Jennifer Grant
Question: My husband is 45 and is very clean and always has been. He spends too long in the shower if anything. However, recently I have noticed he smells a bit odd — slightly stale and musty. It is a body odour and not coming from his breath. It’s very distinctive and I want him to go to the GP to have tests to see what it is. He just laughs when I say it to him but my daughter also gets the smell, so I am not imagining it. What could it be?
Dr Grant replies: Everyone has their own unique body odour, mostly due to the natural release of pheromones, primarily from the armpits. Excessively foul-smelling sweat causing body malodour is termed “bromhidrosis” — bromo meaning stench and hidros meaning sweat in Greek — generally diagnosed when body odour has a negative effect on an individual, their social interactions, or quality of life.
There are two types of bromhidrosis. The first is related to the apocrine sweat glands located in abundance at the armpits (axillae), anogenital areas, and breasts. The primary role of the apocrine glands is the secretion of pheromones. These glands develop around the time of puberty. As you never noticed a bad odour from your husband until recently, he most likely has the second type, called after the odour secreted from the eccrine glands. Eccrine glands are primarily responsible for thermoregulation and are found all over the body apart from the lips, ear canal, and genitals.
Eccrine bromhidrosis can occur at any age and may be generalised or local, when it typically affects the feet. There is another type of sweat gland which is a combination of both apocrine and eccrine features, and most likely contributes to bromhidrosis. The sympathetic nervous system controls the activity of all sweat glands. Factors that trigger the sympathetic nervous system include exercise, heat, emotion, certain foods, medications, and some medical conditions. Washing temporarily reduces the problem.
The malodour typically results from bacterial degradation of fatty acids secreted in apocrine sweat. Risk factors include a family history of bromhidrosis, hyperhidrosis (excessive sweating) or increased size/number of apocrine glands. For eccrine bromhidrosis, specific triggers may include foods such as garlic or alcohol ingestion.
The particular odour you say is stale and musty, which might mean it is related to possible liver or renal disease as this has an ammonia-like smell (think strong, dehydrated urine smell). If the odour can be localised, treatment usually involves methods to reduce bacteria and/or sweating in the affected areas such as antibacterial skin washes or products containing alpha and beta-hydroxy acids. If excess sweating is a contributing factor, efforts to reduce sweating include aluminium-containing antiperspirants.
He should wear cotton underwear, socks and garments as much as possible. Exfoliation with a foot scrub or pumice stone can help remove excess layers of skin. Topical antibiotics such as clindamycin or erythromycin are worthwhile applying twice daily. But first, he should attend his GP for a set of routine bloods to ensure normal liver and kidney function and rule out gout.
Dr Jennifer Grant is a GP with Beacon HealthCheck
On This Day In History - June 27th
