Letter to Editor
A Case of Late-Onset Chromhidrosis
Tatsuhiko Mori and Toshiyuki Yamamoto*
Corresponding Author: Toshiyuki Yamamoto, Department of Dermatology, Fukushima Medical University, Fukushima 960-1295, Japan; E-mail: toyamade@fmu.ac.jp
Received: April 5, 2016; Revised: May 30, 2016; Accepted: April 18, 2016
Citation: Mori T & Yamamoto T. (2016) A Case of Late-Onset Chromhidrosis. Dermatol Clin Res, 2(2): 93-94.
Copyrights: ©2016 Mori T & Yamamoto T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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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.