Sweating It: Understanding Kids, Armpits, and Body Odor

Commonly, the armpit, or axilla as it is known in medical circles, is considered to be icky, sort of the New Jersey of the human body.  I find this an unfair characterization on two levels. First, I am an NJ native, and can testify to the quirky beauty of that state’s non-Turnpikey landscape. Second, to behold the armpit is a rare but worthwhile exercise.  It is a zip code of poorly understood secrets, unfair laments, and potentially, a telling barometer of the health or lifestyle of an adult or child.  Let us clear the air of any noisome myths and take a look.

The armpit (aka oxter in the United Kingdom) houses what is known as the axillary fossa, or compartment of the underarm made by the chest wall, the deep chest muscles on the front, and the insertion of the scapular muscles of the shoulder at the back. The drape of the arm, between the underarm and the big wide world, gives the armpit its unique, pockety microenvironment, allowing it to retain moisture. Evolution and  the development of the structures within the armpit–and how they interplay with (im)maturing individuals have at times, well, conspired to make a big stink.

The Anatomy: Who Knew?

Inside the sling of soft tissue at the bottom of the armpit lies a network of vessels and nerves that power and supply the upper extremity. A system of lymph vessels whose glands protect the arm from injury and infection occasionally draw our attention when they become inflamed or swollen.  As any annoying uncle knows, ample innervation to the axilla makes it exquisitely sensitive and prone to ticklishness. And the rotator cuff joint of the shoulder, just upstairs, allows the remarkable range of motion of our upper extremity, from scratching that spot on our midback toposing downward dog for a yoga class.

While all that may be very interesting, it is the dermatologic apparati of the armpit that make it so very unique, and controversial.  From birth, a human’s skin has two types of secretory glands. Eccrine glands are found over most of the the body, with the exception of the lips, nail beds, particular parts of the genitalia, external ear canal (in case you were looking somewhere else to apply that roll-on).  Eccrines sweat a clear, slightly salty solution to prevent overheating.

Apocrine glands are similar, but different. They are found in the underarms, in the anal and genital areas, and have specialized versions in our ears (to produce wax), and in the breasts of women (where they lactate).  Apocrines produce a cloudy, odorous fluid that contributes mightily to the stench associated with heavy perspiration when decomposed by bacteria on our skin.

The axillary apocrine glands do not function until the exposed to certain hormones, which usually start to appear in children somewhere between 9 and 15 years old. Interestingly, and sometimes tenderly, my observation in clinic of a child’s malodorous ripeness may be the parents’ first realization that their son or daughter is at the beginning of the beginning of puberty.  More on that below.

Armpit hair arrives differently in boys and in girls. Generally, girls will note the growth of axillary hair at about the same time they note they are developing pubic hair. By contrast, most boys will note their pits don’t get furry til about 2 years after they notice their pubic hair. Just about all teens will have some armpit hair by the time they are 17. If high schoolers are coming up on that birthday and are lacking hair, or other signs of pubescence, it may merit some evaluation for a delayed puberty.  Conversely, the appearance of excessive body odor or armpit hair below 8 years of age (along with pubic hair, or breast growth) may suggest a case of early, “precocious” puberty. I’d suggest a trip to the clinic to assess and evaluate, if concerned.

The role of armpit hair isn’t so clear. Does it ‘wick away’ moisture as one perspires? Perhaps. Are there varying cultural norms and differing attitudes about whether to leave it be or to shave it off? You’d better believe it. Do I have a medical opinion about when/if girls should shave? I leave that decision to a family, but do advise them to supervise the axillary hair trimming the first few times,  so that it takes place safely, and without injury.

Ooh that smell.

In a large number of the families I serve, the household is abundantly aware of the rising tween’s blossoming body odor before he is. It can get rank, believe me!  Developmentally, most 10 or 11 year old have not developed fastidious hygiene, and the old formula of a shower per week isn’t cutting it. This can make for quite the battle around the kitchen table as parents gasp for air, and while working to update their son or daughter’s self-care skills before it becomes a social embarrassment. Generally, I’ll advise parents to address this issue diplomatically, but straight on.

