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Pseudochromhidrosis

Author: Dr Duncan Lyons, Resident Medical Officer, Gold Coast University Hospital, Gold Coast, Queensland, Australia. Medical Editor: Dr Helen Gordon, Auckland, New Zealand. DermNet 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 pseudochromhidrosis?

Pseudochromhidrosis describes the excretion of normal colourless sweat, which then becomes coloured on the skin due to an exogenous agent.

Who gets pseudochromhidrosis?

Pseudochromhidrosis is rare. It has been seen in adults and in children [2].

What causes pseudochromhidrosis?

In pseudochromhidrosis, the sweat is coloured by chromogenic bacteria, a coloured chemical, or a dye on the skin surface.  

  • Serratia marcescens has been associated with pink-red sweat.
  • Pseudomonas has been associated with green-black sweat.
  • Corynebacterium has been associated with black-brown sweat.
  • Malassezia furfur and Bacillus have been associated with blue sweat. 

Other organisms and colours have also been reported. 

  • Yellow staining is often seen on pale clothing worn near the axillae due to the aluminium in antiperspirants mixing with sweat.  
  • Self-tanning lotion can stain sweat brown.

What are the clinical features of pseudochromhidrosis?

Pseudochromhidrosis can affect any body area. The colour of the sweat depends on the underlying chromogen or dye. The stain may be seen on the skin or clothing [1–5]. 

What is the differential diagnosis of pseudochromhidrosis?

The differential diagnosis for pigmentation of sweat and skin may include [1–4]:

How is pseudochromhidrosis diagnosed?

Pseudochromatosis is diagnosed by taking a thorough history and checking for any possible contact on the skin with chemicals, dyes, and coloured clothing. Check for possible risk factors for skin infection.

The diagnosis may be supported by:

What is the treatment of pseudochromhidrosis?

The treatment of pseudochromhidrosis may include a combination of topical and oral erythromycin for 1 to 2 weeks if chromogenic bacteria are suspected, even when culture-negative [4,5].

Any likely causative chemical or dye should be removed.

What is the prognosis for pseudochromhidrosis?

Pseudochromhidrosis often clears up once the cause has been identified and removed or treated.

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References

  1. Harada K, Morohoshi T, Ikeda T, Shimada S. A patient with Pseudochromhidrosis presenting with pink nails. J Am Acad Dermatol 2012; 67: 74–5. DOI: 10.1016/j.jaad.2011.08.026. PubMed
  2. Chromhidrosis: Uptodate (for subscribers). Available at: www.uptodate.com/contents/chromhidrosis/print [accessed 27 July 2020]
  3. Thami G, Kanwar A. Red facial pseudochromhidrosis. Br J Dermatol 2000; 142: 1219–20. DOI: 10.1046/j.1365-2133.2000.03554.x. PubMed
  4. Nair P, Kota R, Surti N, Diwan N, Gandhi S. Yellow pseudochromhidrosis in a young female. Indian Dermatol Online J 2017; 8: 42–4. DOI: 10.4103/2229-5178.198778. PubMed Central
  5. Tempark T, Wittayakornrerk S, Jirasukprasert L, Chatproedprai S, Wananukul S. Pseudochromhidrosis: report and review of literature. Int J Dermatol 2017; 56: 496–502. DOI: 10.1111/ijd.13495. PubMed

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