BROMIDROSIS

Synonyms.—Osmidrosis; Stinking sweat; Fr., Bromidrose; Ger., Stinkschweiss.

Definition.—Sweat secretion of an offensive odor, either pri­
marily or secondarily from some change after excretion.

Symptoms.—While bromidrosis is most frequently associated
with increased secretion (hyperidrosis), it is not necessarily so. The
whole body sweat of some persons, even if normal in quantity, pos­
sesses a heavy, disagreeable odor, and this is habitual with them, and
is even noticeable, but naturally to a less extent, immediately after
bathing. In most instances coming under observation the regions
commonly involved are the axillae, genitocrural regions, and feet; the
last is most frequent, or is the one for which advice is generally sought.
As a rule, it is associated with increased sweating, but this may not be
unusually large in amount, as observed in hyperidrosis; it is sufficient
in most cases, however, to keep the stockings and shoes damp and the
soles of the feet moist and sodden looking. In other instances the secre­
tion is excessive. In addition to the symptoms sometimes presented in
cases of hyperidrosis—tenderness, puffiness, pinkish-red periphery, oc­
casionally with vesicles or blebs at the sides of the foot, just on or close
to the edge of the sole—there is an intense, penetrating, characteristic
odor, pathognomonic to one who has once known the smell. It is hard
to describe, and has been variously likened to the odor of an uncared-for
goat, putrid cheese, stale urine, etc A room or car in which such a
patient is or has been soon becomes offensive, and the odor holds for a
long time after his exit. The axilla is also often the seat of abundant
perspiration with disgusting smell, but never to the same extent nor of
the same penetrating and peculiar character as that of the feet.

Etiology and Pathology.—The same factors are to be consid-
sidered etiologic in this disease as in hyperidrosis, to which it is closely
allied. Chlorotic, anemic, and nervous individuals are its most com­
mon subjects. It is more frequent between the ages of twenty and forty,
and in those who are obliged to stand a greater part of. the day, and whose
life is within doors. The ingestion of certain drugs is known to give
the sweat peculiar odors—some not necessarily offensive. Thus the odors
of asafetida, sulphur, onions, garlic are noted in this secretion as well
as exhaled by the lungs; musk, copaiba, benzoic acid, etc, also are de­
tectable in the perspiration. Hammond¹ recorded several cases of nerv­
ous disorders in which the odor of violets and pineapple was given off
during paroxysms or emotional attacks. It is known, too, that in various
systemic diseases the sweat secretion has an odor peculiar to each, as in
small­pox, cholera, typhoid, etc²

¹ Hammond, “The Odor of the Human Body as Developed by Certain Affections
of the Nervous System,” Med. Record, 1877, vol. xii, p. 460.

² See admirable paper by Monin, “Sur les odeurs du corps humain," Paris, 1885,
full abstract translation in Jour. Cutan. Dis., 1885, p. 211. This considers the various
human odors in health and disease, and from certain foods and drugs, and in individuals
of different climes and nationalities.

1076                        DISEASES OF THE APPENDAGES

Hebra believed that the odor does not reside in the sweat as secreted,
but that it is due to some chemical change after excretion, and this
doubtless is true in most instances. Thin¹ also took this view, and was,
moreover, of the opinion that the odor is not in the feet themselves,
but in the socks and shoes, in which the secretion has soaked, and in
which develop bacteria—Bacterium fœtidum—in large numbers. Accord­
ing to Crocker, similar micrococci can generally be found between the
toes without accompanying bromidrosis. Parkes² looks upon the foot-
wear as the cause, as it has been noted that soldiers with uncovered
feet never present the disease. The most probable source of the
odor is the decomposition of the fatty acids of the sweat, to the
rapidity of which the Bacterium fœtidum may materially contribute;
the sweat secretion containing some oil, as Unna and Meissner have
pointed out.

Prognosis and Treatment.—As the troublesome cases of
bromidrosis, those associated with increased sweating, are probably
closely analogous to hyperidrosis or, in most instances, simply examples
of the latter with the secretion undergoing rapid decomposition, spon­
taneously or from an added external bacterial factor, the prognosis is
essentially the same as in that disease. The foot cases, which are, as
a rule, those which apply for treatment, can always be much benefited,
and if an acquired condition of not too long duration, a cure is usu­
ally possible. Absolute cleanliness—frequent ablutions—and frequent
change of the foot-wear are essential; the subject of the affection should
have several pairs of shoes, changing daily, so that the pair worn can
be aired or remain unused for a few days before they are again worn.
The treatment is practically the same as that employed in hyperidrosis
(q. v.), the best plans among those there named being with boric acid
powder and the ointment method. Thin strongly commended the treat­
ment with boric acid; his plan is as follows: The feet are frequently
washed with a saturated solution of boric acid; the stockings changed
often, and washed in the solution and dried; cork soles, which are also
soaked in the solution and dried, are worn in the shoes; and powdered
boric acid dusted freely in the stockings and shoes. This is an effectual
plan in some cases, and beneficial in all, lessening or completely abolish­
ing the disagreeable odor.

Various other methods are, however, frequently resorted to. The
Germans, especially for use in the army, extol a solution of chromic acid
of 5 to 10 per cent, strength; according to action and severity of the
disease it is painted on once in three to six weeks; it should be used with
care. For the milder cases and as a preventive measure they also com­
mend anointing with a 2 per cent, salicylated mutton suet. Duhring
states that a solution of potassium permanganate, 1 to 3 grains (0.065-
0.2) to the ounce (32.), used as a wash, often acts happily.³ The for-

¹ Thin, Brit. Med. Jour., Sept. 18, 1880, p. 463.

² Quoted by Hyde and Montgomery, Diseases of the Skin, seventh ed., p. 135.

³ Weiss, “Hyperidrosis Pedum and Its Treatment by Baths of Permanganate of
Potash,” Jour. Amer. Med. Assoc, Aug. 6, 1904, also lauds this old remedy highly, both
in hyperidrosis and bromidrosis; using it nightly as a foot bath, ankle deep, for fifteen
minutes; the next morning applying freely a dusting-powder consisting of 13 parts potas-

CHROMIDROSIS

1077

maldehyd lotions referred to in Hyperidrosis are valuable, and to be
tried in obstinate cases. Grosse¹ and Ullmann² speak well of a powder
of 1 part tannoform and 2 parts talc, both in hyperidrosis and bromi-
drosis; the parts are first washed and then the powder applied freely.
In obstinate cases Grosse uses a plaster made with 25 per cent, of tanno-
form, and prefers it to Hebra’s plan with diachylon ointment. Upon
the whole, the most effectual plans in my experience are those with the
continuous ointment application, and Thin’s method, with 3 to 10 per
cent, of salicylic acid added to the powder. Instead of the ointment,
strapping with diachylon plaster can be practised. For particulars as
to ointment method and for other plans sometimes employed the reader
is referred to the article on Hyperidrosis. For offensive sweating in the
axillae and in the genitocrural region the powder and lotion applications
there referred to are prescribed. X-ray treatment is sometimes helpful
in regional cases.

Constitutional treatment, when demanded, is according to indica­
tions, chlorosis, anemia, etc, receiving their appropriate remedies.
The several special drugs advised in Hyperidrosis can also be experi­
mentally tried, among which Crocker considers the best to be sulphur.

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