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TO THE EDITOR,
Apocrine
chromhidrosis is a rare disease characterized by the secretion of colored
sweat. Patients complain of discoloration of underclothes. Apocrine
chromhidrosis occurring aged people is rare. We describe a rare case of
late-onset of apocrine chromhidrosis.
A 70-year-old male visited our hospital, complaining of blue staining
of the towels after wiping the sweat, which he noticed 10 months ago. He had
past histories of lung squamous cell carcinoma, paroxysmal atrial fibrillation,
hypertension, hyperlipidemia, emphysema, reflux esophagitis, cerebral
infarction, and bronchial asthma. He was taking many drugs for over 5 years,
such as prednisolone, nifedipine, clotiazepam, olmesartan medoxomil,
esomeprazole magnesium hydrate, cibenzoline succinate, dabigatran etexilate
methanesulfonate, fluvastatin sodium, and montelukast sodium. He brought a
towel wiping his axilla, which was turned to pale blue (Figure 1). Dermatological examination revealed normal skin
appearance. He denied hyperhidrosis and seasonal alteration. Results of
laboratory examination including complete blood count, and liver and kidney
functions were normal. He denied occupational and environmental changes in
recent years. He did not want biopsy. Based on the clinical examination, we
diagnosed this case as apocrine chromhidrosis.
Apocrine chromhidrosis targets the axilla, face and areola. Secretion
of colored sweat, such as yellow, blue, green, or black, has been reported,
which depends on the levels of oxidation of lipofuscin secreted in apocrine
glands [1]. Also, trypsine, melanin, and haeme breakdown products have been
implicated as possible color-producing molecules. Also, substance P is
implicated as a possible pathogenic factor, because the application of topical
capsaicin reduced chromhidrosis [2]. By contrast, pseudo-eccrine chromhidrosis
is production of colorless sweat which turned colored when it reached the skin
and reacts with chromogenic bacterial products, chemicals, paints, and dyes
[3]. True eccrine chromhidrosis is exceedingly rare, and conditions are induced
by eccrine secretion of water-soluble agents such as dyes and drugs, without
systemic diseases. The patient was previously treated with antibiotics
(clarithromycin) for his emphysema, however, colored seating was unchanged.
Also, he does not contact with chemicals, paints, or dyes in his occupation or
hobbies. Nor he did use perfume. Therefore, we denied pseudo-eccrine
chromhidrosis.
In the majority of cases, apocrine chromhidrosis occur in puberty. Cases
of either pediatric or elderly onset are few. To date, apocrine chromhidrosis
in elderly persons have been reported in only a few cases, which occurred at
the ages of 60, 62, and 76 years old [4-6]. Our patient belongs to the cases
with late-onset of chromhidrosis. The reason of late-onset of chromhidrosis is
unknown; however, tartrazine coating of bisacodyl, a purgative, has been
suggested to be causative for eccrine chromhidrosis [7]. In our case, the
patient had taken various kinds of drugs, which however were unchanged for over
5 years. Therefore, we consider that the association of drugs are unlikely to
play a causative role in the induction of chromhidrosis in our case.
REFERENCES
1. Cilliers J, de Beer C (1999) The case of the red lingerie: chromohidrosis revisited. Dermatology 199: 149-152.
2. Marks
JG (1989) Treatment of apocrine chromohidrosis with topical capsaicin. J Am
Acad Dermatol 21: 418-420.
3. Thami
GP, Kanwar AJ (2000) Red facial pseudochromohidrosis. Br J Dermatol 142:
1219-1220.
4. Bilgin
I, Kelekci KH, Catal S, Calli A (2014) Late-onset apocrine chromhidrosis.
IndianJ Dermatol Venereol Leprol 80: 579.
5. Mapare
A, Tapre VN, Khandelwal AK (2012) Apocrine chromhidrosis over dorsum of foot: a
case report. IOSR J Dent Med Sci 2: 33-34.
6. Beer
K, Oakley H (2010) Axillary chromhidrosis: report of a case, review of the
literature and treatment considerations. Cosmet Dermatol 9: 318-320.
7. Krishnaram
AS, Bharathi S, Krishnan S (2012) An interesting case of bisacodyl
(dulcolax)-induced chromohidrosis. Indian J Dermatol Venereol Leprol 78:
756-758.
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