Bromidrosiphobia

It's not a big deal, you tell yourself. It's just a little problem that kinda bugs or embarrasses you. Nothing you'd spend good money talking to a doctor about, right?

Well, we're not afraid to ask the tough questions. So we did, and darned if we didn't discover that medical science does have something to say about smelly feet, stretch marks, and other minor medical maladies.

Bad dogs. When sweat is allowed to evaporate, there is no smell. It is stagnant sweat that allows skin bacteria to produce foul, eye-watering odor. That's what is happening when feet become, shall we say, excessively aromatic. (Fungus, which causes athlete's foot, is also a factor.)

"Smelly feet can be a problem with avid boot wearers," says Joseph P. Bark, M.D., a dermatologist in Lexington, Kentucky. "Someone buys $500 alligator boots and won't wear anything else. He comes in, takes off his boots, and I have to leave the room. His feet smell like a dead goat." Changing shoes on occasion would allow the boots to dry out and would eliminate most of the odor.

Keeping feet dry also reduces odor production. Wear cotton socks, which absorb sweat, and change them midday. Nylons are bad because they trap perspiration. Wear well-ventilated shoes with a wide toe box. Sandals are even better. Change shoes daily and use several pairs. Children develop smelly feet because they typically wear one pair of athletic shoes all day, every day, in all kinds of mucky conditions.

Treat smelly feet with powders, antiperspirants, topical antibiotics, fungicides, antibacterial soaps, and Drysol, a powerful drying agent applied at bedtime. And remember to wash. People either forget the feet or don't bend down to wash and dry them as they do other parts of the body, says Dan Fick, M.D., assistant professor in the Departments of Family Practice and Orthopaedic Surgery at the University of Iowa College of Medicine.

One cautionary note: Sometimes, dear reader, the fault lies not in your feet, but in your heads. There is a condition called bromidrosiphobia--an unreasonable fear of foul-smelling sweat. "I had one patient who believed she lost her job because her feet smelled," says Diana Bihova, M.D., clinical assistant professor of dermatology at the New York University School of Medicine. "She wouldn't leave the house because of it. She went from dermatologist to dermatologist absolutely convinced the smell was overwhelming and no one could be next to her. I couldn't smell a thing, but this did not satisfy her. She asked to be referred to a surgeon to have the sweat glands on her feet removed. (Interestingly, this is a procedure than can be performed on underarm areas, though not on feet.)

"This is a rare case, but it shows that smelly feet can be a psychiatric rather than a dermatologic problem," says Bihova.

Ring around the ear. "For me, tinnitus is one of the most frustrating things to treat," says Fick. "A trillion things can cause it."

Well, not quite. However, inner ear infections, earwax, noise pollution, hardening of ear blood vessels, cysts, tumors, and arthritis medications can cause tinnitus (TIN a tiss), a constant ear ringing or buzzing. One of the most common causes is taking large doses of aspirin over a long period. Fatigue, depression, and high blood pressure are also associated with tinnitus.

Tinnitus affects 20 percent of the general population and 30 percent over age 65. In most cases tinnitus is "a nuisance, but not medically dangerous," says Edwin Monsell, M.D., Ph.D., head of the Division of Otology and Neurotology at Henry Ford Hospital in Detroit.

If the cause of tinnitus is unclear (as is often the case), then "there is no good treatment," says Monsell. Antianxiety or antidepressant drugs may help, but most people try to mask the ringing with a radio, a TV, or a tape player set on low.

Once in a while, what appears to be tinnitus is easily cured. Fick had a patient whose tinnitus was just the humming of fluorescent lights. And Black had a patient whose ear buzzing was from, "believe it or not, a flea stuck in the earwax," she says.

Stretch marks the spot. Although associated most closely with pregnancy, stretch marks appear on arms, shoulders, hips, bellies, and breasts. Sudden weight gains are the culprits, says Bark. These changes cause elastin fibers in the skin to tear, producing red marks that fade with time but never disappear completely.

Stretch marks run in families, typically affecting pubescent girls and pregnant women. However, men who gain weight fast can get stretch marks too, especially men who pump up their chests with weight lifting.

Creams and vitamin E ointments won't remove or prevent stretch marks. Plastic surgery and skin abradings work but are considered radical treatments. Retin-A, an anti-wrinkling prescription cream, has had spotty success with stretch marks, says Bark, author of Retin-A and Other Youth Miracles (Prima Press, 1989, $8.95). Women who are pregnant or breast-feeding should not use Retin-A.

One success story: "A woman in our office took a ballet class and developed stretch marks on her thighs because of the high kicks," says Bihova. "She used Retin-A cream twice a day, and the stretch marks cleared up in two months."

Hair apparent. Excessive hairiness is usually nothing more than an unpleasant inheritance. Any family can pass along the trait, though unwanted hair is more common among women of Mediterranean and tropical descent than those of northern European ancestry, says Susan Black, M.D., a family physician in private practice in Lowell, Mass., and a member of the Board of Directors, American Academy of Family Physicians.

