Pseudochromhidrosis Case Report

Summary: INTRODUCTION Chromhidrosis is a rare condition that presents with the secretion of colored sweat [1]. A less common etiological subtype is pseudochromhidrosis or pseudo-eccrine chromhidrosis that can occur anywhere eccrine glands are located on the body [1]. Pseudochromhidrosis, while similar in appearance to chromhidrosis, is the result of colorless sweat combining with an exogenous substance, such as dyes, chemical agents, or resulting from changes in the skin’s microflora due to a medication [1-2]. Different species of bacteria have been indicated to produce varying ranges of color, depending on the environmental factors in which the bacteria are thriving (e.g. hydration, oxygen, and pH levels) [3]. Pseudochromhidrosis is often considered a cosmetic health concern, which can cause psychological symptoms of varying effect on an individual’s daily life and mental health [3]. CASE DESCRIPTION Seventy-one-year-old male presented with 2-month long history of skin discoloration of the left hand. The patient’s left palm develops yellow blotches that come and go and worsens at night, but he is otherwise asymptomatic. The discoloration leaves behind residues on clothing, towels, and around the home. During his visit, paper towel samples of the yellow substance were collected. Patient reported that he does not use any personal care products routinely beyond soap and shampoo. He works on a computer for much of his workday, and he does not perform any work that could explain the phenomenon or work routinely with solvents or other products. The patient has a history of hypertensive disorder and hypothyroidism. The initial impression included hyperhidrosis and chromhidrosis. The treatment plan comprised of 1% topical clindamycin phosphate (twice daily) and 20% topical aluminum chloride (once or twice weekly, then once weekly for four weeks). The patient’s condition resolved completely within one week with no recurrences and no other lifestyle or dietary modifications. On three-month follow-up, he had no recurrences of this phenomenon. DISCUSSION This case was originally assumed to be chromhidrosis, due to the yellow color of the sweat. This is a chronic condition, and symptoms are usually managed with botulinum toxin type A injections, manually induced expression of apocrine glands, or capsaicin cream [1]. However, due to the patient’s rapid response to the topical antibiotic treatment regimen and lack of recurrence following discontinuation of topical antiperspirant therapy, the diagnosis was determined to be pseudochromhidrosis. Potential testing of the patient’s yellow stained towels could allow for further evaluation of the causative agent, however given therapeutic success this was not performed. REFERENCES Wilkes D, Nagalli S. Chromhidrosis. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554395/ Tempark T, Wittayakornrerk S, Jirasukprasert L, Chatproedprai S, Wananukul S. Pseudochromhidrosis: report and review of literature. International Journal of Dermatology. 2017;56(5):496-502. doi:10.1111/ijd.13495 Nair PA, Kota RK, Surti NK, Diwan NG, Gandhi SS. Yellow pseudochromhidrosis in a young female. Indian Dermatol Online J. 2017;8(1):42-44. doi:10.4103/2229-5178.198778