For starters, most kids can manage their body odor by stepping up to a daily shower schedule. I’ll suggest parents review with their kids where and how they clean, emphasizing the need to soap and cleanse under their arms especially. Other lifestyle changes help, too, including changing into clean (cotton!) clothes daily and avoiding foods that can lend a sour, strong tang to body odor, such as garlic, onions, and other spicy dishes.  Some kids may need to ratchet up the odor control a level as they move into adolescence; they sweat more, and become ever more fragrant.

For tweens and young teens, parents looking to the next step in scent control should first consider a deodorant. I find it appropriate and helpful to engage a child in the process:  picking a brand or fragrance of their choosing increases the likelihood of their compliance and minimizes the likelihood of another round of “aww, mom!”  (Minimizes, only. This is pediatric advice, not magic).    If the deodorant doesn’t seem to be enough, it may be time to apply an antiperspirant. While these products are generally regarded as safe in the marketplace, they contain ingredients that have drawn smoldering concern in some quarters.

For example, some users of deodorants may develop a skin reaction to deodorants containing propylene glycol. This may be especially true for young women who apply these products immediately after shaving. Following my research for this article, I’ll counsel parents to eschew products containing parabens, which has been identified as potentially increasing the risk of breast cancer.

Anti-perspirants appear to block sweat glands by the action of aluminum salt compounds. Certainly, young athletes should apply these products ONLY where they were intended: the underarm areas. I have seen self-consciously sweaty kids come into the ER having applied spray over their chest and back, and had overheated because of it.  It wasn’t pretty; be aware.

The impact of using an antiperspirant aluminum salts over months and years hasn’t been entirely established.  Unfortunately, labelling on  these products  can be as confusing as it is helpful.    Fortunately, families can find alternative approaches online .  Witch hazel, baking soda, lavender oil?  Maybe so, but:  I still urge parents to consult with their doctor regarding the their choices, to ensure against interactions with other treatments or conditions.

All in all, the lowly armpit and it’s odors present a challenge that most kids can overcome. Reports from the field do confirm what the teaching tells us, tweens and teens can achieve a reasonable, if not neutral fragrance. Thusly illuminated, they will no doubt discover the other uses for the axilla, as when used as an alternative site for taking a temperature, warming cold hands on a cold day, or even, armpit farting their way through the Star Spangled Banner.

And, hey, it could be worse. In the rarest of cases, there are individuals with pathologic armpit issues. Ponder the following:

Hyperhidrosis, or excessive sweating. Individuals with this malady often find anti-perspirants inffective, and may consider a variety of treatments, including botox injections to the armpit, laser therapy, electrolysis or surgery.

Bromhidrosis may be an unpleasant association with hyperhidrosis, and constitutes room-clearing, excessive body odor.   These unhappy people may suffer uncommon diagnoses such as odor of cat syndrome, fish odor syndrome (trimethylaminuria), or other metabolic disorders. Historic textbooks, of note, also note peculiar and foul body smells associated with scurvy, gout, and even schizophrenia.  Foreign bodies lodged in the nose, such as a bead, have been reported to cause this problem in children.

And, lastly, there’s chromhidrosis, or ‘color sweat.’ Sufferers of this condition produce an overabundance of garment-staining lipofuscin, an odorless secretion that can oxidize in perspiration to a variety of hues, including yellow, green, blue, brown or black. There’s no cure for this, but having a good dry cleaner helps.

And so, keeping an axilla clean and tidy should avoid most problems, and can be a starting point as families encourage rising tweens and teens to take charge of their hygiene and grooming. It sounds easier than it is, right? Raise your hand if you’re sure!

Photo above by dhmetal

Cartoon below by me.