Temporary treatments for run-of-the-mill hairiness include shaving, bleaching, plucking, clipping, depilatory creams, and waxing (applying hot wax to an area, letting it cool, then removing wax and embedded hairs). Electrolysis is usually permanent and involves inserting fine needles into hair follicles. Heat or electricity conducted through the needles destroys the follicle. (To guard against infection, be sure the technician uses only sterilized needles.)

Hirsutism, the excessive growth of hair or the presence of hair in unusual places, isn't always benign, however. Unusual amounts of hair on the upper lip, chin, cheeks, eyebrows, breasts, or bikini area may signal adrenal or ovarian tumors or perhaps hormonal problems (lack of estrogen, steroid abuse, infertility) in premenopausal women. Women who might fall into these categories need to see a doctor. A few drugs can also encourage hair growth. Make sure your doctor knows all the medications you are taking.

What about men? "You seldom find males who complain of too much hair," says Bark, "but some men have hairy, |gorilla backs' and get embarrassed at the beach." Because men are the naturally hairier sex, their situation isn't thought of as hirsutism by the medical profession. The only safe permanent "cure" for excess hair in men is electrolysis.

Fat attack. Doctors consider cellulite a cosmetic, not medical, problem. Cellulite is lumpy fat found in the thighs, hips, and buttocks of some women. It takes on a dimply, "cottage cheese" appearance because of age- and gene-related changes in tissue surrounding fat cells.

Liposuction is not always a good treatment; it removes fat, but the lumpy look can remain, says Bihova. Diet and exercise can help. "Whenever I see a dancer or someone with a well-toned body, there is usually no cellulite," says Bihova.

Losing weight may mean losing the cellulite eventually, but keep in mind you cannot spot-reduce. Weight loss means depleting tat stores from all over the body, says Fick, including interior fat you don't see.

Ultimately, one of the best things most women can do is accept cellulite, and themselves. "Have a self-image that says cellulite is a normal function of aging skin," she says. "Constantly fighting it can be fruitless."

Black-and-blue blues. "A patient came to me in a panic because she couldn't figure out why she kept bruising her lower forearm," says Bihova. "I noticed she wore heavy bangles, which caused the bruises."

Many folks bruise easily. "I bet I'm asked two or three times a week about this," says Robert N. Richards, M.D., a dermatologist in private practice and a lecturer at the University of Toronto. This bruising may be related, rarely, to a blood-clotting problem, liver disease, rarely, to a blood-clotting problem, liver disease, leukemia, or malnutrition. A medical checkup can detect these problems.

For many people, bruising easily is a harmless artifact of aging. Skin gets thinner as it loses fat and the natural network of collagen, says Bihova. Less fat means less protection. At the same time, blood vessel walls become less elastic, which contributes to bruising.

Canker sore spots. Not much you can do with these tormenting tongue and mouth ulcers except grin and bear ,em. But who wants to grin? Canker sores affect eating (salty or acidic foods bring you to your knees) and make socializing a problem. "Canker sores can ruin a date," says Richards. "You have trouble talking before dinner, trouble eating, and you don't feel like kissing afterward because the mouth is too sore."

Canker sores, which last five to 10 days, are not caused by bacteria or viruses and cannot be spread with a kiss. They are a puzzle to doctors, who think a change in the immune system during stress or trauma causes them.

Canker sores have no cure. Treatment is relieving discomfort and guarding against infection. Your doctor may prescribe topical corticosteroids, which help heal skin beneath the sore. Doctors also are experimenting with stomach ulcer treatments for canker sores, says Jack L. Lesher Jr., M.D., associate professor of dermatology at the Medical College of Georgia in Augusta.

By the way, canker sores are different from cold sores (fever blisters). Cold sores are fluid-filled lip sores activated by stress, fever, hormonal changes, and sunlight. The herpes simplex virus causes cold sores, which heal in seven to 10 days. Until healing is complete, cold sores can spread to the eyes and genitalia of you and others.

Stand up and be dizzy. After stooping a while in the garden, you stand quickly and get dizzy. Why? Blood has pooled in the arms and legs, and your nervous and circulatory systems cannot adjust quickly enough to prevent a blood pressure drop and shortage of oxygen to the brain. Doctors call this orthostatic hypotension.

This form of dizziness is normal and common, but it's still a good idea to mention it to your doctor. He or she can rule out a serious problem such as heart disease and perhaps adjust the dosage of medications you are taking. The wrong dosage of antidepressant or blood pressure drugs can cause orthostatic hypotension.

You can help yourself with orthostatic hypotension by squatting, not stooping. "And when the phone rings while you are sitting, take your time," says Maryville, Mo., physician Patrick Harr. "You don't have to answer it on the first ring.

COPYRIGHT 1994 Meredith Corporation