Clinical features of axillary osmidrosis: A retrospective chart review of 723 Japanese patients

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.

Long-Term Use of Antiperspirant is Associated with a Low Risk of Postoperative Complications in Patients with Axillary Osmidrosis

Purpose

Many patients with axillary osmidrosis (AO) cannot tolerate the local irritation of strong antiperspirants and discontinue AO use within a short time. This study evaluates the effect of long-term antiperspirant use on postoperative complications after osmidrosis surgery.

Patients and Methods

A total of 116 females (66 antiperspirant and 50 non-antiperspirant cases) who underwent osmidrosis surgery were retrospectively reviewed. Postoperative complications were compared between the 2 groups.

Results

Patients with long-term antiperspirant use had a lower risk of full-thickness skin necrosis compared with those who did not use antiperspirants (odds ratio [OR] = 0.048, 95% confidence Interval [CI]: 0.006–0.392, p = 0.005). Patients with antiperspirants use also had a lower risk of moderate-to-severe erythema compared to those without antiperspirants use (moderate vs mild erythema: OR = 0.351, 95% CI: 0.129–0.959, p = 0.041; severe vs mild erythema: OR = 0.161, 95% CI: 0.047–0.550, p = 0.004). Patients who used antiperspirants also had a lower risk of severe skin erosion compared to those who did not use antiperspirants (severe vs mild skin erosion: OR = 0.164, 95% CI: 0.037–0.725, p = 0.017). There was a trend of lower risk in moderate skin erosion in patients with antiperspirant use compared to those without antiperspirant use, but it was not statistically significant (moderate vs mild epidermal damage and peeling: OR = 0.406, 95% CI: 0.158–1.043, p = 0.061).

Conclusion

Postoperative complications in patients with AO who undergo osmidrosis surgery are lower in those with a long-term antiperspirant use compared to patients who did not use antiperspirants.

Treatment of Recurrent Axillary Osmidrosis: Trimming and Electrocoagulation of Apocrine Glands Under Direct Vision Through Double Incisions

OBJECTIVE

The aim of this study was to explore the clinical effect of treatment for recurrent axillary osmidrosis (AO) after small-incision minimally invasive surgery by trimming and electrocoagulation of apocrine glands under direct vision through double incisions parallel to axillary creases.

METHODS

This was a retrospective study. From September 2012 to January 2019, 75 axillae in 48 cases of recurrent AO after small-incision minimally invasive surgery were treated using trimming and electrocoagulation of apocrine glands under direct vision through double incisions parallel to axillary creases. Patient data, such as sex, age, original surgery method, the severity of underarm malodor before and after the operation, and occurrence of complications, were collected and analyzed.

RESULTS

For the follow-up of at least 12 months after the surgery, all patients' underarm malodor disappeared or was significantly reduced. Patients with preoperative severity of grade I did not show a recurring AO, whereas the recurrence rate of grade II and grade III AO was 7.9% and 14.3%, respectively. Furthermore, the AO recurrence rate was 9.1% for those younger than 18 years and 6.2% in those 18 years or older. Subcutaneous hematomas appeared on 3 axillae (4.0%), and the contraction of subdermal fibrotic bands appeared on 5 axillae (6.7%).

CONCLUSIONS

Patients with recurring AO after small-incision minimally invasive surgery achieved good treatment results by trimming and electrocoagulation of apocrine glands under direct vision through double incisions parallel to axillary creases.

Effectiveness and safety of the improved mini-incision surgery for osmidrosis treatment

BACKGROUND

As the mainstream treatment of axillary osmidrosis, surgical treatment is still limited by various complications, such as paresthesia, scars, local infection, hematoma, flap necrosis, and long recovery time. In this study, we tried to adopt the improved mini-incision surgery for osmidrosis treatment.

OBJECTIVES

The paper aims to evaluate the clinical effectiveness and safety of the improved mini-incision surgery for axillary osmidrosis treatment.

PATIENTS/METHODS

Clinical series of patients underwent improved mini-incision surgery were retrospectively reviewed. Dates of complications, including paresthesia, scars, infection, hematoma, skin necrosis, and recurrence were analyzed.

RESULTS

Among 61 cases, 58 cases had a preoperative osmidrosis score of 3 and 3 cases had a preoperative score of 2; while 13 cases had a postoperative osmidrosis score of 0, 43 cases had a postoperative score of 1 and 5 cases had a postoperative score of 2, significantly lower than that before (p < 0.001). A total of 12 axillae complications occurred, 2 axillae (1.6%) had paresthesia; 5 axillae (4.1%) had hematoma; 2 axillae (1.6%) had local flap necrosis due to hematoma; and 3 axillae (2.4%) had hypertrophic scars.

