Bromhidrosis & Body Odour

A frequently asked question on internet websites is: “What can I do?! Co-worker + BO at work! Help!” (just to quote one common phrase). The usual answers to this would be “Buy him some soap!” or “Ask him if he has ever heard of washing!

disgusting body odor remedies needed

photo above | “Dude, take a shower! Ever heard of deodorants?!”

What most people do not know: In many cases the ‘air polluters’ are innocent. They are exactly free of blame in the matter because their body odour has nothing to do with personal hygiene, changing clothes or deodorants. The causes of the malodor are neither controllable nor avoidable.

The unknown illness: permanent body odour

Bromhidrosis (greek: bromos_hidros; ∼ the buck’s stench_sweat), also known as consecutive body odour (b.o.), is a common phenomenon in postpubertal individuals. In many cases, bromhidrosis may become pathologic if it is particularly overpowering or if the Bromhidrosis significantly interferes with the lives of the affected individuals. Bromhidrosis is a chronic condition in which excessive odour, usually an unpleasant one, emanates from the skin. Bromhidrosis, determined either by apocrine gland or by eccrine gland secretion, can substantially impair a person’s quality of life.

The WHO’s official ICD-10 classification code for Bromhidrosis is:

  • L75.0 → Bromhidrosis

Compendium:

Body odour, med. Bromhidrosis: severe and permanent body odour; diagnosable pathological condition; classified and registered by the WHO

Symptoms: abnormal apocrine or eccrine odour, emanated from the skin, mostly from armpits, genitals, inner tights and scalp

Side- and after-effects: psychological distress; social isolation; contaminated clothes

appocrine body odour areas of bromhidrosis

Recommended treatments:

➊ special disinfectant soaps and washing foams
<p>
➋ prescription antiperspirants if Hyperhidrosis is the cause of eccrine Bromhidrosis

➌ evaluation of possible causes, guided by health professionals; when indicated psychosomatic therapy

Other treatments:

special diet; abstinence (alcohol, nicotine, caffeine, drugs); medications

Competent medical experts:

dermatologist; internist; psychotherapist

Online support and help:

Main causes

Excessive secretion from the sweat glands that becomes malodorous on bacterial breakdown is the predominant cause of Bromhidrosis. There are two types of human sweat glands:

  • Eccrine glands are distributed all over the skin. They are responsible for bodily thermoregulation by means of sweat production. They secrete large amounts of salty fluid, which is odourless upon reaching the skin surface.
    <p>
  • Apocrine glands have a limited distribution involving the axilla, genital skin, scalp and breasts. Apocrine glands have no thermoregulatory role but are responsible for characteristic pheromonal odours. They secrete a small amount of oily fluid, which is rather odourless upon reaching the skin surface (most pheromones are not noticeable for human noses).

apocrine glands produce bodily malodour

fig. above | The apocrine sweat gland is attached to the hair follicle. Its straight duct releases the apocrine secretion directly into the channel of the hair shaft. In contrast to this, a eccrine sweat gland secrets its salty fluid directly onto the skin’s surface.

Apocrine body odour:
Apocrine bromhidrosis is the most prevalent form of bromhidrosis. Bacterial decomposition of apocrine secretion yields ammonia and short-chained acids (mostly butyric and formic acids) with their characteristic strong odours. The individual secretion of pheromones is important, too. Pheromones are the main cause of subliminal odours which other people will notice unknowingly, although they are a contributing factor to one’s subjective decision to find an individual person attractive or not.

Eccrine body odour:
In certain circumstances, eccrine secretion, which is typically odourless, assumes an offensive aroma and causes eccrine bromhidrosis. When eccrine sweat softens keratin, bacterial degradation of the keratin yields a foul smell. Ingestion of some foods, including garlic, onion, curry, alcohol, nicotine, caffeine, certain drugs (for example penicillin) and toxins may cause eccrine odours. Lastly, eccrine bromhidrosis may result from underlying problems:

  • metabolic dysfunction
  • renal dysfunction
  • liver failure
  • other endogenous dysfunctions

Hyperhidrosis:
Excessive sweating, known as Hyperhidrosis, may promote the spread of apocrine sweat and contribute further to bromhidrosis by creating a moist environment, one ripe for bacterial overgrowth.

Genetic predisposition:
Researchs suggested that Bromhidrosis is also caused by a genetic trait. Most patients can be genetically predisposed to body odour, especially when there is a known family history of Hyperhidrosis and family members had a certain bacterial skin flora.

