CHROMIDROSIS
Description
🔹 Definition:
#Chromhidrosis is an uncommon disorder that is characterized by sweat glands secreting colored sweat.
#Depending on the underlying reason, the discoloration may be yellow, green, blue, brown, or black.
🔹 Types:
#Chromhidrosis can be divided into three primary categories according to the gland that is affected:
1) Apocrine Chromidrosis -
•The most prevalent type, apocrine chromhidrosis, is brought on by the oxidation of the lipofuscin pigment in the apocrine glands.
•Usually impacts regions where apocrine glands are highly concentrated:
Face
Anogenital region
Axillae Areolae
•The discharge might be blue, black, brown, or yellow in color, and it can be triggered by friction, heat, or emotional stress.
2. Eccrine chromhidrosis:
•Extremely uncommon.
•As a result of chemicals or pigments that are expelled through eccrine glands.
•Sweat frequently affects the cheeks, palms, and soles and can be caused by dyes, medications, or heavy metals.
3. Pseudo chromhidrosis:
•Sweat is normally colored, but it turns that way when it comes into touch with chromogenic bacteria or fungus.
•Paints, dyes, or chemicals applied on the skin's surface can typically be resolved by getting rid of the cause.
🔹 Etiology:
#Apocrine chromhidrosis is caused by the following pathophysiological and etiological factors:
Oxidation of lipofuscin granules within apocrine glands.
Darker hues are produced by lipofuscin in higher oxidation stages.
#Eccrine chromhidrosis is caused by:
The excretion of medications or pigments that dissolve in water, such as copper, quinine, or rifampin.
#Pseudo chromhidrosis is caused by:
Chemical or microbial contamination of the surface.
🔹Clinical Characteristics:
• Discharge or sweat that is colored (brown, green, yellow, black, or blue).
• Found in apocrine-rich regions. · A recurring or chronic course.
• May leave stains on skin, clothing, or towels.
• Usually, there are no systemic signs.
• Mental anguish brought on by one's appearance.
🔹 Diagnosis:
1. Clinical assessment:
• Colored sweat was noted. •Apocrine gland locations match to distribution.
2. Wood's lamp examination: •Fluorescence may be seen, particularly in cases of apocrine chromhidrosis.
3. Microscopic or histopathologic analysis:
•Usually avoided on the face for aesthetic reasons; contains lipofuscin pigment granules within apocrine glands.
4. To rule out pseudochromhidrosis, clean the affected region with alcohol; if the coloring continues, true chromhidrosis is probably present.
5. Eliminate external factors, such as medication reviews and metal or dye contact.
🔹 Management:
#There are a number of management strategies available, but there is no proven cure:
1. Topical therapies:
•Capsaicin used topically (0.025–0.1%) decreases production and depletes substance
•Topical aluminum chloride (20%): ~May help reduce perspiration, but its effectiveness is limited.
~The production of lipofuscin may be decreased by topical tretinoin (variable response).
2. Injections of botulinum toxin type A:
• In many situations, very effective. • Reduces apocrine secretion by blocking the release of acetylcholine.
• Repeat injections as necessary; effects last 3–6 months.
3. Other choices:
•Antihistamines taken orally Removal of glands or laser ablation
4. General guidance:
• Steer clear of friction, heat, and stress as they can cause secretion. •Avoid exogenous coloring chemicals and practice proper hygiene.
🔹 Prognosis :
•The prognosis is benign but persistent.
• Recurrences are common, particularly after the botulinum toxin's effects wear off.
•Despite the absence of systemic harm, it can result in considerable psychological and social distress.
🔹Case report:
• Patient demographics: female, age 32, without health insurance.
• The main complaint was a year-long dark blue discharge from both cheeks.
•Medication history: No recent prescriptions have been taken.
• Physical examination: Both cheeks have a dark blue discharge.
• Topical tretinoin 0.1% every other day at night for three months was the first treatment; however, there was no improvement.
