CHROMIDROSIS

Synonyms.—Colored sweat; Ephidrosis discolor; Stearrhœa or seborrhœa nigri-
cans (Wilson and Neligan); Fr., Chromidrose.

Definition.—An affection of the sweat-glands in which the effused
secretion is colored.

Several varieties and practically diverse conditions have been from
time to time described under this title, all of which, before Le Roy de
Méricourt’s³ excellent contribution on the subject, were generally looked
upon with considerable suspicion and of probable factitious origin.
It is now known that the effused sweat may in rare instances be of
various colors. Sometimes, however—pseudochromidrosis, red chro-
midrosis—the color, which is thought to be excreted with the sweat,
is due to some external factors—micro-organisms. Indeed, it is not im­
probable that future investigation will relegate some of the supposed
true cases to the latter class. While in most instances the color is in
the sweat secretion, in others—in the minority, in which there is
more or less accompanying greasiness—it is found in the sebaceous
secretion.

Symptoms.—In the idiopathic class the most usual color is
brownish or blackish (melanidrosis), often with a bluish shade, although
it may be bluish (cyanidrosis) or a dirty gray. In the 38 cases collected

sium permanganate, 1 part alum, 18 parts each of zinc oxid and calamin, and 50 parts
talc, applying also between the toes, and keeping these slightly separated by absorbent
cotton. The bath is 1 per cent, in strength for the first three oaths, and then of gradu­
ally increasing strength to saturation, in warm to hot water. The only disadvantage is
the staining. The average course of treatment is two weeks, but the dusting-powder
should be continued longer.

¹ Grosse, Klin.-therap. Wochemchr., 1899, pp. 487 and 527.

² Ullmann, Cent. f. d. ges. Therap., 1899, p. 257.

³ Le Roy de Méricourt, Memoire sur la Chromidrose, Paris, 1864.

1078                     DISEASES OF THE APPENDAGES

by Foot,¹ which he believed to be authentic, it was noted to be black,
blackish, or brownish in 21, blue, bluish-black, bluish-brown, or violet
in 15, and yellowish-brown in 2. In rare instances a red color has been
noted, as in a case of a man reported by Dubreuilh,² in whom the right
thumb and left wrist were the seat of the manifestation. The most
common sites are about the eyelids, especially the lower, the forehead,
and cheek. The breast, neck, back, hands, axillæ, groins, and genito-
crural region are, however, more rarely noted to be the seat of the dis­
coloration. The orbital region is the most usual one, and doubtless
many of the suspected cases of artificial penciling of this part are in reality
unfortunate victims of this malady. The part becomes discolored, as
a rule, slowly, the secretion gradually collecting. Examined closely it is
noted to be of a grimy, dirty character, consisting of a powdery or granu­
lar deposit, and gives to the cloth used in wiping it a look of smuttiness,
or as Mitchell³ expressed it, as if fine lead-pencil dust were upon it.
After thoroughly removing it, which can be done only by rubbing and
washing with some force, it again collects slowly, the color becoming
gradually more and more pronounced. Instead of remaining localized,
it may spread, and it may also be seen involving extensive surface; as
a rule, however, the latter is rarely observed, the condition usually limit­
ing itself to a circumscribed region, and, as remarked, most frequently
the orbital regions. White⁴ records a case, a male, in whom it was
unilateral, covering half the trunk, and of a yellow color; the patient
was aged twenty. In rare instances the color has been noted to change;
and the discoloration has also been observed to move its position.

The secretion never seems very abundant, and is more suggestive
of a discolored, oily seborrhea than of a true sweating. Crocker,⁵ in 3
cases, noted it to be largely composed of flaky and granular fat, and from
appearances more of the nature of seborrhea than sweat secretion. In
most subjects the condition is noted to vary somewhat, being more in­
tense when the patient is not in good health or when nervously depressed.
In some instances, after lasting for some months or even a few years,
it disappears spontaneously; as a rule, however, when once established,
it is more or less persistent. Constipation, digestive disturbance, men­
strual irregularity, various nervous symptoms, headache, hyperesthesia,

¹ Foot, Dublin Quarterly Jour. Med. Sci., Aug., 1869, and Dec, 1873 (a good
paper with particulars of 38 cases); see also paper by Pooley, loc. cit., who has col­
lected a number of reported cases; and Heidingsfeld, “The Pathology of Chromidrosis,”
Jour. Amer. Med. Assoc, Dec 13, 1902 (brief review, histologic study, and bibli­
ography).

² Dubreuilh, Arch. Clin. de Bordeaux, Jan., 1894.

³J. K. Mitchell, “Seborrhœa Nigricans,” Philada. Med. Jour., Jan. 15, 1899,
reports a remarkable case involving both eyelids and adjacent parts, and reviews similar
cases recorded; Colcott Fox, London Clin. Soc’y Trans., 1881, vol. xiv, p. 211, reports
2 somewhat similar cases, the exudation being of a bluish-black color; Putnam, New
York Med. Jour., July 4, 1903, also reports a case of “inky-black“ chromidrosis of eye­
lids, malar regions, upper portion of the nose, and the edge of the mucous membrane
of the lips, in a young woman aged nineteen, associated with hysteric paralysis and
amenorrhea; final recovery was made, the chromidrosis lasting nine months (case
also seen in consultation by Dr. G. W. Wende). See also, for unusual cases, interesting
paper by Osier, “Ochronosis, the Pigmentation of Cartilages, Sclerotics, and Skin in
Alkaptonuria,” Lancet, Jan. 2, 1904.

