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Jami L Miller, MD
Section Editor
Mark V Dahl, MD
Deputy Editor
Abena O Ofori, MD


Sweat-related body odor manifests in essentially all individuals at some point during life. Excessively foul-smelling sweat is considered pathologic and termed bromhidrosis, a term derived from the Greek "bromos" (stench) and "hidros" (sweat). Synonyms of bromhidrosis include "bromidrosis," "osmidrosis," and "ozochrotia."  

The degree of odor considered "excessive" and sufficient for a diagnosis of bromhidrosis is not definitive. Bromhidrosis is generally diagnosed when noticeable body odor has a negative effect on an individual's self-view, social interactions, or quality of life.

Bromhidrosis is divided into apocrine bromhidrosis and eccrine bromhidrosis. The most common site for apocrine bromhidrosis is the axilla. Eccrine bromhidrosis most often affects the feet.

The clinical features, diagnosis, and management of bromhidrosis will be reviewed here. Hyperhidrosis (excessive sweating) is reviewed separately. (See "Primary focal hyperhidrosis".)


Bromhidrosis is subdivided into apocrine and eccrine variants based upon the type of sweat gland involved. Apocrine glands develop after puberty and are most densely distributed in the axillae, anogenital areas, and breasts. The primary role of apocrine glands appears to be the secretion of pheromones. Eccrine glands are widely distributed all over the body, with the exception of the external auditory canal, lips, clitoris, labia minora, and glans penis. Eccrine glands are primarily responsible for thermoregulation.

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Literature review current through: Dec 2017. | This topic last updated: Apr 10, 2017.
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  1. Spielman AI, Sunavala G, Harmony JA, et al. Identification and immunohistochemical localization of protein precursors to human axillary odors in apocrine glands and secretions. Arch Dermatol 1998; 134:813.
  2. Zeng C, Spielman AI, Vowels BR, et al. A human axillary odorant is carried by apolipoprotein D. Proc Natl Acad Sci U S A 1996; 93:6626.
  3. Natsch A, Derrer S, Flachsmann F, Schmid J. A broad diversity of volatile carboxylic acids, released by a bacterial aminoacylase from axilla secretions, as candidate molecules for the determination of human-body odor type. Chem Biodivers 2006; 3:1.
  4. Mancini M, Panasiti V, Devirgiliis V, et al. Bromhidrosis induced by sphingomonas paucimobilis: a case report. Int J Immunopathol Pharmacol 2009; 22:845.
  5. Martin A, Saathoff M, Kuhn F, et al. A functional ABCC11 allele is essential in the biochemical formation of human axillary odor. J Invest Dermatol 2010; 130:529.
  6. Bang YH, Kim JH, Paik SW, et al. Histopathology of apocrine bromhidrosis. Plast Reconstr Surg 1996; 98:288.
  7. Sato T, Sonoda T, Itami S, Takayasu S. Predominance of type I 5alpha-reductase in apocrine sweat glands of patients with excessive or abnormal odour derived from apocrine sweat (osmidrosis). Br J Dermatol 1998; 139:806.
  8. Kurata S, Itami S, Komada S, Takayasu S. Intranuclear androgen and cytosolic receptor concentrations in the axillary skin of osmidrosis. Arch Dermatol Res 1990; 282:33.
  9. Inaba M, Anthony J, Ezaki T. Radical operation to stop axillary odor and hyperhidrosis. Plast Reconstr Surg 1978; 62:355.
  10. Shang D, Zhang X, Sun M, et al. Strong association of the SNP rs17822931 with wet earwax and bromhidrosis in a Chinese family. J Genet 2013; 92:289.
  11. Helou J, Habre M, Soutou B, et al. Reversibility of hyperhidrosis post axillary depilatory laser. Lasers Med Sci 2014; 29:717.
  12. Helou J, Haber R, Kechichian E, Tomb R. A case of generalized bromhidrosis following whole-body depilatory laser. J Cosmet Laser Ther 2015; 17:318.
  13. Lucky AW. Acquired bromhidrosis in an 8-year-old boy secondary to a nasal foreign body. Arch Dermatol 1991; 127:129.
  14. Tee CK, Suzaily W. Unremitting body odour: A case of Olfactory Reference Syndrome. Clin Ter 2015; 166:72.
  15. Lee JB, Kim BS, Kim MB, et al. A case of foul genital odor treated with botulinum toxin A. Dermatol Surg 2004; 30:1233.
  16. He J, Wang T, Dong J. A close positive correlation between malodor and sweating as a marker for the treatment of axillary bromhidrosis with Botulinum toxin A. J Dermatolog Treat 2012; 23:461.
  17. Heckmann M, Teichmann B, Pause BM, Plewig G. Amelioration of body odor after intracutaneous axillary injection of botulinum toxin A. Arch Dermatol 2003; 139:57.
  18. Shin JY, Roh SG, Lee NH, Yang KM. Osmidrosis Treatment Approaches: A Systematic Review and Meta-Analysis. Ann Plast Surg 2017; 78:354.
  19. Fan YM, Wu ZH, Li SF, Chen QX. Axillary osmidrosis treated by partial removal of the skin and subcutaneous tissue en bloc and apocrine gland subcision. Int J Dermatol 2001; 40:714.
  20. Li ZR, Sun CW, Zhang JY, et al. Excision of apocrine glands with preservation of axillary superficial fascia for the treatment of axillary bromhidrosis. Dermatol Surg 2015; 41:640.
  21. Zhao H, Li S, Nabi O, et al. Treatment of axillary bromhidrosis through a mini-incision with subdermal vascular preservation: a retrospective study in 396 patients. Int J Dermatol 2016; 55:919.
  22. Ou LF, Yan RS, Chen IC, Tang YW. Treatment of axillary bromhidrosis with superficial liposuction. Plast Reconstr Surg 1998; 102:1479.
  23. Seo SH, Jang BS, Oh CK, et al. Tumescent superficial liposuction with curettage for treatment of axillary bromhidrosis. J Eur Acad Dermatol Venereol 2008; 22:30.
  24. Lee D, Cho SH, Kim YC, et al. Tumescent liposuction with dermal curettage for treatment of axillary osmidrosis and hyperhidrosis. Dermatol Surg 2006; 32:505.
  25. Kim IH, Seo SL, Oh CH. Minimally invasive surgery for axillary osmidrosis: combined operation with CO2 laser and subcutaneous tissue remover. Dermatol Surg 1999; 25:875.
  26. Park JH, Cha SH, Park SD. Carbon dioxide laser treatment vs subcutaneous resection of axillary osmidrosis. Dermatol Surg 1997; 23:247.
  27. Jung SK, Jang HW, Kim HJ, et al. A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis. Ann Dermatol 2014; 26:184.
  28. Kao TH, Pan HC, Sun MH, et al. Upper thoracic sympathectomy for axillary osmidrosis or bromidrosis. J Clin Neurosci 2004; 11:719.
  29. Nasr MW, Jabbour SF, Haber RN, et al. Comparison of microwave ablation, botulinum toxin injection, and liposuction-curettage in the treatment of axillary hyperhidrosis: A systematic review. J Cosmet Laser Ther 2017; 19:36.