Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2023;13(1):e2023028 1 Various Colors of Presentation of Pseudochromhidrosis - A Case Series Priyadarshini Sahu1, Disha Chakraborty1, Surabhi Dayal1, Meenakshi Sachdeva1 1 Department of Dermatology, Venereology and Leprosy, Pt B.D. Sharma, University of Health Sciences, Rohtak, Haryana, India Key words: pseudochromhidrosis, red, black, pink Citation: Sahu P, Chakraborty D, Dayal S, Sachdeva M. Various Colors of Presentation of Pseudochromhidrosis - A Case Series. Dermatol Pract Concept. 2023;13(1):e2023028. DOI: https://doi.org/10.5826/dpc.1301a28 Accepted: June 8, 2022; Published: January 2023 Copyright: ©2023 Sahu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Priyadarshini Sahu, Department of Dermatology, Venereology and Leprosy, Pt. B. D. Sharma, University of Health Sciences, Rohtak, Haryana, India. Pin-124001 Tel: +91-9416536159 E-mail: priyadarshini.sahu.9@gmail.com Introduction Colored sweat is a sporadic disorder, which can be due to apocrine, true eccrine and pseudo-ecrrine chromhidrosis [1]. Pseudo-chromhidrosis is characterized by excretion of nor- mal colorless sweat, which becomes colored following contact with products of chromogenic microbial or extrinsic chem- icals on the skin surface [2]. There are very few case reports of pseudo-chromhidrosis [1-4]. Hereby, we present three sporadic case of red, black and pink pseudo-chromhidrosis. Case Presentation Case 1. An apparently healthy 10-year-old female presented with reddish discoloration of both palms for last 7 days. Her brother was also suffering from the similar complaint. Clinical examination revealed palmar creases with reddish secretion (Figure 1). Skin biopsy was negative for lipofuscin granules around eccrine orifices which ruled out apocrine chromhidro- sis. Clinical diagnosis of pseudo-chromhidrosis was made. Case 2. A 7-year-old boy presented with progressive darkening of both the palms since last 5 days. Skin bi- opsy was performed which supported the diagnosis of pseudo-chromhidrosis. Case 3. A 36-year-old female, known case of rheuma- toid arthritis presented with 10 days history of pink dis- coloration of both palms which aggravated with exertion. She did not give consent for biopsy. Clinical diagnosis of pseudo-chromhidrosis was made. In all the three cases, color fade on rubbing with ab- solute alcohol. All patients denied intake of food, vitamin supplements, use of cosmetics or dyes that could have caused such discoloration. There was no specific odor or bleeding from any site. Psychological assessment was nor- mal and family history was insignificant for all patients. Routine biochemical tests, gram staining, fungal scrapping and staining revealed no abnormality. All patients were prescribed oral erythromycin and topical clindamycin which resulted in complete relief with no recurrence for all patients. 2 Research Letter | Dermatol Pract Concept. 2023;13(1):e2023028 Figure 1. Pre-treatment and post-treatment photographs of patients of red pseudo-chromhidrosis. Figure 2. Pre-treatment and post-treatment photographs of patients of pink pseudo-chromhidrosis. Conclusions Chromhidrosis, ie colored sweat can be produced by eccrine and apocrine glands. Eccrine chromhidrosis due to intrinsic factors is known as true eccrine chromhidrosis and second- ary to extrinsic factors is known as pseudo-chromhidrosis. In pseudo-chromhidrosis, sweat produced is colorless but it becomes colored because of chromogen, which include chro- mogenic bacteria, chemicals, paints, dyes and self-tanning products [2]. Apocrine chromhidrosis is due to presence of increased amount of lipofuscin granules in apocrine glands and their excretion in sweat produces colored sweat [5]. While the di- agnosis of eccrine chromhidrosis depends on detailed patient history and exclusion of ingestion of pigments, diagnosis of pseudo-chromhidrosis is based on exclusion of chromhidrosis and successful treatment with antibiotics or antiseptic scrub in this case. Thus, it is very important to distinguish between apocrine or eccrine chromhidrosis and pseudo-chromhidrosis as there is difference in management with different types. Pseudo-chromhidrosis can be treated with topical or systemic antibiotics and cessation of offending agents. Although, pseudo-chromhidrosis does not constitute a health issue, it may cause psychological stress and social embarrassment. Thus, dermatologist must be aware of the various colors of chromhidrosis in order to determine its ac- tual cause as pseudo-chromhidrosis is easily treatable with antiseptic scrub, topical, systemic antibiotics [2]. On detail literature scan, red pseudo-chromhidrosis has never been reported on palms and pink pseudo-chromhidrois has been once been reported in the literature. References 1. Nair PA, Kota RK, Surti NK, Diwan NG, Gandhi SS. Yellow pseudochromhidrosis in a young female. Indian Dermatol On- line J. 2017;8(1):42-44. DOI: 10.4103/2229-5178.198778. PMID: 28217472. PMCID: PMC5297270. S4C Highlight AU: Figure 2 citation is missing in text. Kindly confirm. Research Letter | Dermatol Pract Concept. 2023;13(1):e2023028 3 2. Koley S, Mandal RK. Red and black pseudochromhidrosis. In- dian J Dermatol. 2016;61(4):454-457. DOI: 10.4103/0019 -5154.185733. PMID: 27512200. PMCID: PMC4966413. 3. LeFeber WP, Golitz LE. Green foot.   Pediatr Dermatol. 1984;2(1):38-40. DOI: 10.1111/j.1525-1470.1984.tb00439.x. PMID: 6438617. 4. Mapare A, Tapre V, Khandelwal A. Apocrine chromhidrosis over dorsum of foot. Journal of Dental and Medical Sciences. 2012;2(3):33-34. 5. Singal A, Thami GP. Red pseudochromhidrosis of the neck. Clin Exp Dermatol. 2004;29(5):548-549. DOI: 10.1111/j.1365 -2230.2004.01567.x. PMID: 15347348.