CONCLUSIONS

The results showed that the improved mini-incision surgery was safe and effective for osmidrosis treatment.

Refined tumescent liposuction-curettage with pruning in small incisions for treatment of axillary bromhidrosis

Axillary bromhidrosis is a widespread social problem in our society. Various modalities have been developed for the destruction or removal of the apocrine sweat glands to eliminate underarm odor. However, conventional surgical treatments often result in a high complication rate and frequent recurrence. In this study, we aimed to evaluate the effect of refined tumescent liposuction-curettage with pruning in small incisions as treatment for axillary bromhidrosis. Between July 2013 and April 2019, 110 patients (75 women and 35 men) with axillary bromhidrosis underwent refined tumescent liposuction-curettage with pruning. The results of eliminating underarm odor were evaluated by both the patients and doctors and rated as very satisfied (excellent), satisfied (good), slightly satisfied (fair), and not satisfied (poor). Postoperative complications, such as dehiscence, infection, wound contracture, cyst, subcutaneous hydrops, hematoma, or seroma, were also evaluated. Preoperative and postoperative histological examinations of axillary tissues were performed in two patients. In the subjective evaluation of 110 patients, 33 (30.0%) were very satisfied with the results, 70 (63.6%) were satisfied, and seven (6.4%) were slightly satisfied. The objective evaluation showed that 43 (39.1%) patients graded the results as excellent, whereas others graded the results as good. No serious complications occurred, except three patients with slight local subcutaneous hydrops and hematoma. Histologic examinations showed that the apocrine glands were significantly decreased or destroyed after the surgery. Refined tumescent liposuction-curettage with pruning in small incisions is an effective method for the treatment of axillary bromhidrosis.

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.

Combination of topical agents and oxybutynin as a therapeutic modality for patients with both osmidrosis and hyperhidrosis

INTRODUCTION

The association of osmidrosis and hyperhidrosis often causes emotional and social problems that may impair the patients' quality of life. The purpose of our study was to analyze the therapeutic results of oxybutynin and topical agents in 89 patients with both osmidrosis and hyperhidrosis.

METHOD

We conducted an observational study at two specialized centers of hyperhidrosis between April 2007 and August 2013. Eighty-nine (89) patients with both osmidrosis and hyperhidrosis were treated with oxybutynin and topical agents. Patients were evaluated before treatment and at 3 and 6 weeks after treatment started, by using the Quality of Life Questionnaire and the Sweating Evolution Scale.

RESULTS

Before treatment, 98% of the patients presented with poor or very poor quality of life. After six weeks of treatment, 70% stated their quality of life as being slightly better or much better (p<0.001) and nearly 70% of the patients experienced a moderate or great improvement in sweating and malodor. Improvement in osmidrosis was significantly greater when the axillary region was the first most disturbing site of hyperhidrosis.

CONCLUSION

There was a significant improvement in quality of life and a reduction in sweating and malodor after six weeks of treatment with topical agents and oxybutynin in patients with both hyperhidrosis and osmidrosis. Therefore, clinical treatment should be considered before invasive techniques.

Clinical and Molecular Evidence of ABCC11 Protein Expression in Axillary Apocrine Glands of Patients with Axillary Osmidrosis

Accumulating evidence suggests that the risk of axillary osmidrosis is governed by a non-synonymous single nucleotide polymorphism (SNP) 538G>A in human ATP-binding cassette C11 (ABCC11) gene. However, little data are available for the expression of ABCC11 protein in human axillary apocrine glands that produce apocrine sweat—a source of odor from the armpits. To determine the effect of the non-synonymous SNP ABCC11 538G>A (G180R) on the ABCC11 in vivo, we generated transiently ABCC11-expressing transgenic mice with adenovirus vector, and examined the protein levels of each ABCC11 in the mice with immunoblotting using an anti-ABCC11 antibody we have generated in the present study. Furthermore, we examined the expression of ABCC11 protein in human axillary apocrine glands extracted from axillary osmidrosis patients carrying each ABCC11 genotype: 538GG, GA, and AA. Analyses of transiently ABCC11-expressing transgenic mice showed that ABCC11 538G>A diminishes the ABCC11 protein levels in vivo. Consistently, ABCC11 protein was detected in the human axillary apocrine glands of the 538GG homozygote or 538GA heterozygote, not in the 538AA homozygote. These findings would contribute to a better understanding of the molecular basis of axillary osmidrosis.