Bromhidrosis is excessive or abnormal body odor caused by decomposition by bacteria and yeasts of sweat gland secretions and cellular debris.
(See also Introduction to Sweating Disorders.)
Apocrine secretions are lipid-rich, sterile, and odorless but become odoriferous when decomposed by bacteria into volatile acids on the skin surface.
Eccrine sweat is generally not malodorous because it is nearly 100% water.
Eccrine bromhidrosis can occur when bacteria degrade keratin that has been softened by eccrine sweat. Eccrine bromhidrosis can also result from ingestion of certain foods (eg, curry, garlic, onion, alcohol) and medications (eg, penicillin).
Studies suggest a strong correlation between bromhidrosis and wetness or stickiness of earwax (in association with a single nucleotide polymorphism of the ABCC11 gene) (1).
The diagnosis of bromhidrosis is primarily clinical, based on patient history and physical examination demonstrating malodorous sweat.
General reference
1. Nakano M, Miwa N, Hirano A, et al. A strong association of axillary osmidrosis with the wet earwax type determined by genotyping of the ABCC11 gene. BMC Genetics. 2009;10:42. doi: 10.1186/1471-2156-10-42
Treatment of Bromhidrosis
Various methods to control odor and reduce sweating
In some patients, a few days of washing with an antiseptic soap, which may be combined with use of antibacterial creams containing clindamycin or erythromycin, may be necessary. Shaving the hair in the armpits may also help control odor. Data on efficacy of these treatments are sparse (1).
People can also promptly remove sweaty clothing and use deodorants or antiperspirants. Deodorants mask odor, whereas antiperspirants reduce sweat production.
Results are variable with other modalities such as botulinum toxin, microwave-based devices, lasers, and surgery (2); the choice of treatment depends on patient preference, tolerability of adverse effects, and/or need for repeated treatments.
Treatment references
1. Malik AS, Porter CL, Feldman SR. Bromhidrosis treatment modalities: A literature review. J Am Acad Dermatol. 2023;89(1):81-89. doi: 10.1016/j.jaad.2021.01.030
2. Lin Q, Cai B, Chen L, et al. Contemporary Algorithm for Treating Bromhidrosis: A Review of Treatment Available. Aesthetic Plast Surg. 2025;49(13):3841-3848. doi:10.1007/s00266-024-04633-7
Drug Information for the Topic