Other causes may include the following:

  • obesity
  • Diabetes mellitus
  • Intertrigo (rash)
  • Trichomycosis axillaris (underarm infection of the hair shafts)
  • Erythrasma (superficial skin disease)
  • wrong clothing (non-breathable fabrics)

Recommended remedies:

Medical experts frequently recommend the following measures:

  • appropriate clothing: breathable fabrics of natural origin (cotton, leather etc.)
  • disciplined washing routine (see below)
  • daily usage of special washing foams (e.g. BromEX foamer) or soaps
  • daily usage of prescription strength antiperspirants if Hyperhidrosis (excessive sweating) is the main cause (e.g. AHC20 sensitive)
  • regular shaving or trimming of bodily hair (e.g. armpits)
  • abstinence (no garlic and hot spices, no alcohol, caffeine, nicotine, drugs)
  • diet (natural and healthy food without artificial colourants, glutamates etc.)
  • general health check-up (in order to exclude hidden diseases as a cause)

Interesting body odour facts:

Carnal differences:
There is a significally difference between female and male odour. Males will develop much more odour, which has a masculine, strong characteristic because of the dominating testosterone hormone. Women emanate a more sweeter scent which is mostly affected by feminine estrogens. A Swiss study done by researchers in Geneva revealed that women’s body odour contained high levels of sulphur, which together with dermal bacteria produces the chemical compound thiol that has a smell of garlic or onion. According to the study, men’s sweat was found to contain more fatty acids, which when mixed with bacteria from the skin, produces a certain brute smell, resembling cheese.

Ethnic differences:
Excessive sweating is a more common problem for Caucasians and Africans, who tend to have more hair follicles to which the apocrine glands are attached. East Asian people appear to have less and smaller apocrine glands, which explains why they might not need to use deodorants as often as populations of Africa and Europe (see paragraph below). As a matter of fact the deodorant/antiperspirant market in Asia is much smaller than in the western world. Surely, though, there may be many exceptions since body odour is obviously influenced by many factors, for example by one’s personal diet (spicy asiatic food etc.).

Earwax – the ethnic key to BO:
Earwax comes in two types, wet and dry. The wet form predominates in Africa and Europe, where 97 percent or more of the people have it, and the dry form among East Asians, while populations of Southern and Central Asia are roughly half and half. By comparing the DNA of Japanese with each type, scientist Koh-Ichiro Yoshiura and his team from Nagasaki University were able to identify the gene that controls which type of earwax a person has. The Japanese team says that the earwax-affecting gene, known to geneticists as the ATP-binding cassette C11 gene, lies with three other genes in a long stretch of DNA that has very little variation from one person to another. This is why the Nagasaki scientists linked the earwax characteristics with sweating and individual body odour. They suggest that earwax type and armpit odour are correlated, since populations with dry earwax, such as those of East Asia, tend to sweat less and have little or no body odor, whereas the wet earwax populations of Africa and Europe sweat more and so may have greater body odor. Several Asian features, such as small nostrils and the fold of fat above the eyelid, are conjectured to be adaptations to the cold. Less sweating, the Japanese authors suggest, may be another adaptation to the cold climate in which the ancestors of East Asian peoples are thought to have lived. 1

Indicator for health problems:
Some types of smell may reveal hidden health problems. It is known that if your sweat smells like peroxide (bleach), it may indicate a kidney or liver disease, while fruity body odour often points to diabetes. Also a rare genetic disorder, called TMAU-Syndrome (trimethylaminuria), makes a person produce constant fishy body odor.

Unique as a fingerprint:
Your body produces one of its kind odour – subtly, not noticeable for human noses – irrespective of outer influences. Individual odourtypes are genetically determined, they contain volatile organic compounds (VOCs) and pheromones that provide a certain smell, absolutely different from others, just like fingerprints or DNA samples. Scientists are working at creating special devices to identify individual odourtypes to find criminals, terrorists or missing children.

females and children develop less body odor

photo above | His mother may develop body odour because of her underarm sweating. His own infant apocrine sweat glands will not start to work before adolescence (see paragraph below).

Childrens and BO:
Smelly feet or armpits are usually not a problem for kids. Healthy children will not develop any unpleasant sweat odour until they enter adolescence between the ages 8 to 14 years. During puberty, the androgen hormones trigger increased sweating and thereby development of body odour.