⁴ J. C. White, Jour. Cutan. Dis., 1884, p. 293.         ⁵ Crocker, Diseases of the Skin.

CHROMIDROSIS

1079

neuralgic pains, and distinct hysteric symptoms are associated in many
cases.

Etiology.—While in some instances it may be attributed to
malingering and is of artificial production, it is now well established
that this is not the fact in most cases. The disease is, it is true, ex­
tremely rare. Its subjects are mostly women between the ages of
sixteen and fifty, and usually of the nervous, neurasthenic class. The
immediate exciting cause is often noted to be mental excitement, fright,
anxiety, etc. Uterine disturbance¹ and pronounced constipation are
also seemingly factors, especially the latter. Mitchell states that in
almost all cases in the report of which the habitat was mentioned, the
place of residence was near the sea. De Méricourt thought that possibly
there was some causal relationship in this fact, to which he also called
attention.

It is known, too, that the ingestion or absorption of certain chem­
icals or drugs has been responsible in rare instances for the production
of colored sweat. Thus green sweat has been caused by copper, as noted
by Clapton,² Halford,³ and others. Temple⁴ noted pink perspiration,
which also stained the hair, in a patient taking potassium iodid. In
the Kollmann-Scherer⁵ case of blue chromidrosis the color was presumed
to be due to the iron the patient had been taking, iron protosulphate
being found in the sweat.

Pathology.—The pathology of chromidrosis is still involved in
obscurity. According to our present knowledge, it must be considered
a functional disorder of the sweat-glands, although it is not improbable
that the secretion from sebaceous glands may, in some cases at least,
be partly responsible. In many instances the disease doubtless belongs
among the hysteric neuroses (Besnier and Doyon, Crocker, and others).
Indican has been found by various observers (Hoffmann, Bizzio, and
others) in the secretion, to the chemical transformation of which in con­
tact with the air the color is supposed to be due. Others, however, have
not succeeded in finding this, so that as yet the subject needs further
investigation. In Mitchell's case microscopic and bacteriologic exami­
nations of the exudate failed to throw any light on the condition; the
material was found to be insoluble in ether and soluble in acids, which
seemed to show that it was not a fatty exudate, as Neligan had believed.
On the other hand, in White’s patient the coloring-matter was soluble
in ether, and the exudate was of an oily nature; careful examinations
failed to explain its origin. Heidingsfeld’s histologic examination of a
single case showed it to be an anomaly of pigmentation, entirely inde­
pendent of the glandular secretions.

Prognosis and Treatment.—The condition is usually per­
sistent, lasting several years or longer, though it is often variable as

¹ Barié, Annales, 1889, p. 937 (with review and literature references), records a case
of brownish-yellow chromidrosis of the palm and dorsal surface of the hand, recurring
alternately on each hand, at several consecutive menstrual periods.

² Clapton, Med. Times and Gaz., 1868, p. 658 (a number of cases referred to).

³ Halford, London Med. Gaz., 1833, p. 211.

⁴ Temple, Brit. Med. Jour., Aug. 29, 1891, p. 477.

⁵ Quoted by Hoffmann, Wiener med. Wochenschr., 1873, No. 13, p. 292.

1080

DISEASES OF THE APPENDAGES

to degree. In some cases it has disappeared for a time, to reappear
subsequently. Final recovery is, however, to be expected. The un­
derlying condition—most frequently nervous disorders, uterine disturb­
ances, and protracted constipation—is to be treated by appropriate
methods. Ordinarily external treatment is of no avail. In White’s
case, however, the use of an ointment containing boric and salicylic
acids brought about a disappearance of the blemish.

Red Chromidrosis—Pseudochromidrosis.—As already stated, the
effused sweat in these cases is free from color, but it subsequently becomes
stained by extraneous micro-organisms. The axilla is the most common
site for it, although it is also seen in the genitocrural region; in fact,
any warm, moist, hairy region may be its seat. The color is usually
orange or red. The investigations of Hoffmann,¹ Babes,² Balzer and
Barthélemy,³ and Hartzell⁴ go to show that this condition is due to
chromatogenous bacteria, which are found attached to the hairs in agglu­
tinated masses—zoöglea—and also, according to Balzer and Barthélemy,
in scrapings of the epidermis and in the discolored linen. These latter
observers found, both in the cleanly and uncleanly, parasitism of the axilla
quite common, but it is not always accompanied by color formation.
Other hairy regions were also noted to be the seat of the same zoöglea,
but rarely accompanied by red coloration. Balzer and Barthélemy
concluded, from their valuable studies, that there is a form of parasitism
which occurs as a transitory or permanent condition in a large number
of individuals subject to profuse perspiration, and in whom masses of
microbes, generally non-chromatogenous, sometimes chromatogenous,
may develop. It is probable, as Van Harlingen⁵ states, a change in the
character of the secretions from some unknown cause affords an oppor­
tunity for development, and the germs of the disease assume unwonted
vitality; apparently, too, abundant perspiration favors the multiplica­
tion of the chromatogenous organisms. According to Crocker, red
sweat is always associated with lepothrix.

Treatment consists of the frequent use of soap and water and appli­
cations of boric acid and resorcin lotions, as prescribed in Eczema. Cor­
rosive sublimate solution, 1 or 2:1000, washings with chloroform, aro­
matic vinegar, and ether are commended by Balzer and Barthélemy.
Any faulty condition of the general health should be corrected.

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