Pot páchnoucí
- Common phenomenon in postpubertal individuals
- Pathologic if significantly interferes with the lives of the affected
- Chronic condition in which excessive odor, usually an unpleasant one, emanates from the skin [1]
- Most commonly originates from the axillary region or genital or plantar
- Described as pungent, rancid, musty, or sour
- Impair a person's quality of life [1]
Apocrine glands
- Have no thermoregulatory role but are responsible for characteristic pheromonal odors [1]
- Secrete a small amount of oily fluid, which is odorless upon reaching the skin surface [1]
- Characteristic odor is due to bacterial decomposition of the oily fluid
- Individuals with bromhidrosis display more numerous and larger apocrine glands
- Become apparent between the ages of 8 and 14 years [1]
- Contribute heavily to overall axillary sweating [1]
- Develop during puberty from eccrinelike precursor glands [1]
- Appears to be under sympathetic nervous control with the peripheral mechanisms regulated by catecholamines [1]
- Purinergic receptors within the gland also indicates the use of a secondary sudomotor pathway with nucleotide involvement in the secretory glands [1]
Apocrine bromhidrosis
- Most prevalent form of bromhidrosis
- Should be differentiated from the less common eccrine bromhidrosis
- Bacterial decomposition of apocrine secretion yields
- Ammonia
- Short-chain fatty acids
- (E)-3-methyl-2-hexanoic acid (E-3M2H)
- Brought to the skin surface bound by 2 apocrine secretion odor-binding proteins
- ASOB1
- ASOB2 = apolipoprotein D (apoD)
- (RS)-3-hydroxy-3-methlyhexanoic acid (HMHA) [1]
- Released through the action of a specific zinc-dependent N -alpha-acyl-glutamine aminoacylase (N-AGA) from Corynebacterium species [1]
- Also release other odoriferous acids from glutamine conjugates in sweat, which may be the basis of individual body odor [1]
Eccrine bromhidrosis
- Bacterial degradation of the keratin yields a foul smell
- Some foods, including garlic, onion, curry, alcohol
- Certain drugs (eg, penicillin, bromides)
- Toxins
- Underlying metabolic or endogenous causes
- Hyperhidrosis may promote the spread of apocrine sweat and contribute further to bromhidrosis by creating a moist environment, one ripe for bacterial overgrowth [1]
- Eccrine hyperhidrosis may cause a decrease in odor because the eccrine sweat flushes away the more odoriferous apocrine sweat [1]
Genetic involvement
- Family members who also have bromhidrosis
- Autosomal dominant inheritance pattern has been proposed in one study [1]
- More common in many Asian countries
- In Asian patients, apocrine bromhidrosis may be associated with a positive family history
- Even minimal body odor is associated with personal distress, and can be diagnosed as bromhidrosis, more so than in other regions of the world
- Social stigma of body odor leads more patients to seek treatment in these countries than in other countries
- Is believed to be more common in patients in dark-skinned ethnic groups than in others
- Male predominance
- Exclusively after puberty, rarely in the elderly population
Diferenciální diagnostika
- Cizí těleso v nose u dětí
- Atrofická rhinitida - ozena
- Bakteriální infekce
- Malhygiena
- Obesity
- Diabetes mellitus
- Intertrigo
- Trichomycosis axillaris
- Erythrasma
- Primarily disturbances in amino acid metabolism
- Phenylketonuria
- Trimethylaminuria [fish odor syndrome]
- Sweaty feet syndrome
- Odor of cat syndrome
- Isovaleric academia
- Hypermethioninemia
- Foods
- Drugs
- Toxic materials
- Gout
- Scurvy
- Typhoid
