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G344(P) Skin deep? a case of pseudochromhidrosis presenting to the children’s assessment unit (cau)
  1. R Kirk,
  2. A Gite
  1. Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK

Abstract

Introduction

  • Chromhidrosis is a rare disorder beginning in puberty, characterised by the production of coloured sweat from sweat glands containing an increased number of lipofuscin pigments.

  • Pseudochromhidrosis is the result of colourless perspiration that acquires colour when it reaches the skin and comes into contact with an external chromogen such as chromogenic bacteria (for example Corynebacterium species), fungi or dye from clothing.

  • Pseudochromhidrosis can present with a variety of colours depending on the aetiology. Involvement of the face, palms, or neck is most frequently reported, although it can present anywhere on the body.

Case

  • A fifteen year old boy with no significant past medical history was referred to CAU with three weeks of developing blue/grey patches intermittently on his skin.

  • These episodes occurred daily with differing distributions, not coinciding with a particular time of day, nor a particular activity level.

  • Examination revealed blue/grey patches on the patient’s hands and elbows bilaterally.

  • Thorough examinations, observations and haematological/biochemical investigations to identify a cause of presumed cyanosis were all normal.

  • Bacterial and fungal cultures of the skin were negative.

  • The affected areas were wiped with a damp cloth – there was evidence of blue/grey staining on the cloth following this.

  • Given the patient was systemically well, the transient nature of episodes and being able to wipe the coloured fluid from the skin, a preliminary diagnosis of pseudochromhidrosis was made.

  • Formal diagnosis has been challenging as the patient is reluctant to undergo further investigations, including skin biopsies. In the interim, he is using antiseptic skin scrubs to help control episodes.

Learning points

  • There are no known causes or associations for (pseudo)chromhidrosis.

  • Diagnosis of chromhidrosis is made through identifying lipofuscin granules in a skin biopsy. Pseudochromhidrosis is a clinical diagnosis based on exclusion of chromhidrosis.

  • Evidence regarding optimal therapy is limited. Satisfactory management remains challenging.

  • The prognosis is good if the extrinsic cause is identified and the inciting factor (such as chromogenic bacteria) is eliminated.

  • Systemic and topical antibiotics, as well as topical antiseptic scrubs, are the mainstay of treatment for pseudochromhidrosis.

  • There are no known medical sequelae other than social embarrassment and psychological stress.

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