Axillary Osmidrosis: Past, Present, and Future

Comparative Study of 1444 nm Laser Monotherapy versus Integrated Liposuction in the Treatment of Axillary Osmidrosis

Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO and compared the results with those of a group treated only with a laser. Materials and Methods: This study compared the outcomes of AO treatment between the two groups up to six months postoperatively. The first group of 18 patients underwent laser treatment alone, and the second group of 12 patients underwent integrated liposuction surgery in addition to laser treatment. Outcomes were assessed using the following variables: degree of malodor (DOM), sweating area, patient satisfaction, pain levels, and complications, such as burns, swelling, and contractures. Results: Compared to the laser-only group, the integrated liposuction group demonstrated significantly superior outcomes in terms of DOM (p = 0.002) and patient satisfaction (p = 0.006), as well as a reduction in the sweating area (p = 0.012). The pain rating was higher in the liposuction group, but the difference was not statistically significant (p = 0.054). Compared with the patients in the integrated liposuction treatment group, those in the laser treatment group exhibited a significantly higher number of burns under the axillae (p = 0.025). However, no significant differences were observed in the swelling or contracture between the groups. Conclusions: Integrated liposuction with laser therapy significantly improved treatment outcomes, including malodor, patient satisfaction, sweat test results, and decreased complication rates.

Clinical Efficacy, Safety, and Complications of the Arthroscopic Cartilage Shaving Procedure for Secondary Osmidrosis Treatment

BACKGROUND

Axillary osmidrosis is a common disease with negative psychosocial impact on patients. Further, many treatment modalities are not sufficient and result in recurrence.

OBJECTIVE

We aimed to evaluate the effectiveness and safety of using a cartilage shaver in patients with recurrent osmidrosis to remove tightly attached apocrine glands and subdermal scars.

METHODS

We retrospectively evaluated 24 patients with secondary axillary osmidrosis who underwent cartilage shaving surgery between January 2013 and May 2022. We analyzed the incidence of complications, including seroma, infection, pigmentation, wound dehiscence, skin necrosis, scarring, shoulder movement limitation, comedones/sebaceous cysts, and nerve injury. Clinical effectiveness was also evaluated.

RESULTS

Excellent or good efficacy with improved malodor was achieved in 24 patients (47 axillae [100%]). Complications were observed in 16 (36.17%) axillae, including hematomas (n = 2), pigmentation (n = 7), skin necrosis (n = 3), and comedones/sebaceous cysts (n = 4); one patient (2.13%) required local debridement. Mean Vancouver Scar Scale scores were markedly low (5.41 to 4.67). Scar tissue did not interfere with the shaving surgery, allowing for successful removal of the apocrine glands.

CONCLUSIONS

Secondary osmidrosis treatment using a cartilage shaver system yielded satisfactory and better scar results than the patients' previous treatments.

Treatment of periorbital aging with negative pressure fractional microneedle radiofrequency: A self-controlled clinical trial

BACKGROUND

Several treatment modalities are used for the treatment of periorbital rejuvenation with variable results. Recent studies showed that fractional radiofrequency may be an effective treatment modality for periorbital aging. This study aims to determine the efficacy and safety of negative pressure fractional microneedle radiofrequency (NPFMR) as a treatment for periorbital aging.

METHODS

Twenty-five patients with periorbital aging were involved in this study. They were treated two times with an interval of 1 month. The patients were evaluated before treatment and 1, 3, and 6 months after the final treatment.

RESULTS

The research findings suggest that periorbital wrinkles of the patients were significantly improved by VISIA system (p < 0.05). Physiological indicators detected by MPA10 system showed that compared with before treatment, the hydration increased (p < 0.05) and trans epidermal water loss (TEWL) decreased (p < 0.05) at 3 and 6 months after treatment. The glossiness increased at 1 month after treatment compared to pre-treatment (p < 0.05) and returned to the baseline level at 3 and 6 months after treatment. There was no significant change in melanin content (p > 0.05). Periorbital dermal thickness of the patients significantly increased at 1, 3, and 6 months after treatment according to skin ultrasound (p < 0.05). A periorbital skin biopsy revealed that the collagen fibers in the dermis were significantly thicker and more orderly after treatment, and the expression of type I collagen fibers and elastic fibers was increased compared with that before treatment. One patient developed post-inflammatory hyperpigmentation (PIH) at 1 month after the first treatment, which improved after active treatment. No other adverse reactions were observed.

CONCLUSIONS

NPMFR could be an effective and safe treatment modality for the treatment of periorbital aging.