• Additional care:
~A skin biopsy was suggested, but the patient declined for aesthetic concerns (scar phobia).
~No improvement after using a 20% solution of topical aluminum chloride every night for a month.
•Botulinum toxin type A (100 units) combined with 2.5 cc of regular saline (4 units per 0.1 cc) is the final treatment.
•Result: After three months of follow-up, there was no relapse and total resolution.
•Prognosis: The effects of botulinum toxin should lessen with time; a follow-up session might be necessary if the condition recurs.
Protocol
# Nursing Management :
1. Psychological Distress / Low Self-Esteem:
🔹 Issues encountered:
• The patient may experience social withdrawal, anxiety, or embarrassment as a result of the obvious discolouration.
• Fear of social rejection or misinterpretation (others may believe the discharge is contagious).
• A possible disruption in body image or depression.
🔹 Nursing management:
• Offer emotional support and promote candid communication about emotions.
•Assure patients that the illness is harmless and not communicable.
• Inform the patient about the disorder's characteristics and available therapies (such as topical agents and botulinum toxin).
•In the event that anxiety or depression is severe, consult a psychologist or counselor.
• Promote the sharing of emotions through online patient forums or support groups.
2. Reduced Skin Integrity and Skin Irritation Risk:
🔹 Issues encountered:
• Using harsh cleansers or frequent washing to get rid of discolouration can irritate the skin.
• Certain topical medications (such as capsaicin, aluminum chloride, and tretinoin) may result in peeling, burning, or dryness.
🔹Nursing administration:
• Teach the patient how to take care of their skin gently.
• Make use of gentle, fragrance-free moisturizers and cleansers.
• Steer clear of exfoliants and vigorous cleaning.
• Keep an eye out for indications of skin irritation or allergic responses to topical medications.
• Administer prescribed drugs precisely as instructed (typically in small doses at night).
• To avoid photosensitivity while on tretinoin medication, recommend wearing sunscreen.
3. Lack of Knowledge About the Condition:
🔹 Issues faced :
•Patients frequently don't know much about chromhidrosis and can mistake it for an infection or poisoning.
• Misconceptions may cause unwarranted anxiety or treatment noncompliance.
🔹Nursing management:
• Clearly and simply explain the following:
~The cause (oxidation of lipofuscin or buildup of pigment).
~The distinction between pseudochromhidrosis and real chromhidrosis.
~The disease's benign character.
• Provide information about available treatments and their anticipated results.
• Promote inquiry and active involvement in decisions about care.
4. Ineffective Coping with Recurrent/Chronic Conditions:
🔹 Issues encountered:
• After treatment wears off, symptoms could return (for example, botulinum toxin lasts 3–6 months).
•The chronic nature of the illness may lead to feelings of frustration or despair.
🔹 Nursing management:
• Establish reasonable expectations for the length of treatment and its recurrence.
•Reiterate the possibility of maintenance treatment (such as repeated botulinum injections). •Since stress might make people sweat more, promote stress-relieving activities.
• Continue to schedule routine follow-up appointments for assistance and monitoring.
5. Infection Risk:
🔹 Issues encountered:
• Regular cleaning of afflicted regions may result in microabrasions and raise the risk of infection.
• The skin barrier may be weakened by topical medications.
🔹 Nursing management:
• Teach patients to wash gently, pat dry, and refrain from picking or itching.
•Check for pus, swelling, or redness and report right away.
•Aseptic method should always be used.
• To promote skin health, promote hydration and a healthy diet.
6. Noncompliance with therapy:
🔹 Issues encountered:
• Some patients may discontinue therapy early because topical treatments cause discomfort or lack of quick results.
•Botulinum toxin costs may also make adherence difficult.
🔹 Nursing management:
• Stress the value of follow-up care and continuous implementation.
• Spread knowledge about the importance of long-term management and incremental progress.
•Work together with the medical staff to develop treatment programs that are both reasonable and bearable.
Notes
https://doi.org/10.7759/cureus.53401