Bromhidrosis: Differential Diagnoses & Workup

This Medscape article from WebMD discusses at length the Differential Diagnoses, Workup, Treatment & Medications involved in dealing with bromhidrosis. There are two causes of bromhidrosis noted in this article are Erythrasma, a chronic superficial infection of the intertriginous areas of the skin by the organism Corynebacterium minutissimum, and Trichomycosis Axillaris, a superficial bacterial colonization of the axillary hair shafts, as noted under 'Differential Diagnoses'.

Workup

Laboratory Studies

• Typically, the olfactory perception of the diagnostician is the only clinical tool required for diagnosis.
* Chromatography or spectroscopy may help identify odor-producing chemicals; however, the specific identification of odoriferous molecules is largely of academic interest and lacks diagnostic or therapeutic importance.
* In addition, results of chromatography or spectroscopy do not help in differentiating normal odor from odor caused by bromhidrosis.

• If concomitant erythrasma, a chronic bacterial infection of Corynebacterium minutissimum is suspected, the skin has a characteristic coral-red fluorescence under Wood lamp examination, and a potassium hydroxide preparation is negative for hyphae.

• Potassium hydroxide preparation shows bacteria within concretions from axillary hair in cases of trichomycosis axillaris.

• If an underlying metabolic disorder is suspected as a cause of odor, specific testing of urine or sweat may be indicated to detect the aberrant amino acid product.

Miscellaneous

...Failure to recognize systemic diseases (eg, fish odor syndrome) that contribute to the development of offensive odor could serve as the basis for a claim of delay in diagnosis if body odor was the chief presenting sign.

http://emedicine.medscape.com/article/1054088-overview