From the Research
The workup for a patient with bromhidrosis (body odor) should begin with a thorough history and physical examination, focusing on areas where apocrine glands are concentrated, and management typically starts with improved hygiene measures and antiperspirants containing aluminum chloride, as recommended by the most recent study 1. The history should include questions about the onset, duration, and pattern of the odor, associated symptoms, diet, medications, and personal hygiene habits.
- Key points to consider in the history include:
- Onset and duration of symptoms
- Associated symptoms such as sweating or skin conditions
- Diet and potential triggers for body odor
- Current medications and personal hygiene habits Physical examination should focus on areas where apocrine glands are concentrated (axillae, groin, scalp) and look for signs of infection or skin conditions.
- The examination should include:
- Inspection of the skin for signs of infection or inflammation
- Palpation of the affected areas to assess for tenderness or swelling Basic laboratory tests may include complete blood count, comprehensive metabolic panel, and thyroid function tests to rule out systemic causes.
- These tests can help identify underlying conditions that may be contributing to the body odor, such as hyperthyroidism or anemia. For persistent cases, consider testing for trimethylaminuria (fish odor syndrome) with a urine test for trimethylamine, as suggested by 2. Management typically starts with improved hygiene measures including daily bathing with antibacterial soap, frequent clothing changes, and use of antiperspirants containing aluminum chloride.
- Topical antibiotics like clindamycin or erythromycin may help reduce bacteria that cause odor, as mentioned in the example answer.
- For severe cases, oral antibiotics such as doxycycline 100mg twice daily for 7-10 days might be prescribed, although this is not directly supported by the provided evidence. Dietary modifications can help, particularly reducing foods high in choline and carnitine if trimethylaminuria is suspected, as noted in the example answer.
- Body odor often results from bacterial breakdown of sweat components, particularly in apocrine gland secretions, which is why addressing both the bacterial load and excessive sweating can effectively manage the condition, as discussed in 3 and 4. The most recent and highest quality study 1 provides a stepwise approach to investigating and treating patients with hyperhidrosis, which can be applied to the management of bromhidrosis.
- This approach emphasizes the importance of a thorough history and physical examination, as well as the use of antiperspirants and other topical treatments to manage excessive sweating and reduce body odor.