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A Bad Case of Bromhidrosis in a Teenage Girl

A Bad Case of Bromhidrosis in a Teenage Girl


  • A Bad Case of Bromhidrosis (aka, "Toelio") in a Teenage Girl

  • A 17-year-old girl is seen for extreme foot odor.

  • Patient history: Over the past 4-6 months, patient has noticed "holes" on the soles of her feet. The malodor has become progressively worse.

  • Patient history: Patient describes mild discomfort, some foot pain upon weight bearing. Reports no trauma.

  • Physical examination finds "holes" and plaque-like areas of ulceration.

  • Physical examination finds "holes" and plaque-like areas of ulceration.

  • Plaque-like ulcerations on the heel of left foot.

  • Pits and small ulcerations on the ball of the foot and great toe.

  • Physical examination: No callous formation found; no bruising, petechiae. Plantar surfaces are moist, malodorous.

  • Differential diagnosis: Basal cell nevus syndrome; circumscribed acral hypokeratosis; focal acral hyperkeratosis; keratolysis exfoliativa; tinea pedis; pitted keratolysis; plantar warts

  • Diagnosis: Pitted keratolysis.

  • Pitted keratolysis: Crateriform pitting on pressure-bearing aspects of plantar surface. Superficial cutaneous bacterial infection caused by Kytococcus sedentarius.

  • Pitted keratolysis: K. sedentarius produces keratin-degrading enzymes. Odor related to production of sulfur compound byproducts.

  • Pitted keratolysis: Treatment. Keep feet dry; use topical aluminum chloride hexahydrate, erythromycin; clindamycin for 3-4 weeks.

  • Pitted keratolysis: Treatment. Acne medication off-label--combination of clindamycin and benzoyl peroxide.

  • Pitted keratolysis: Resolution. 4-wk course of QD topical clindamycin and BID topical aluminum chloride solution.

A 17-year-old girl sees you after her mother threatens to fumigate the young woman's bedroom. The problem is foot odor that you can barely tolerate when you enter the exam room. There are physical clues to the underlying problem as well as the pungent air. Follow the case in the slides above.

What's in your differential? Your diagnosis? 

 

Comments

Thanks v instructive. Usfull

Claudia @

Corynibacterium

Peter @

Thank you for your comments and participation. I learned early as a resident that there are a plethora of instructive cases/stories that can and should be shared with each other. My mentor was and still is Dr. Andy Margelith (cat scratch disease fame). His enthusiasm for dermatology and teaching is well known to those of us in the military and to those who have been fortunate to hear him on the lecture circuit. Dr. Andy is in his mid 90's and still going strong. I think it important to recognize and thank those who have shared their experiences and by doing that, have made us better physicians. So, have a camera available in your practice and a stack of permission permits. It will revitalize your practice and you can provide a public service by sharing your cases.
Jon - PGY 42.5

Jonathan @

I have treated this successfully with a single application of clindamycin in an ionax solution.

Sam @

Bromhidrosis.

Sam @

athletes foot

Peter @

good information

Zarina @

good information

Zarina @

Great case! Thanks so much! Even Medscape and Epocrates apps have nothing on this.

Theresa @

I guessed right! But I bet this girl's feet were less stinky than those of a woman I saw when I was a medical student, at a clinic in Valdosta GA. This woman had seen a "root doctor" for her toenail fungus who recommended soaking her socks in crank case oil, that is, the stuff you get when you do an oil change, before putting them on. She had been compliant with this fellows prescription for several weeks but was concerned that the soles of her feet were rotting, and so sought a second opinion. At least the fungus, along with her toenails, was pretty much gone. Score one for alternative medicine!

Stephen @

I guessed right! But I bet this girl's feet were less stinky than those of a woman I saw when I was a medical student, at a clinic in Valdosta GA. This woman had seen a "root doctor" for her toenail fungus who recommended soaking her socks in crank case oil, that is, the stuff you get when you do an oil change, before putting them on. She had been compliant with this fellows prescription for several weeks but was concerned that the soles of her feet were rotting, and so sought a second opinion. At least the fungus, along with her toenails, was pretty much gone. Score one for alternative medicine!

Stephen @

fungal

kareem @

Note from author... Good detective work. I cannot tell you that our patient indicated true hyperhydrosis. She indicated that the pits and ulcerations seemed to occur first and her sneakers kept her feet on the "moist side." So, the lesions you see were her primary problem made worse by occlusive foot wear.
Jon
P.S. This was the worst case of smelly feet that I have ever experienced... Closing down the clinic for a few hours was not an option. My nurse and corpsman should have received a Purple Heart!

Jonathan @

Fyngus

Aster @

Fyngus

Aster @

f

April @

Hyperhidrosis

ROBERT @

hyperhidrosis & poor hygiene

ROBERT @

Hyperhidrosis

ROBERT @

Fantastic case!! Thanks for sharing.

Adele @

Bomhidrosis

moza @

Slide show not working.

Barbara @

Pitted keratolysis

mala @

Slideshow does not work properly. Please fix.

Robert @

Pseudomonas

Roberta @

dd

Catherine @

dd

Catherine @

pseudomonas

Anonymous @

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