Epidemiological analysis of axillary apocrine bromhidrosis in China: a survey from Chinese higher education students

Background

There are few epidemiological data on axillary apocrine bromhidrosis (AAB) in the Chinese population, making it impossible to accurately estimate its prevalence or impact on individuals.

Objective

To estimate the prevalence of AAB in China, and to survey and compare the psychological status of individuals with and without AAB.

Methods

Students in several universities in China were surveyed online for AAB, and the prevalence of AAB was calculated. The Symptom Checklist 90 (SCL-90) was used to evaluate the psychological status.

Results

The prevalence of AAB in the surveyed students was 7.5% (194/2571). The projected number of Chinese higher education students with AAB was about 3 million. The onset age of AAB was mainly between 11 and 20 years old (79.90%, 155/194). 68.04% (132/194) of individuals with AAB had a positive family history, and 60.30% (117/194) had wet earwax. Individuals with AAB often felt depression, anxiety, loneliness and social alienation, and scored significantly higher on the nine primary psychological symptom dimensions than individuals without AAB.

Conclusion

AAB affects a small proportion but large numbers of Chinese population. China and the West or East-Asia and the West have different perception, recognition and treatment preferences for AAB.

Minimally invasive 1,444-nm Nd:YAG laser treatment for axillary bromhidrosis

Background

Axillary bromhidrosis is an apocrine glands hyperactivity disease.

Methods

A total of 24 patients (15 men and 9 women) with axillary bromhidrosis underwent a laser procedure with a 1,444-nm Nd:YAG laser. Parameters evaluated in this study were as follows: the degree of malodor (T0, baseline; T30, after 1 month; and T180, after 6 months), postoperative pain, short-term decreased mobility (T1, after 1 day; T7, after 7 days; and T30, after 1 month), and overall satisfaction (T30, after 1 month and T180, after 6 months). A visual analog scale (VAS), from 0 to 10, was used to assess pain and decreased mobility, with lower values denoting less severity.

Results

A total of 24 patients were followed up for 6 months after laser treatment. At baseline, all patients (100%) complained of a strong axillary malodor (mean degree of malodor at T0 = 2.0 ± 0.00). It decreased to 0.50 ± 0.64 at T30. At T180, the degree of malodor was 0.54 ± 0.57. Both T30 and T180 degrees of malodor significantly decreased from the baseline value (p < 0.01). The mean degree of patient satisfaction at T30 was 1.75 ± 0.52, and at T180, it was 1.67 ± 0.21. Among the 24 patients, eight complained of moderated pain 1 day after treatment. The pain subsided on day 7, except for two patients, with VAS = 1. Pain and mobility restrictions were in any case resolved within T30.

Conclusion

Treatment with a 1,444-nm Nd:YAG laser for subdermal interstitial coagulation could be a less invasive and more effective option treatment for axillary bromhidrosis.

Comparative Study of En Bloc Excision and Dermal Shaving in Treating Axillary Osmidrosis

BACKGROUND

Axillary osmidrosis is a distressing problem caused by hyperactivity of apocrine glands. There have been numerous studies on various surgical treatment methods. In this study, we evaluated the effectiveness of en bloc excision in comparison with dermal shaving.

METHODS

The electronic records of 146 patients (286 axillae) who underwent surgery at our center for axillary osmidrosis between January 2009 and December 2020 were reviewed. Twenty-five patients (49 axillae) underwent en bloc excision and 121 (237 axillae) underwent dermal shaving. Patients in the en bloc excision group underwent Minor test preoperatively to detect sweating areas. Severity of osmidrosis was graded using a 4-point scale (0-3). A satisfaction questionnaire was used to evaluate patient experiences in the 2 types.

RESULTS

Mean operation time was significantly shorter in the en bloc excision group than in dermal shaving group. Most en bloc excisions were performed on an outpatient basis under local anesthesia. Both groups showed an improvement in osmidrosis score at 6 months after surgery. A satisfaction questionnaire revealed better perioperative experiences in the en bloc excision group. Various surgical complications such as hematoma, wound dehiscence, and flap necrosis occurred in the dermal shaving group, and the en bloc excision group experienced significantly fewer complications that required intervention.

CONCLUSIONS

En bloc excision combined with Minor test effectively reduces malodor without causing severe complications. In addition, perioperative patient satisfaction was better in the en bloc excision group than in the dermal shaving group as en bloc excision provided more rapid returns to normality and simplified communications with patients.

Potential use of microwave technology in dermatology

BACKGROUND

Microwaves are used in medicine for diagnostics, and treatment of cancer. Recently, novel microwave devices (Swift^®, Emblation Ltd, UK and miraDry^®, Miramar Labs Inc., CA) have been cleared by the FDA and Health Canada for various dermatological conditions.

