Apocrine chromhidrosis is a rare diagnosis that occurs due to colored sweat being secreted from the apocrine glands, which are located in the axillae, anogenital skin, and areolae and over the skin of the trunk, face, and scalp. We present the case of a 65-year-old woman who presented with a sudden onset of pink sweating affecting mainly her axillae but also her pelvis, causing staining of clothing and bed sheets. There was nil to note on examination and histology with immunostaining demonstrated focally prominent yellow-brown lipofuscin granules in the cytoplasm of the apocrine secretory cells confirming the diagnosis. The disease can have a significant psychosocial impact, and treatment remains challenging. Our case is unique because the red and pink coloring of sweat is less common in cases of apocrine chromhidrosis, which is often in favor of darker colored sweat, and the distribution involved the inguinal canal, which is also less often seen.

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Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by recurrent painful nodules, abscesses and sinus tracts in predominantly apocrine gland-bearing skin. Adalimumab is an antitumour necrosis factor biologic approved by the National Institute for Health and Care Excellence in June 2016 for the management of moderate-to-severe HS and is the only licensed biologic for HS. We conducted a retrospective review of patients attending our specialist HS service who were initiated on adalimumab. Demographics, Hurley stage, HS physician global assessment (HS-PGA), patient-reported psychosocial outcomes and reasons for treatment discontinuation were examined. The cohort comprised 57% females (53%). Seventy-four per cent of patients were overweight or obese (n = 80), with a mean weight of 90 kg. Seventy-eight per cent were current or ex-smokers (n = 83). Twelve per cent reported a positive family history of HS (n = 13). Patients had an average baseline Hurley score of 2.8, representing moderate-to-severe disease (Hurley stages 2–3) and a HS-PGA of 3.7 (3 = moderate and 4 = severe). Concomitant treatment with antibiotics and/or systemic therapy was required in 44% of patients (n = 48). Oral antibiotics (n = 30; 28%), Septrin® (n = 16; 15%) and acitretin (n = 10; 9%) were the three most commonly coprescribed medicines. Nineteen per cent of patients underwent a surgical procedure for HS during treatment. The average treatment duration of adalimumab was 22 months. Thirty-two per cent of patients discontinued. Reason(s) for discontinuation included primary failure (n = 13), side-effects (n = 12), malignancy (n = 3; lung adenocarcinoma, plasma cell myeloma, extramammary Paget disease), COVID-19 concerns (n = 3), loss to follow-up (n = 2), secondary failure (n = 2), personal stress (n = 1), serious infection (n = 1; tuberculosis) and pregnancy (n = 1). Statistically significant improvements in HS-PGA score at 16 weeks were demonstrated compared with baseline (3.7 vs. 2.8; P < 0.001). Hurley score remained stable at these timepoints. Disease-related quality of life (Dermatology Life Quality Index) also significantly improved from 18.35 at baseline (reflecting severe impact) to 12.4 at 16 weeks (P < 0.001). Statistically significant differences were also found for the following patient-reported outcomes at 16 weeks compared with baseline (rated out of 100): severity (67 vs. 52; P < 0.013), odour (59 vs. 49; P = 0.008), discharge (64 vs. 46; P < 0.001), pain (65 vs. 46; P < 0.001) and fatigue (66 vs. 54; P = 0.006). Paired t-tests were used for all statistical analyses. In summary, adalimumab is an effective treatment for moderate-to-severe HS leading to clinical improvement in the HS-PGA scale and patient-reported outcomes. One-third of patients discontinued treatment due to a lack of response or side-effects. Adalimumab is often used in combination with other systemic therapies and surgery, reflecting the challenges of HS management.