If a bad smell seems to follow you even in air-conditioned rooms (leave alone after a long run), you might have something to worry about.

Many people who suffer from bad body odour are too embarrassed to talk about it or seek help, and some may not even be aware of their condition. In this article, Dr Nazirin Ariffin, Consultant Dermatologist at Nazirin Skin Clinic and Pantai Hospital Kuala Lumpur, enlightens us about this medical condition.

What is body odour?

Body odour is normal, and mainly caused by bacteria breaking down sweat, sebum and keratin on the skin’s surface. Everyone has their own unique odour, and it is usually harmless. However, a sudden change in one’s body odour could be an indication of a health issue.

What causes unpleasant body?                                   

Unpleasant or foul-smelling body odour is known as bromhidrosis. It is more common in adults than in children, as the sebaceous and apocrine sweat glands start to become more active at puberty. Sebaceous glands are found over the entire surface of the body except the palms, soles, and dorsum of the feet (area facing upwards when standing), while apocrine glands are found mainly in the axillae (underarm area), genital region, aereola and eyelids.

Contrary to popular belief, sweat on its own does not cause bromhidrosis, as human sweat is virtually odourless. However, when bacteria break down the keratin protein and fat in the sweat, a foul smell can emerge.

Bromhidrosis can be caused by many reasons including poor hygiene and bacterial infections such as erythrasma (which affects skin folds under the arms, in the groin and between the toes), pitted keratolysis on the feet and trichomycosis on the armpits and genital areas.

Certain odour-inducing foods such as garlic, onion, some medications, and curry – especially those that contain spices such as cumin – can also cause body odour to be unpleasant.

Dr Nazirin Ariffin, Consultant Dermatologist at Nazirin Skin Clinic  and Pantai Hospital Kuala Lumpur

What are some reasons for sudden change in body odour?

Some people find that sweat produced after exercise or in a hot environment doesn’t smell, but when they are stressed, their sweat becomes foul-smelling. This is because the sweat during exercise is produced by eccrine glands, but when we are stressed, it is our apocrine glands that actively produce sweat.

Compared to sweat from the eccrine glands, which is mostly water, sweat composition in the apocrine glands have a higher concentration of fat and proteins. When bacteria break down these proteins and fat, the odour becomes more prominent.

Your body odour can also change due to a change in diet, a change in the bacteria colonies on the skin, or if there is infection caused by bacteria or fungi. Sometimes, a change in body odour can indicate underlying medical issues like obesity, diabetes, liver disease, kidney disease and some metabolic disorders.

What medical conditions can cause unpleasant body odour?

  1. Liver disease: Patients with liver disease can suffer from excessive sweating and foul-smelling body odour akin to rotten eggs due to the accumulation of sulphur in the body. They can also have fetor hepaticus; breath with a strong musty smell.
  2. Kidney disease: Those who suffer from kidney disease tend to have bad breath, known as uraemic fetor. Since sick or damaged kidneys are not able to effectively dispose of the urea in the body, the urea is removed through the breath.
  3. Diabetic ketoacidosis: patients with diabetes can have fruity-smelling breath and a pungent body odour.
  4. Genetic metabolic disorders: Disorders like phenylketonuria cause defects in the enzyme needed to break down high-protein foods, leading to neurological, intellectual and behavioural problems, plus a musty-smelling breath. Another disorder, trimethylaminuria also causes an unpleasant fishy odour due to the build-up of trimethylamine, which is excreted from the body through sweat, urine, and breath.

How can one minimise or manage unpleasant body odour?

Assuming the body odour is not caused by any underlying medical condition, we can manage or minimise it by practising good hygiene, which includes regular showers using soaps and cleansers, regular changing and washing of clothes in particular undergarments, as well as using deodorants and antiperspirants with aluminium chloride.

Putting on an antiperspirant at bedtime gives the product a better chance to work while you are asleep and not sweating. Keep your underarms dry as bacteria have a hard time breeding in clean and dry areas. Regular shaving or removal of facial and body hair can also help prevent the accumulation of bacteria and can reduce sweat and odour. And finally, avoid consuming too much odour-inducing foods.

What are some treatments for severe body odour?

In more severe cases I would recommend:

  1. A solution of hydrogen peroxide and water to destroy some of the bacteria that create odour. Dilute 1 teaspoon of hydrogen peroxide (3%) to 1 cup (approximately 236ml) of water, and wipe onto affected areas like underarms, feet and groin with a washcloth. It is essential for the hydrogen peroxide to be diluted properly so it does not irritate skin.
  2. Antiseptics or antimicrobials such as octanedione and benzoyl peroxide wash to reduce bacterial colonisation. Effective topical antibiotic creams include clindamycin and fucidic acid. Clotrimazole powder and miconazole cream can also help.
  3. Oral antibiotics such as erythromycin in severe cases of erythrasma (a bacterial infection in the folds of the skin).
  4. Treatments using botulinum toxins and iontophoresis for severe hyperhidrosis or abnormally excessive sweating. Iontophoresis is a process where a medical device uses mild electrical currents to deliver medication across biological membranes, often while the affected body part is submerged in water.
  5. Removal of apocrine glands via a sympathectomy, which is a procedure to cut or block a nerve in your body
  6. Dietary modification for metabolic disorders.

Body odour is usually harmless. However, if it there is a sudden change to your usual body odour, or if you start receiving complaints from those close to you about strong odour despite practising good hygiene, using antiperspirants or deodorants, and avoiding aggravating factors like odour-causing food, you should consult your doctor or a dermatologist.

Feature photo by Dreamstime.
Dr Nazirin’s photo courtesy of Dr Nazirin Ariffin