(1):42-44.
  4. Bilgin I, Kelekci KH, Catal S, Calli A. Late-onset apocrine chromhidrosis. Indian J Dermatol Venereol Leprol. 2014;80(6):579.
  5. Harada K, Morohoshi T, Ikeda T, Shimada S. A patient with pseudochromhidrosis presenting with pink nails. J Am Acad Dermatol. 2012;67(2):e74-75.

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Last updated: 2018-06-22 04:56