OBJECTIVE AND METHODS

To review the dermatological use of microwave-based treatments (plantar warts, corns, actinic keratosis, dermatophytosis, axillary hyperhidrosis, osmidrosis, and hidradenitis suppurativa). Clinical trials, case reports, or in vitro studies for each condition are summarized.

RESULTS AND CONCLUSION

Microwaves are a promising alternative therapy for cutaneous warts, actinic keratosis, axillary hyperhidrosis, and osmidrosis, with favorable safety profiles. However, patients with hidradenitis suppurativa have had negative clinical outcomes. Limited treatment of corns showed good pain reduction but did not resolve hyperkeratosis. A preliminary in vitro study indicated that microwave treatment inhibits the growth of T. rubrum. We present the first case of toenail onychomycosis successfully treated with microwaves. Despite the advancements in the use of microwaves, the mechanism of action in non-ablative treatment is not well understood; further research is needed. More high-quality randomized clinical trials with larger groups and long follow-up periods are also required to evaluate the clinical benefits and possible adverse effects of microwaves in treating dermatological conditions.

Power-assisted rotary cutter with negative pressure suction through small incision for axillary osmidrosis

BACKGROUND

The glandular fluid secreted by apocrine sweat glands is decomposed by parasitic bacteria on the skin surface and releases a bad smell called axillary osmidrosis.

OBJECTIVE

To evaluate the effect of power-assisted rotary cutter with negative pressure suction through small incision for axillary osmidrosis.

METHODS

From January 2017 to January 2022, 647 patients with axillary osmidrosis underwent power-assisted rotary cutter with negative pressure suction through small incision surgery to treat for axillary osmidrosis. The operation time (min), intraoperative bleeding (ml) and recovery time (days) were counted. 3 months after operation, the amount of underarm sweat, the disappearance of underarm hair, the incidence of operation, the effective rate of operation and the satisfaction of operation results were evaluated by questionnaire.

RESULTS

There were no postoperative complications except 5 cases of mild axillary pigmentation after 3 months. All patients evaluated good odor elimination. No patient was rated as average or poor. No recurrence.

CONCLUSION

Power-assisted rotary cutter with negative pressure suction through small incision is an effective and ideal surgical method to reduce the complications and recurrence of axillary osmidrosis. This article is protected by copyright. All rights reserved.

Treatment of Axillary Osmidrosis by Rebalancing Skin Microecology With Lactobacillus bulgaricus

Corynebacterium accounts for around 20% of the armpit microbiome and plays an essential role in axillary osmidrosis (AO). In this study, the effects of Lactobacillus bulgaricus treatment on the microecological environment of armpits and its efficacy in the treatment of AO were investigated. A total of 10 AO patients were enrolled in this study. The patients were treated with L. bulgaricus mixed with saline on the left armpit (experimental group) and pure saline on the right armpit (control group) for 28 days. After treatment, AO severity showed a significant decrease (p = 0.013) in the experimental group compared with the control group, and the Corynebacterium abundance also showed a corresponding significant decrease (p < 0.01). Moreover, no significant variation in Staphylococcus abundance was found between these two groups. The microbe diversity is not disturbed in the treatment. Accordingly, our study demonstrates that L. bulgaricus can serve as an effective probiotic microbe for AO treatment by reducing the abundance of Corynebacterium and rebalancing the microecological environment.

Comparison of Long-Term Effectiveness and Safety of Microwave and Surgery in the Treatment of Axillary Osmidrosis: A Single-Center Retrospective Study

BACKGROUND

A microwave-based device is a newly developed method for treating axillary osmidrosis. Few studies have compared the difference between microwave therapy and subcutaneous curettage for axillary osmidrosis.

OBJECTIVE

To compare the long-term effectiveness, complications, and recurrence of osmidrosis after microwave therapy and subcutaneous curettage.

METHODS AND MATERIALS

Medical records of 155 patients with osmidrosis treated with microwave therapy or subcutaneous curettage were reviewed retrospectively. Demographic data, visual analog scale for odor, hyperhidrosis disease scale, complications, and recurrence were analyzed.

RESULTS

Osmidrosis improved significantly in both treatment groups at 6 months. Effective improvement was observed in 90% and 23% of the patients in the surgery and microwave groups, respectively, after 3 years postoperatively. The recurrence rates were 39% and 21% in the microwave and surgery groups, respectively. The transient complication rate was higher in the microwave group, and long-term complications only occurred in the surgery group.

CONCLUSION

Subcutaneous curettage is a more effective approach for axillary osmidrosis. However, microwave therapy is recommended for patients with cosmetic concerns.

