ASK DR. BAUGHAN                                             August 27, 1999

TO B.O. OR NOT TO B.O.

A reader asked, “What is the difference between antiperspirants and deodorants and the health effects of each?”

It has been a hot, sweaty summer.  In hot, humid conditions, we need to sweat to keep from getting heat stroke.  As I discussed recently, one reason the elderly are more prone to suffer from the heat is that their sweat glands may not work as well as they used to.  If we do not remain well hydrated to have sweat to produce, we are more likely to get heat prostration.  Some people are born without sweat glands.  They have great difficulty regulating their body temperatures.  So for heat regulation, sweat is natural and necessary.

Our culture, though, has the Victorian remnants that disapproves of moisture in armpits.  In the past 20 years, sweat on the face and chest when exercising can be sold as sexy, but sweat under the armpits is still un-cool.  So there is a huge industry to stop perspiration under armpits.  The ingredient in almost all “anti-perspirants” that influences sweat production is aluminum.  Sticks, sprays, wipes all contain aluminum.  Antiperspirants for men, antiperspirants for women - all contain aluminum.  “Extra-strength” means higher concentrations of aluminum.  Like all metals on the skin, some people get a skin irritation and some get an outright allergic reaction to aluminum.  If you use a spray, you are breathing aluminum (as well as butane, the same ingredient in cigarette lighters) and can have cough and wheezing from it.  We do not know the long-term effects of inhaling aluminum.

Although I am leery of mass social use of aluminum for a non-illness, there are some people who are generally miserable because of excess sweating called hyperhidrosis.  Even in cool weather, their hands and feet drip with perspiration.  They fill cupfuls.  Their skin gets soft and cracked if they do not change socks multiple times a day.  Shaking hands with them is shaking hands with a dripping washcloth.  Treatment of hyperhidrosis is difficult.  A 20% aluminum product called Drysol requires a prescription.  The higher the concentration of aluminum, the greater the chance of skin irritation.  Products that deliver low currents of electricity to hands, feet or armpits in a technique called iontophoresis work pretty well but take time and tolerance.  The latest hype on the Internet is laparoscopic sympathectomy, a surgical procedure where the nerve to the sweat glands is cut.  It works for some, not for all, and can have some other long term side effects.

Body odor is another story.  Tolerance of smells is very different from culture to culture.  White Americans have generally been conditioned to approve only of body smells that come from bottles.  Odors considered offensive are usually a combination of oils that the body produces and the odors produced by the bacteria and yeasts that live on our body.  Bacteria and yeasts and fungi thrive in areas where it is warm, moist, dark, and oily - armpits, skin folds, feet and groin.  We cannot fully eradicate them with antibiotics.  We would only produce stronger bacteria.  Antiperspirants do nothing about body oils.  So deodorants either compromise the living conditions for the microbes by absorbing moisture and odors or by covering them up with another more acceptable smell.  They may include glycols or glycerols that help the product slide smoothly and may soothe some of the irritation of the aluminum.  They may contain aloe or other herbs for soothing, and they may alter the environment so bacteria and yeasts proliferate less.  Any fragrance, natural or not, may cause a skin irritation as well.

The healthiest approach to odor management is probably bathing.  I am reminded of the rapid approach to bathing in the old washtubs of Appalachia.  Stand up, quickly wash down as far as Possible, rinse, quickly wash up as far as Possible, rinse, then wash Possible.  Since most body odor comes from Pits and Possible, if we regularly wash Pits and Possible, we should smell OK.