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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.

Eccrine chromhidrosis — codes and concepts
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What is eccrine chromhidrosis?

Eccrine chromhidrosis is the production of coloured sweat by the eccrine sweat glands. 

Who gets eccrine chromhidrosis?

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

What causes eccrine chromhidrosis?

Eccrine chromhidrosis is due to water-soluble coloured dyes and other chemicals being excreted in the eccrine sweat. Examples include:

  • Ingestion of medications, metals, and dyes including tartrazine-coated bisacodyl laxatives, quinine, rifampicin, clofazimine, methylene blue, mercury, and copper
  • Excessive consumption of beta-carotene (carotenaemia) and other food additives/colouring agents
  • Hyperbilirubinaemia
  • Uraemia.

What are the clinical features of eccrine chromhidrosis?

Eccrine chromhidrosis can affect the skin over any body area but is often worst on the palms and soles where eccrine sweat 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.

It can cause considerable embarrassment for sufferers, and the changing of clothing multiple times each day.

What is the differential diagnosis of eccrine chromhidrosis?

The differential diagnosis for eccrine chromhidrosis can include the following:

How is eccrine chromhidrosis diagnosed?

Eccrine chromhidrosis is usually a clinical diagnosis, but the following may be used to confirm the diagnosis:

  • Dermoscopy to examine the character and location of the pigment
  • Skin biopsy to distinguish from apocrine chromhidrosis
  • 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?

Elimination of the causative agent or treatment of the underlying condition results in resolution of the discoloration.

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References

  • Erdol S, Karakaya S, Saglam H, Tarim O. Chromhidrosis due to exogenous oxidizing heavy metals: clinical and laboratory findings. Pediatr Dermatol. 2018;35(4):448-52. doi:10.1111/pde.13491. PubMed
  • Jaiswal AK, Ravikiran SP, Roy PK. Red eccrine chromhidrosis with review of literature. Indian J Dermatol. 2017;62(6):675. doi:10.4103/ijd.IJD_755_16. PubMed
  • Uzoma M, Singh G, Kohen L. Green palmoplantar vesicular eruption in a patient with hyperbilirubinaemia. JAAD Case Rep. 2017;3(4):273–5. doi:10.1016/j.jdcr.2017.05.001 Journal
  • Wyrick K, Cragun T, Russ B, Royer M. Atypical chromhidrosis: a case report of orange sweat. Cutis 2008;81(2):167–70. Journal
  • Xu L, Qiao J, Fang H. Eccrine chromhidrosis: a case report and review of the literature. Indian J Case Reports 2018;4(4):268–71. doi: 10.32677/IJCR.2018.v04.i04.005. Journal

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