What’s that smell – Part 2 Body odor as we mature

Many of my articles start when a patient catches me off guard with a question.  As a dermatologist, I learn new things every day.  The internet and social media really keep me on my toes because patients are learning new things every day online that may not be a hot topic for dermatologic education.  Here’s the question that started off this series of articles.

“I’m worried about old age smell and wonder if I should be using persimmon soap?”  Mind you this question came from a very well educated and well-groomed woman.  I encouraged her… you smell fine!  But in the back of my head, I wondered, where did she come up with this crazy idea? Turns out she was on to something, and I STILL have A LOT to learn.

So, I spent some time re-educating myself on the mechanism and science of body odor and her question in particular.  While I admittedly started out with Google, I did a deep dive into research on body odor, old age smell and persimmon soap.  Let’s start with some background knowledge.

If you missed the first article in this series, it is linked below.  You may want to read it first to get some background information. Below was my conclusion.

The most important thing for reducing odor is personal care more than a magical product.

Wash face and neck and folds at least once a day.

Wash body every other day minimum.

Wash hair at least twice a week.

Change clothes and undergarments daily.

Wash outer clothes after more than one wearing. Underwear should not be reworn. 

Wash towels and bedsheets once a week.

For my older patients, this is huge hurdle.  Many elderly patients cannot adequately perform self-care well as they age.   Bathing and washing hair have fall by the wayside as it is often difficult, and sometimes even dangerous, to bathe without assistance.  When I question many of my older patients, many of them do not bathe more than once a week.  And many more do not change their clothes and underwear daily.

Women tend to be worse.  Men tend to retain more muscle mass that allows them to navigate showering easier later in life.  Also, shorter and easily styled hair allow men to wash their hair on a more regular basis without worrying about styling it. In my observation, body odor is a bigger issue for older women that older men, and I smell a lot of bodies up close every day.

The problem extends further than the physical inability to shower, sometimes it is hard for patients to adequately get to the smellier areas of their underarms and groin to clean them well on their own.  

Often the smell is also exacerbated by urine leakage.  Inability to wash and change clothes and undergarments frequently is a huge issue that leads to a urine smell in the elderly.  

Nobody wants to talk about or think about these things, but we will all face the same issues someday. 

So what’s the average aging person to do?  Ask for help!  While it’s humbling for us all to ask for help, asking for help with personal care and cleansing is on a different level.  If a family member is not available, perhaps a home health aid would be of assistance. 

But most of us won’t ask for help, so here’s a few other ideas.  There are many “wipes” available now for cleansing without significant water.  I often recommend Cetaphil Gentle Skin Cleansing Cloths for athletes after practices, but they work well for elderly who can’t bathe for some reason.  While these cloths are great for cleansing, they do not kill the bacteria that are involved in producing scents.  So, an antibacterial cleanser or agent is needed to achieve the best results.

Unfortunately, many anti-bacterial soaps and ingredients were pulled from the market by the FDA in 2016.  And many antibacterial soaps are too harsh to be used in the sensitive skin folds where odor and bacteria reside.  So, my favorite recommendation is to use Hibiclens.  This can be purchased OTC and used topically with a very small amount on a cleansing wipe as a powerful antibacterial agent.  Hibiclens has an extended release action so it really only needs to be used twice a week in most patients. It is harmful to the eyes and mucous membranes but can safely be used on other areas. While we may want to preserve our skin biome to an extent, killing bacteria in our folds is a simple way to reduce body odor.

But turns out, my well-educated patient knew something that I didn’t.  There is a smelly compound that is secreted more as we age, starting as early as the 40s.  In my next article we’ll talk more about it, persimmon soap , and the answer to my patient’s question.