Sports and Fitness

Bromhidrosis – Bad Body Odour

/ Subash Rau / Leave a comment

Bromhidrosis refers to excessive foul smelling sweat. Other synonyms include Osmidrosis and Ozochrotia. It is diagnosed when noticeable body odour has a negative effect on an individuals self view, social interactions and Quality of Life.

2 types of Sweat glands are seen
Apocrine – It develops at puberty and usually disappears in the elderly. It usually affects axilla, anogenital (perinatal) areas and the breasts. The primary role of Apocrine glands is to secrete Pheromones.

Eccrine glands are distributed all over the body especially over the palms and soles.They are not found in the External Auditory Canal, Lips, Clitoris, Labia minora and Glans penis. Eccrine glands are primarily responsible for thermoregulation and secrete water based secretions. Eccrine Bromhidrosis can occur at any age and can be localised or generalised.

Pathogenesis of Body odour
Sweat is usually odourless and its secretion is controlled by the sympathetic nervous system. Heat, exercise, emotion, certain foods and medicines stimulate its secretion.

Apocrine glands secrete odoriferous fatty acids bound to odour binding proteins. Bacterial action releases odour causing fatty acids leading to the malodour. A variety of bacteria such as Corynebacterium, Staphylococcus, Cutibacterium (previously called Propionobacterium) and Sphinogomonas act on the apocrine secretions and produce odour. Pheromones such as Androsterone and Androsterol are also malodorous. Poor hygiene especially in diabetics and obese individuals cause odour especially with skin conditions such as Erythrasma, Intertrigo and Trichomycosis axillari.

Eccrine Bromhidrosis: Sweating leads to maceration of skin and secondary bacterial growth and skin degradation. Eccrine bromhidrosis can occur due to:
Diet – garlic, onion, curry and alcohol
Medication – Penicillins and bromides
Toxins – heavy metals
Metabolic causes – Phenylketonuria, Trimethylaminuria, Isovaline acidaemia, Hypermethioninemia.
Systemic diseases– Liver and Renal failure, Gout, Scurvy and Typhoid.

Diagnosis requires elicitation of a detailed history.
Usually Lab tests are unnecessary.

Treatment of Body Odour
1.Personal hygiene: to bathe regularly and daily but not excessively. Excess washing may cause skin irritation. Intertrigo, erythrasma need to be treated.
2.Clothing: wearing absorbent clothes/cotton clothes may help. Sweat soaked clothes need to be change immediately. Washed clothes need to be sun dried.
3.Exfoliation: to remove stratum corners may help.
Hair removal by shaving, chemical epilation, electrolysis and laser treatment may be helpful.
4.Antibiotics – applied topically may help. Topical Erythromycin and Clindamycin are commonly used. Prolonged continuous therapy may be needed.
Oral Roxithromycin 150 mg twice daily for 7-10 days may help.
5.Topical antiperspirants: Antiperspirant contain aluminium salts that plug sweat ducts and reduce seating.
6. Antifungal dusting powders may also be helpful.
7. Botulinum toxin Injection: Skin injections can temporarily reduce sweating.
8. For Refractory Localised Bromhidrosis- destruction of Apocrine glands is an option by surgical excision,Liposuction, microwave and Nd-YAG or CO2 laser can be helpful.
9. Thoracic sympathetectomy can be done with good results.

Treatment options for Axillary Hyperhidrosis (sweaty armpits)
1.Topical Antiperspirants (Aluminium containing gels) need to be applied nightly without occlusive wrappings. Topical Glycopyrrolate 2.4% can reduce sweating significantly.
2. Systemic agents – Anticholinergics- Glycopyrrolate can take up to a week for effect.
Clonidine 0.1 mg twice daily, Beta Blockers, Benzodiazepines will reduce sweating.
3. Iontophoresis
4. Microwave Thermolysis
5. Botulinum toxin injections can temporarily reduce sweating.
6. Surgery: Endoscopic thoracic sympathetectomy

Do more pushups and live LONGER?

/ Subash Rau / Leave a comment

A new article published in the Jama this year find a strong association between man’s capacity to do push ups with long term benefits in reducing Cardiovascular events and improving cardiovascular risk factors.

Cardio vascular disease is the term used to describe all diseases that affect the heart and blood vessels including Coronary Artery disease, Strokes, Transient Ischaemic attacks, Heart failure, Aortic disease, valvular heart disease and arrhythmias.

Physical inactivity and lack of exercise has long been recognised as an independent risk factor in development of heart disease, Cancer, Alzheimers disease and strokes. Assessing cardiorespiratory fitness and to correlate it with beneficial effect in the prevention of cardiovascular disease is often time consuming, expensive and requires the professional facilities in a hospital.

The authors of this paper have performed a nice study recruiting active fire man from the state of Indiana USA and following them up over a 10 yr period. The participants were 18 years and older. A detailed history was taken first (with regards to Healthy lifestyle, smoking and alcohol habits,marital status, family history of illnesses, education levels) they were then examined physically (height weight, blood pressure and resting heart rate were measured ) anthropometric measurements were taken and they were tested for their push up capacity and also a maximum exercise stress test was done with modified Bruce protocol.

For checking the push ups capacity a metronome was set to 80 beats per minute the, the staff doing the study counter the number of pushups until 80 was reached or more than 3 beats were missed or the participants stopped due to exhaustion or complaints of breathlessness dizziness or chest pain.

When they analysed the results they had 1562 who participated over a 10 year period. The cohort had a mean age of 39 and a mean BMI of 28. Information regarding the push-up capacity was available in 1104 participants.

They found that the Push ups capacity was inversely related to most baseline risk factors of coronary artery disease such as age, BMI, systolic and diastolic blood pressures, total cholesterol, triglycerides, LDL, glucose and smoking status. And it was positively associated with VO2 max values. During the period of follow up 37 cardiovascular disease related outcomes were noted. Participants who were able to complete 40 pushups had a 96% reduction in cardiovascular disease event compared to those who could complete 10 pushups or less only. Push ups capacity was noted to be associated with not only a reduction in the incidence of cardiovascular disease but also in the reduction in the risk factors for cardiovascular disease.

The authors conclude that assessing push up capacity is a low cost predictor for Cardiovascular disease risk in a middle age man and is a good measure of cardiorespiratory fitness and muscular strength.

Take Home lessons

1. Check out how many push ups you can do without a break.

2. If you can’t do 40, you would be well advised to start working on your fitness.