I was on a flight to Abuja from Lagos once. I boarded early, found my seat, and got ready to enjoy the one hour flight. There were three seats on my side of the aisle and I had the window seat. I was glad because it looked like I was going to have the entire row to myself, but at the last minute, someone came and took the aisle seat, and with him came this really strong garlic-like odour. It was so strong that I had to reopen the vent I had closed earlier because I was cold. Better to be cold than to choke you know? Yet, I struggled most of the flight. I was shivering AND choking. Oh well. Garlic does have a lot of health benefits, and Asians know it. He was Asian.
*BODY ODOUR:*
*Definition:*
Known medically as Bromhidrosis or Osmidrosis is a chronic condition in which excessive odour, usually unpleasant, emanates from the skin.
Truth is everyone has an odour, but when it becomes unpleasantly excessive, and starts to affect the quality of a person's life, then there's a problem.
It is most common in postpubertal people (because the most common type only occurs after puberty) and Asians have been documented to be most dominantly affected, mostly because of their diets and clinical visits on account of resultant depression. A positive family history of Bromhidrosis in them is also a strong predisposing factor.
It is also more common in males than in females.
Pathophysiology*
How does it happen? There are two major types of sweat (human secretory) glands in the body;
*The Apocrine glands*
These glands are found mostly in the axilla (arm pits), genital skin, and breasts. Some are also found in the periorbital (around the eyes) and periauricular (around the ears) areas. They are found in the reticular dermis and subcutaneous tissue and are controlled by the sympathetic nervous system. They are responsible for Pheromonal odours (basically that unique smell that everyone has that's distinct to them and makes them sexual attractive). They are not responsible for thermoregulation. They are larger. *Apocrine Bromhidrosis* is therefore, more common and it occurs when there is bacterial decomposition (commonest of which is corynebacterium species) of apocrine secretion, which yields Ammonia and Short chain Fatty acids, which have strong odours. The secretions by themselves are odourless. Bacterial action on them give rise to the unpleasant odour.
*The Eccrine glands* are found all over the skin surface and are found in the dermis. They are responsible for thermoregulation via the production of sweat. *Eccrine Bromhidrosis* occurs when eccrine sweat softens Keratin (in hair follicles) and then bacterial degradation of this keratin yields a foul smell. Ingestion of garlic, onion, curry, alcohol, drugs (like penicillin and bromides) and toxins all predispose to Eccrine Bromhidrosis because they lead to excessive sweating ( *Hyperhydrosis* ). Excessive sweating leads to more softening of keratin, which in turn leads to more bacterial degradation.
*Precipitating Factors*
Are there things that can predispose you to having a body odour? YES! They include;
●Inadequate hygiene
●Medical or dermatological conditions associated with Hyperhydrosis or over growth of bacteria, which include;
° Obesity
° Diabetes Mellitus
° Intertrigo
° Trichomycosis axillaris
° Erythrasma
Others include
● Post - Laser treatments
● Foreign body in the nose in children
● Gout
● Scurvy
● Typhoid.
Symptoms and Signs*
The odour is usually mostly axillary (from the arm pits). It's described as pungent, rancid, musty or sour. The other common sites include the genital area and the soles of the feet.
There are usually no significant physical signs to be demonstrated by the physician, except in cases where there are concurrent illnesses, for example, fungal infections like Trichomycosis axillaris in which concretions are seen at the root of the hair follicles in the armpits.
*Investigations*
Not really indicated here; it is a clinical diagnosis. However, in cases of other concurrent illnesses, or where they are suspected, tests are requested for in that line.
*Treatment*
So what do you do when you can't seem to be able to get rid of that smell? (Please note that you should confirm that you actually do stink!!! Ask your loved ones! They say only someone who loves you will tell you that you stink. This is for such cases. Not people who "imagine" that they stink. 😉).
*Health Education*
Very important.
■ Use antibacterial soaps
■ Use antiperspirants
■ If you wear clothes with dried sweat on them, you will stink!
■ Avoid excessive intake of spicy food. Reduce your garlic, curry, e.t.c 🙂
■ Reduce Alcohol!
■ And while you're at it, stop smoking!!!
In other words, reduce the amount of toxins you load your body up with.🙂
■ Oh yeah, wash your armpits! Shave too!
*Medical Treatment*
■ Topical antibiotics can be used when disinfectants fail.
■ Treat underlying skin conditions like Intertrigo, Erythrasma and Trichomycosis axillaris
■ Botulinum toxin: please see your doctor! It basically aims to reduce sweat production by inhibiting the nervous system.
*Surgical Treatment*
Reserved for severe cases, especially those in psychological distress. Common among Asians.
■ Some of the Apocrine sweat glands with cellular and subcutaneous tissue in the armpits can be removed, leaving behind the skin.
■ Superficial Liposuction Curretage; in which a tube is attached to the armpits and subcutaneous fat is drained out.
*Conclusion*
Body Odour is a medical condition caused by over secretion of apocrine or eccrine glands that becomes malodorous on bacterial breakdown. It can be managed by certain health practises, but when those fail, please seek medical help, because it has been found to be a source of social and psychological distress.
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