The Olf – the scale of smell:
The Olf (latin olfactus; ∼ sense of smell) is used to measure the strength of a pollution source that can be inhaled and smelt by human nose. It was introduced by Danish professor P. Ole Fanger in 1988. One Olf is the sensory pollution strength from a standard person defined as “an average adult working in an office or similar non–industrial workplace, sedentary and in thermal comfort, with a hygienic standard equivalent of 0.7 bath per day and whose skin has a total area of 1.8 square metres“. It was defined to quantify the strength of pollution sources which can be perceived by humans.
Nowadays, the Olf scale is used to rate smellable emissions from materials, for example at car design centers, where fabrics with a pleasant scent are designed (e.g. dashboard or seat coatings). To this day, there are no technical devices for the Olf measurement. Qualified testers still use their sensitive noses.
Body odours of all kinds could also be measured in Olf. It is foreseeable that the WHO will use the Olf scale for classification and diagnosis of Bromhidrosis in near future.

Ole Fanger at Syracuse University

photo above | Professor Povle Ole Fanger (* 16. Juli 1934; † 20. September 2006) at Syracuse University, NY. In 1988 he introduced the Olf scale for quantification of smellable pollution.

Twin + twin = malodour²
In a Swiss study (Kuhn F. et al. 2005), the aim was to use a group of qualified human ‘sniffers’ to match axillary odour samples from monozygotic (identical) twins who did not co-habit (so as to avoid cohabiting factors being relevant). The research showed that identical twins odour samples were matched by the human sniffers more often than chance would dictate. Dizygotic (non-identical) twins were also more often matched, but not as often as identical twins. Scientist regard this as a proof that body odour is sort of “blood-borne” and hereditary. Certain genes may play a significant role as a congenital disposition to individual malodour.

Body odour gossip

Library bans: No books for stinkers!
At the Library of San Luis Obispo (California, USA) the staff has the right to ban people with unpleasant body odor from their library rooms. This right has been part of the official library rule since 1994. In 2005, though, the San Luis Obispo County council enacted an even stricter Library Rules of Conduct and Exclusion Process. By this, police officers also got the legitimation to ban stinkers from a total of 14 county libraries (plus one book bus).

In 1989 Mr. Richard Kreimer from Morristown, New Jersey (USA) won a relevant case at the Federal Court. He had conducted this lawsuit after he was banned from an public library because of his body odour. The court mostly followed his argument, that in terms of human rights and honour it is highly discriminating to ban someone from a public place for such questionable reasons. However, the court of appeal refused to countersign this. In 1992 it overturned the 3 year old judicial decision. In the opinion of the appellate court, visitors and employees do not have to endure severe body odour emitted from a singular person. The library staff has officially the right to to banish such persons from their rooms.

In Wigston, Leicestershire (UK), 27 year old worker Stuart Penman was banned from the public Wigston Library for 6 month. Members of the Leicestershire County Council tried to avoid this ban previously. They interwiewed Penman privately but he refused to cooperate. After many complaints from other visitors, Margaret Bellamy, head of library services for the council finally decided to enforce the ban. “We’ve had people leaving and saying it’s because of the smell. I feel very sorry about the whole situation and it’s not a decision we took lightly but we’ve done all we can to help and it’s still not getting any better. […] When people were refusing to come into the library we felt we had no other option.” she said. Penman, who uses the library daily for internet surfing, said he was a victim of circumstances. “Some of the women that work there just tell me to get out because I smell, in front of everyone. It’s very embarrassing when they do that. […] I have a bath every day but I realise my feet do smell. I live with my mum, who smokes, so I smell like cigarettes.” That could be the reason for his odour, he said in an interwiew with This is Leicestershire.

The BO-Bus-Ban
In Honolulu, Hawaii (USA), bus riders with pungent body odour could have faced $ 500 in fines. Honolulu City Council members had considered a proposal to ban riders from buses if their body odor is too stinky. In 2009, the council introduced the bill to regulate a number of dangerous or annoying behaviors on city buses including excessive B.O. Under the bill, police could have cited riders if their body odour annoyed others and a convicted offender could have faced up to $ 500 in fines or six months in prison. However, many critics called the The bus behaviour bill discriminating and heavy handed. Bus drivers and regular passengers, though, said it was a positive sign that bad B.O. got banned along with other offences, such as spitting on buses, being drunk on a bus or urinating when you are on a bus or at a bus stop. After several public hearings and ongoing protests, the council eventually decided to drop the body odour ban from the bill. 2

body odour banned from UK rollercoaster

Hands down, this must be a joke!
Rollercoaster fans at Thorpe Park in in Chertsey, Surrey (UK) may wonder about strange signs (as shown above) which tell visitors to keep their arms down while riding and “Say NO to BO“. In summer, when temperatures reach 84 F (29 °C), park managers expect an excess of perspiration as visitors queue to go on rides. Wardens will also remind people to consider their fellow passengers and anyone ignoring the warnings will be escorted off. Those who continue to do so will be asked to leave the park. Mike Vallis, a director at Thorpe Park, said that the level of unpleasant smells can become unacceptable and that there were many complaints. “Our rides are really scary and people tend to sweat more than normal due to the fear and anticipation they experience while queueing up so it can get really pongy. Therefore, we felt a ban in temperatures of 25 °C plus would be the best way to ensure our guests have the most enjoyable experience and aren’t exposed to any unsavoury armpits. 3

