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Eccrine chromhidrosis

Author: Dr Duncan Lyons, Resident Medical Officer, Gold Coast University Hospital, Gold Coast, Queensland, Australia. Medical Editor: Dr Helen Gordon, Auckland, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof. Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. July 2020.


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What is eccrine chromhidrosis?

Eccrine chromhidrosis is characterised by the production of coloured sweat from the eccrine sweat glands [1]. The eccrine sweat glands cover much of the body but are particularly concentrated on the palms and soles. They play an important part in temperature regulation of the body.

Who gets eccrine chromhidrosis?

Eccrine chromhidrosis is a rare disorder. It can occur at any age and affects both sexes [2].

What causes eccrine chromhidrosis?

The causes for eccrine chromhidrosis include the following [1,2].

  • Lipofuscin granules, which are thought to be due to the oxidisation of unsaturated fatty acids
  • The ingestion of medications, metals, and dyes including tartrazine-coated bisacodyl laxatives, quinine, rifampicin, clofazimine, methylene blue, mercury, and copper
  • The excessive consumption of beta-carotene (carotenaemia)
  • Hyperbilirubinaemia
  • Uraemia.

What are the clinical features of eccrine chromhidrosis?

Eccrine chromhidrosis can affect any body area but is often worse on the palms and soles where the eccrine glands are most concentrated. The colour of the sweat depends on the dye, drug, or chemical involved, with red, blue, orange, brown, yellow, green, black, and white sweat reported [1–4].

A prickly sensation or warmth may occur across the affected skin prior to the release of the coloured sweat.

What is the differential diagnosis of eccrine chromhidrosis?

The differential diagnosis for eccrine chromhidrosis can include the following disorders:

How is eccrine chromhidrosis diagnosed?

Eccrine chromhidrosis is often diagnosed clinically, but the following may be used to confirm the diagnosis [1,2]:

  • Dermoscopy to examine the character and location of the pigment
  • Skin biopsy
  • Liver function and kidney function tests
  • Skin scraping and culture to exclude chromogenic bacteria (the cause of pseudochromhidrosis)
  • Wood lamp skin examination to exclude apocrine chromhidrosis, which may show yellow fluorescence.

What is the treatment and prognosis of eccrine chromhidrosis?

The prognosis can be excellent if the causative dye or agent is eliminated.

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References

  1. Xu L, Qiao J, Fang H. Eccrine chromhidrosis: a case report and review of the literature. Indian J Case Reports 2018; 4: 268–71. Journal
  2. Chromhidrosis: Uptodate (for subscribers). UpToDate
  3. Wyrick K, Cragun T, Russ B, Royer M. Atypical chromhidrosis: a case report of orange sweat. Cutis 2008; 81: 167–70. Journal
  4. Uzoma M, Singh G, Kohen L. Green palmoplantar vesicular eruption in a patient with hyperbilirubinaemia. JAAD Case Rep 2017; 3: 273–5. Journal

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