Chromhidrosis
Colored sweat (chromhidrosis) is a rare sweat gland disorder in which the sweat takes on an unusual color such as black, blue, green, yellow, red or brown. Besides the obvious cosmetic problem of stained clothes and towels, it can take a heavy psychological toll, leaving people distressed and self-conscious.
Chromhidrosis is grouped into main types according to which glands are involved and where the pigment comes from:
- Apocrine chromhidrosis: the most common type. The apocrine gland cells build up excess lipofuscin, a lipochrome pigment formed when lipid membranes are oxidized. Depending on how concentrated and how oxidized the lipofuscin is, the sweat can range from yellow and brown to blue-black or deep black. When the myoepithelial cells around the gland contract in response to emotional stimuli or friction, the pigmented sweat is pushed out onto the skin.
- Eccrine chromhidrosis: very rare. It occurs when water-soluble dyes, chemicals, heavy metals (such as copper or catechol) or drugs (such as rifampicin or clofazimine) are swallowed or infused and then excreted through eccrine sweat glands across the whole body.
- Pseudochromhidrosis: the sweat is clear and colorless when it leaves the gland, but changes color on the skin surface when it reacts with pigment-producing bacteria (such as Corynebacterium and Bacillus), fungi, plant pigments, fabric dyes or applied cosmetics.
At Haute-Derma, our approach to chromhidrosis focuses on telling apocrine, eccrine and pseudochromhidrosis apart accurately, finding the source of the pigment, and combining treatments that reduce secretion with specialist skin care and repair.
Clinical Features and Differential Diagnosis
Examination for chromhidrosis looks at the color of the sweat, the areas affected and how the skin responds to medical light sources:
- Varied colors and stained clothing: the sweat has a distinct color (yellow, green, blue or black) and leaves permanent or hard-to-remove stains on clothes, bedding and furniture.
- Localized or widespread distribution: the apocrine type usually affects the armpits, face (especially the cheeks and around the eyes), areolae and groin folds. Pseudochromhidrosis and the eccrine type can be more widespread, depending on the source of exposure or the route of excretion.
- Fluorescence under a Wood's lamp: lipofuscin in apocrine sweat has a distinctive autofluorescence under UV (Wood's) light, glowing yellow-green or orange-brown. This is a very useful in-clinic diagnostic tool.
- Warning sensation (aura): some patients notice prickling, mild itching or burning in the affected skin just before the colored sweat appears.
- Triggers: colored sweating increases noticeably with emotional stress, exercise, hot weather or rubbing of the skin.
Haute-Derma's Approach to Diagnosis and Treatment
- Accurate diagnosis and classification: the doctor examines the skin and uses a Wood's lamp to check for lipofuscin fluorescence. This step is decisive in distinguishing true chromhidrosis (apocrine or eccrine) from pseudochromhidrosis and choosing the right treatment.
- Removing external causes and controlling the skin microbiome: for pseudochromhidrosis, topical antibacterial or antifungal treatment is prescribed to clear the pigment-producing microbes, along with avoiding exposure to chemicals, fabric dyes or topical products.
- Targeted suppression of apocrine secretion: for apocrine chromhidrosis, we use capsaicin cream (which depletes the neurotransmitter substance P) or medical botulinum toxin (Botox) injections. Botox blocks contraction of the myoepithelial cells around the apocrine glands, greatly reducing the release of pigmented sweat.
- Gentle skin care and barrier support: we advise a gentle, soap-free cleansing routine and a barrier-repair moisturizer to soothe skin exposed to friction and keep it comfortable and healthy.
Common Types of Chromhidrosis
| Type | Mechanism and Clinical Features |
|---|---|
| Apocrine chromhidrosis | Lipofuscin builds up in apocrine glands. Yellow, green or black sweat in the armpits, face and areolae; fluoresces under a Wood's lamp. |
| Eccrine chromhidrosis | Chemicals, dyes, metals or drugs are excreted through eccrine glands. Affects the whole body; the sweat color depends on the substance absorbed. |
| Pseudochromhidrosis | Sweat is clear at first, then changes color on the skin because of pigment-producing bacteria, fungi or dyes from clothing or cosmetics. |