Game over: Body odour now banned from the WSOP
Tablemates with a severe stench now have a bad hand at poker tournaments. According to WSOP (World Series Of Poker) officials, players with bad body odour will be banned from the table. The 2010 Rule 37 B states: “All participants are entitled to expect civility and courtesy from one another at every Tournament table and throughout the Tournament area. Any individual who encounters behavior that is not civil or courteous — or is abusive in any way — is encouraged to immediately contact a Tournament official. This shall include, but is not limited to, any player whose personal hygiene has become disruptive to the other players seated at their table. The determination as to whether an individual’s personal hygiene is disruptive to other players shall be determined by the Tournament Staff which may, in its discretion, implement sanctions upon any such player who refuses to remedy the situation in a manner satisfactory. 4

Facebook’s “clean air” group
Brett Chandler
from Manchester (UK) started a rather funny group at facebook.com: “Campaign To Ban Body Odour From Public Places“. In his profile Chandler descripes his idea in detail. “I’ve started this group to begin a major campaign which I will forward to the government if I get enough members. I want to give the rights to anybody to walk up to any Mr/Mrs Stinky and inform them that they smell awful. Also, I want to give bosses the authority to dismiss smelly employees. I believe that body odour in public places should be a punishable criminal offence.” By now, this group has over 240 members.

Chinese astronauts without body odour

Space hygiene – made in China
It seems like only the ace of human race will go to space. According to China’s list of 100 taikonaut rules, aspiring space travellers need to have a “pleasant and adaptable disposition”. The guidelines make clear that only “super human beings” will go to space. In addition to all the rigorous physical requirements and demands placed on those entering China’s space program, those austronaut wannabes with bad breath, body odour or a family history of serious disease within the past three generations will be banned from space training. Shi Bing Bing, a doctor at the 454th Air Force Hospital in Nanjing, eastern China, said the new rules will help China send the best of the best into space. “Bad body odour will affect fellow colleagues in the narrow confines of a space shuttle,” he said. 5

Draconia Helvetia – Fresh air in Swiss city halls
The Swiss city of Zurich has banned municipal workers from having overbearing body odour. The ban is part of a strict list of rules on behaviour and dress code issued by city officials, which also includes bans on strong perfume and plunging necklines. Workers have been provided with a four-page document with dos and don’ts for employees’ “professional presentation“. Sartorial restrictions are included as well. Too much bare back or stomach on display, mediocre shirts with patterns, trainers, messy beards and short trousers are also forbidden.6 However, city officials will not send dress code inspectors and municipal workers are still allowed to eat Swiss cheese at work.

Perfidious body odour: 3-year prison sentence for Ghanaian rapist
The body odour of a 20-year-old farmer, Raymond Ayeh Ensior gave him away when he attempted to rape Madam Vicentia Kwao in her sleep at Tsome-Afedo, Ghana. In the evening of January 26, 2004 Ensior sneaked into Madam Kwao’s bedroom while fellow tenants including her husband, a Teacher, were watching a football match on television on the compound. He entered the bedroom where Madam Kwao was fast asleep, removed her cover cloth and panties and attempted to rape her. Blessedly, Ensior’s approach was unusual to Madam Kwao, who also noticed that the body odour of Ensior was not that of her husband and, therefore, raised then alarm. The farmer, who pleaded guilty to indecent assault, unlawful entry and causing damage, was sentenced to three years’ imprisonment by the Ho Circuit Court presided over by Mr. Nicholas Abodakpi. 7

1 source: The New York Times, January 29, 2006, “Japanese Scientists Identify Ear Wax Gene”
2
source: kitv.com, September 01, 2009, “Council Considers BO Ban”
3
source: The Telegraph, August 18, 2009, “Thorpe Park bans rollercoaster fans …”
4
source: WSOP, Official Regulations 2010
5
source: bbc.co.uk, August 02, 2009, “Astronauts wanted – no bad breath”
6
source: The “Arbroath” blog, January 19, 2009, “Body odour ban for Zurich workers”
7 source: modernghana.com, August 02, 2004, “Body odour gives rapist away”