An innovative application of follicular unit extraction technique in the treatment of bromhidrosis

BACKGROUND

Surgery is the most effective way to treat bromhidrosis, but postoperative complications are still the biggest obstacles for patients to choose surgical treatment.

OBJECTIVES

To introduce an innovative application of follicular unit extraction (FUE) in the treatment of bromhidrosis.

METHODS

We conducted a case series study on 20 patients who received FUE technique for the treatment of bromhidrosis. The axillary hair follicles were extracted with a one-millimetre punch. The released hair follicles were collected for histological examination. After the operation, the wounds were wrapped with moderate pressure. The dressing was removed 24 h after the FUE operation. The postoperative complications were collected, and the improvement of malodour was evaluated by the 10-point visual analogue scale.

RESULTS

Immediately postoperation, many needle-shaped holes appeared in the armpits. The holes healed 7 days after the operation, with no scar or pinpoint-like scars. Except for a female who complained of mild pain in the left armpit, no other patients had any discomfort. The malodour level varied between 0 and 4 during the follow-up period. The tissue examination showed that more than 90% of the completely plucked hair follicles were accompanied by apocrine glands, and many blocked and dilated apocrine glands were observed. The lumens of the blocked glands were filled with decapitation products, which were positive for K5, Brst-2 and CEA.

CONCLUSIONS

Patients with bromhidrosis have a positive response to FUE technique. The FUE technique is well-tolerated, with only a few postoperative complications, which deserves to be widely promoted.

Open versus Closed Surgery for Axillary Osmidrosis: A Meta-Analysis of Articles Published in Four Languages

Background

Individuals with axillary osmidrosis suffer detrimental effects to their psychosocial functioning. In Asian nations, major operations for axillary osmidrosis include subdermal excision (open surgery) and suction-curettage (closed surgery).

Objective

The aim of this meta-analysis was to determine which of these two procedures is most favorable in terms of safety and efficacy.

Methods

According to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guideline, we searched electronic databases for articles published in English, Japanese, Korean, and Chinese languages. Fixed-effects model meta-analyses of odds ratios (OR) and 95% confidence intervals (CI) were conducted, and the I² was used to assess heterogeneity. Complication rates, recurrence/ineffectiveness rates, and patient satisfaction data were extracted and compared between open and closed surgeries.

Results

Our search yielded 8 articles that include 1,179 patients; 560 underwent open surgery, and 619 underwent closed surgery. Our meta-analysis revealed that suction-curettage had a significantly lower risk of acute adverse events than open excision (OR, 0.15; 95% CI, 0.07~0.32), whereas open excision was significantly superior to suction-curettage for recurrence/ineffectiveness rate (OR, 2.90; 95% CI, 1.37~6.15). Patient satisfaction was equally high with both treatments (OR, 1.58; 95% CI, 0.69~3.60).

Conclusion

Since surgical treatments for axillary osmidrosis have been performed mostly in East Asian nations, it was meaningful to review articles published in four languages. This meta-analysis revealed that closed surgery was safer but less effective than open surgery. However, both patient groups expressed high satisfaction with the outcomes. Our results may be helpful for deciding surgical treatment options.

A retrospective study on comparing the surgery and microneedles radiofrequency and microwaves treatment in axillary osmidrosis

Objective: To compare the traditional treatment of minimally invasion surgery with the evolving treatments of microneedles radiofrequency and microwaves, this study mainly focused on the clinical efficacy and the incidence rate (IR) of complications among three treatments.Methods: From August 2017 to August 2018, a total of 76 patients with bilateral axillary osmidrosis were enrolled respectively underwent minimally invasion surgery, microneedles radiofrequency and microwaves treatment. All these subjects were evaluated the clinical outcomes and collected the complications by themselves or physicians. The difference of objective recovery or effective rate, subjective effective rate, the intense of sweat secretion or armpits hair, IR of complications among these three groups were studied.Results: The baseline characteristics of 33 patients in surgery group, 24 patients in microneedles group and 19 patients in microwaves group were similar. Firstly, the objective clinical efficacy was similar, but the subjective effective rate in surgery group was the soundest. In addition, the reduction of sweat secretion was homologous in three group, but the intense of armpits hair reduction in microneedles group was the minimum in three groups. Moreover, surgery treatment caused the highest IR of complications and the broadest types of complications, especially for the IR of 87.9% in postoperative scar formation. Meanwhile, the microwaves treatment had the best safety profile. At last, the recurrence rate on 6 months postoperatively was also identical with no significant difference.Conclusions: For the advantages and disadvantages of these three treatments, axillary osmidrosis patients should choose the proper therapy with comprehensive considerations.