By Gary M. White, MD
Bromhidrosis is the condition of having abnormal or offensive body odor, usually of the axilla.
The patient has more offensive body odor than the average person. Care must be taken to exclude those patients who are delusional and only think they have an odor. See if you can smell it too.
Rarely, trimethylaminuria (fish odor syndrome) is the cause.
First make sure the patient is bathing daily and using a deodorant. One patient of mine smelled badly because she had stopped using deodorant. She thought (incorrectly) that if she just showered daily and cleaned the area, she would not have an odor.
If associated with hyperhidrosis, one may want to control that first to see if the bromhidrosis resolves. However, it has been argued that since odor is more related to the apocrine glands, treatment of eccrine overactivity (hyperhidrosis) won't help bromhidrosis.
Frequent bathing, changing of underclothes, and application of one of the following clindamycin BID, erythromycin, benzoyl peroxide, or metronidazole are helpful. If medical management fails, superficial tumescent liposuction is an effective and usually permanent solution.
For those who are delusional, psychiatric referral should be considered but patients are usually very resistant to going.
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