What are the other Names for this Condition? (Also known as/Synonyms)

• Trichobacteriosis
• Trichomycosis Axillaris
• Trichomycosis Pubis

What is Trichomycosis? (Definition/Background Information)

• Trichomycosis is a mild bacterial skin infection that mostly affects the hair on the underarms (axilla), or sometimes, the pubis. Thus, it is also known as Trichomycosis Axillaris or Trichomycosis Pubis respectively
• Corynebacterium species of bacteria are commonly associated with the onset of Trichomycosis, which presents smelly and sweaty underarms. The infection is mild in most cases, and hence, usually goes undiagnosed
• Trichomycosis infection is treated using topical antibiotic therapy combined with good body hygiene (including hair removal from the underarms and use of antiperspirants). With suitable treatment, the prognosis of the condition is excellent

Who gets Trichomycosis? (Age and Sex Distribution)

• Trichomycosis may affect both children and adults
• Both males and females are affected
• Worldwide, there is no racial or ethnic preference observed. The infection is more commonly observed in tropical and temperate climates

What are the Risk Factors for Trichomycosis? (Predisposing Factors)

The risk factors for Trichomycosis may include:

• Crowding of people in small spaces
• Individuals who are overweight or obese
• Individuals who sweat excessively (hyperhidrosis), especially at the armpits
• Lack of proper body hygiene
• Wetness or humidity

Individuals who frequently clipper or shave their armpit and pubic hair are at a lower risk for Trichomycosis.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Trichomycosis? (Etiology)

Trichomycosis is an infection that is the result of bacterial overgrowth due to certain favorable factors such as warmth and moistness of skin. In most individuals, the underarm hair is affected; in some cases, the hair on the pubic (anogenital) region is affected. Despite the name including “-mycosis”, this is not a yeast or fungal condition.

The following pathogens have been implicated:

• Corynebacterium species that include:
  • C. flavescens
  • C. propinguum
  • C. tenuis
• Serratia marcescens

Trichomycosis is not a contagious infection that can be transmitted from one individual to another.

What are the Signs and Symptoms of Trichomycosis?

The signs and symptoms of Trichomycosis may be asymptomatic-to-mild in some individuals. In such cases, no significant presentations are noted. In others, the following signs and symptoms may be observed:

• Foul smelling armpits
• Irritation and discomfort in some cases
• Sweat may stain clothing; it may be yellow in color. Rarely, it can be red or black too
• Presence of tiny hard and solid masses around the hair shafts (called concretions); these hard masses are between 1 to 2 mm in size
• The concretions may take on the color of sweat; most are yellow
• In some, hair loss at the affected regions may be noted

In a majority, the armpit hair is involved causing Trichomycosis Axillaris. In some, the pubic hair (causing Trichomycosis Pubis), and rarely in others, the hair between the buttocks may also be affected. The infection may involve more than one site.

How is Trichomycosis Diagnosed?

The following tests and exams may be used to diagnose Trichomycosis:

• Physical examination and a complete medical history; in many cases, the dermatologist may diagnose the condition clinically (through a visual examination and assessment of signs and symptoms)
• Bacterial culture, if needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Potassium hydroxide (KOH) preparation: Microscopic observation of a sample for structures belonging to the bacteria
• Skin biopsy, if required: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis may be undertaken to exclude other skin conditions that present similar signs and symptoms. These may include:

• Pediculosis
• Trichosporon aselie infection

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Trichomycosis?

In a majority, Trichomycosis does not cause any significant complication. In some cases, the possible complications include:

• Emotional stress and embarrassment from sweaty and smelly underarms
• Recurrence of the infection

How is Trichomycosis Treated?

The treatment measures available for Trichomycosis include:

• Topical antibiotic therapy, which may include clindamycin, erythromycin, econazole, or clotrimazole
• Hair removal from the armpits and pubic region
• Maintaining proper body hygiene, such as by showering or bathing regularly, using antibacterial soap and water
• Use of suitable antiperspirants and deodorants
• Applying baby powder or talc-free powder on the underarms and groin region
• Wearing clean and dry/pressed clothes

How can Trichomycosis be Prevented?

Trichomycosis may be prevented by considering the following measures:

• Maintaining good personal and body hygiene
• Keeping armpits clean and clipped/shaved of hair, to decrease one’s risk for Trichomycosis
• Decrease sweating through the use of aluminum chloride antiperspirants
• Use of suitable antiseptics that contain benzoyl peroxide to prevent overgrowth of bacteria, if necessary

What is the Prognosis of Trichomycosis? (Outcomes/Resolutions)

The prognosis of Trichomycosis is typically excellent since it is a mild infection that resolves with appropriate topical antibiotics and good body hygiene.

Additional and Relevant Useful Information for Trichomycosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/