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.
Pseudochromhidrosis is a rare phenomenon in clinical practice, with only a handful of cases described in the literature so far   . 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   . 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     . Irritant contact dermatitis and subsequent use of systemic corticosteroids (that were assumed to aggravate the symptoms) are also noted as possible etiology . 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     . Reports documented isolated coloration of the face, palms, toe webs, and toenails  , whereas generalized changes have also been observed    . Age is not a relevant factor in the appearance of pseudochromhidrosis, as this condition is encountered in children, young adults, and the elderly     . 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     . Because of the extrinsic nature of pseudochromhidrosis, it is self-limiting and resolves after elimination of the underlying cause.
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[…] dermatitis ( Diaper rash, Urushiol-induced contact dermatitis ) · Erythroderma · Lichen simplex chronicus / Prurigo nodularis · Itch ( Pruritus ani ) · Nummular dermatitis · Dyshidrosis · Pityriasis alba Papulosquamous disorders Psoriasis ( Psoriatic arthritis [wikidoc.org]
[…] stimulation and substance P release. 14,15 A few reports have described successful treatment of chromhidrosis with capsaicin cream. 16,17 Capsaicin, a crystalline alkaloid found in red peppers, is commonly used for the temporary relief of pain from rheumatoid arthritis [dermaamin.com]
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CHROMHIDROSIS AND PSEUDOCHROMHIDROSIS Chromhidrosis is the production of colored sweat by eccrine or apocrine sweat gl and s. [yumpu.com]
Abstract Chromhidrosis is a rare condition where colored sweat comes from the apocrine or eccrine glands. [ncbi.nlm.nih.gov]
Chromhidrosis is characterized by the secretion of colored sweat. [deepdyve.com]
The production of colored sweat has an impact on psychological and social functioning.  The differential diagnosis for skin and sweat pigmentation includes hyperbilirubinemia, hematohidrosis, alkaptonuria, copper exposure, Addison disease, and hemochromatosis [idoj.in]
This confirms that it was sweating of blood and not bleeding. Bleeding time, clotting time and prothrombin time was normal. [scienceopen.com]
[…] 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]
[…] 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]
The treatment is usually targeted toward reducing sweat secretion by topical capsaicin cream, which is inexpensive and effective if continued; however, it has side effects such as intolerable pain, pruritus, soreness, and itching. [idoj.in]
[…] herpetiformis Inflammatory Dermatitis and eczema Atopic dermatitis · Seborrhoeic dermatitis ( Dandruff, Cradle cap ) · Contact dermatitis ( Diaper rash, Urushiol-induced contact dermatitis ) · Erythroderma · Lichen simplex chronicus / Prurigo nodularis · Itch ( Pruritus [wikidoc.org]
- Skin Discoloration
For this reason, the physician must conduct a thorough investigation in the presence of skin discoloration. [symptoma.com]
The patient’s sweat was maximally excited at 326 nm, and maximal emission at 514 nm. [yumpu.com]
An aura of warmth or a prickly sensation prompted by emotional or physical excitation may precede onset of colored sweat. Facial apocrine chromhidrosis rarely is seen. It occurs most commonly on the cheeks and malar eminences. [medhelp.org]
[…] fluoresce yellow-green with standard UV microscopy Histologic Findings Normal in size and morphology Increased number of yellow-brown lipofuscin granules Granules are positive on periodic acid-Schiff stains and demonstrate autofluorescence under a UV excitation [medicinman.cz]
The granules are positive on periodic acid-Schiff stains and demonstrate autofluorescence under a UV excitation wavelength of 360-395 nm. Schmorl stains may also be weakly positive. [dermaamin.com]
Excited, Hoogerwerf called the patient and instructed her to start using an antiseptic soap. If the discoloration was caused by bacteria, the soap should put an end to it. [millerscahs.weebly.com]
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   . 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 . 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  . In some cases, however, a favorable response to antimicrobial therapy has been confirmed in the absence of a positive culture . A skin biopsy can be used as a definitive diagnostic method, showing dilated apocrine acini with a colored secretion  .
- 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]
furfur and Bacillus speciesare the agents involved in the blue pseudochromhidrosis. [idoj.in]
- Koley S, Mandal RK. Red and Black Pseudochromhidrosis. Indian J Dermatol. 2016;61(4):454-457.
- 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.
- 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.
- Bilgin I, Kelekci KH, Catal S, Calli A. Late-onset apocrine chromhidrosis. Indian J Dermatol Venereol Leprol. 2014;80(6):579.
- 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.