Re: blue sweat!!!!!
The name of the condition is Chromhidrosis.
Background: Chromhidrosis is an extremely rare condition characterized by intensely colored sweat, mostly secondary to colored apocrine secretions. Chromhidrosis is a localized disease of apocrine-bearing skin, affecting the face, axillae, or areola. Approximately 10% of people without the disease have yellow, blue, or green sweat that is regarded as acceptable and within the normal range.
True eccrine chromhidrosis is rare.
The term pseudochromhidrosis is used when initially colorless sweat that is eccrine in origin becomes colored on the surface of the skin in contrast to true chromhidrosis, in which sweat already is colored prior to secretion on the surface.
Pathophysiology: An increased synthesis of tyrosine, heme, and melanin has been implicated in the pathogenesis of apocrine chromhidrosis. However, more evidence supports elevated levels of lipofuscins in the glands that cannot be accounted for by a systemic or acquired metabolic or dietary alteration. Substance P is postulated to be an important neurotransmitter in this process.
As previously defined, eccrine pseudochromhidrosis is of extrinsic etiology, in which a chemical on the surface of the skin reacts with eccrine secretions and produces the transformation in color.
In the US: Incidence statistics are not available; the disease is rare.
Mortality/Morbidity: No medical sequelae are seen, except the psychological impact on and embarrassment of the patient.
Race: A racial difference applies to the appearance of wax produced by ceruminous glands (modified apocrine glands). For example, Asians produce white cerumen, and Occidentals produce yellow cerumen.
Apocrine chromhidrosis appears to be more common in blacks than in whites.
Age: The condition occurs most commonly after puberty but may be seen at any age. As apocrine glands regress with age, the incidence of apocrine chromhidrosis appears to decline.
History: Comparatively, the quantities of apocrine sweat are much less than those of eccrine sweat.
Usually, patients complain of axillary staining of the undershirt and, less frequently, of staining of the face or areola. Yellow is the most common color of axillary staining.
An aura of warmth or a prickly sensation prompted by emotional or physical excitation may precede onset of colored sweat.
Facial apocrine chromhidrosis rarely is seen. It occurs most commonly on the cheeks and malar eminences. The secretion often can be expressed mechanically.
Physical: Upon careful inspection, it often is possible to identify the following signs:
Yellow, red, blue, or green secretion that is turbid.
Staining that is accentuated in the orifices and pores.
Glistening, adherent, deeply colored flecks that appear as the secretions dry.
Causes: Several extrinsic causes may be involved as follows:
Chromogenic bacteria, especially Corynebacterium species
Dyes and chemical contactants
Other Problems to be Considered:
Bleeding diathesis (red sweat, hematohidrosis)
Copper exposure (blue sweat)
Contamination from corynebacteria, paint, or clothing dyeLab Studies:
Wood lamp examination of colored sweat may be positive. If no sweat is produced at the time of the test, drugs may be used to stimulate sweat secretion.
A more refined test involves autofluorescence of clothing fibers in contact with the secretions using standard UV microscopy.
Perform complete blood counts to exclude bleeding diathesis.
Test urinary homogentisic acid levels to exclude alkaptonuria.
Histologic Findings: The number of glands is variable. Yellow-brown granules may be observed in the apical area of secretory cells on hematoxylin and eosin stain. The granules are periodic acid-Schiff positive and demonstrate autofluorescence corresponding to the lipofuscins.
Medical Care: Reports of successful treatment with capsaicin cream exist; however, relapse occurs when therapy is stopped. The presumable mechanism of action is neuron depletion of substance P, an important neurotransmitter for apocrine sweat production