Treatment of Axillary Osmidrosis Using a Subcutaneous Pulsed Nd-YAG Laser

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.

Percutaneous Interstitial Nd:YAG Laser Therapy for Axillary Osmidrosis

BACKGROUND AND OBJECTIVES

To investigate the effects of percutaneous interstitial Nd:YAG laser irradiation on the apocrine glands and molecules involved in odor production (apolipoprotein [ApoD], androgen receptor [AR]) in the subcutaneous tissue of a pig.

STUDY DESIGN/MATERIALS AND METHODS

Skin on the back of healthy adult miniature pigs was exposed to pulsed Nd:YAG laser irradiation at 5 or 10 W, or continuous Nd:YAG laser irradiation at 10 W. Samples were taken 1 hour, 1 week, and 1 month after treatment for histology, western blot, and real-time quantitative polymerase chain reaction (qRT-PCR) analysis.

RESULTS

One week and 1 month after irradiation, the apocrine glands in pigskin became rounded, glandular cells were shorter, and the glandular cavities were larger compared with controls, but there were no obvious changes in fat cell distribution of collagen around the apocrine glands. One month after irradiation at 10 W in continuous mode, there was a significant decrease in ApoD expression in apocrine cells and ApoD and AR protein and expression levels in pigskin compared with controls. There were also significant differences in ApoD and AR protein and expression levels between treatments.

CONCLUSIONS

Percutaneous interstitial Nd:YAG laser irradiation has potential as a safe and efficacious treatment for axillary osmidrosis as it may decrease the production of volatile unsaturated fatty acids, steroids, and associated unpleasant odors in the axilla. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

An innovative technique of hydrosurgery in the treatment of osmidrosis

BACKGROUND

We aimed at evaluating the effects of hydrosurgery and traditional surgical approach with two parallel incisions in the treatment of osmidrosis.

METHODS

This prospective study enrolled patients with axillary osmidrosis between January 2015 and November 2016. For hydrosurgery, a 1-cm-long incision was made in the middle of the posterior long axis. The hand piece was turned upside down and processed in a 'W-O' way. For traditional method, two 3-cm-long parallel incisions were made transversely. Patient demographics, complications, duration of procedures and the outcomes were collected and compared. All patients had a follow-up period of 24-36 months.

RESULTS

A total of 93 patients were included: 41 patients in hydrosurgery group and 52 patients in traditional method group. No severe complications occurred in the hydrosurgery group, while necrosis occurred in six sides of axillae of traditional surgical group. No recurrence occurred in both groups. Both groups showed similar odor and hair growth reduction rate. Only one in 82 sides occurred slight scar formation, while in traditional group, 22 sides of axillae formed scars (p < .001).

CONCLUSIONS

The application of hydrosurgery in the treatment of osmidrosis is efficient and effective. Moreover, it has less postoperative complications, and high patient satisfaction rates.

Laser-assisted Lipolysis Burn Safety: Proposed Detailed Parameters with Assessment of Their Efficacy and Safety

Supplemental Digital Content is available in the text.

Background:

Many recent studies have evaluated the clinical safety and efficacy of therapeutic lasers in laser lipolysis, but without detailed description of the safe and effective parameters.

Purpose:

To propose a method for adjusting safe and effective parameters for laser lipolysis.

Methods:

Detailed calculations of the safe and effective laser parameters for fat melting are proposed in the study. Amount of energy delivered in joules was calculated based on data from Havenith research. External skin and internal tissues temperatures during the procedure were kept in a recommended range and monitored for safety and efficacy. Prospective statistical study was designed on a series of 300 patients who underwent laser-assisted lipolysis and /or liposuction using 2 different machine manufacturers, delivering 1,064/1,320 nm.

Results:

All areas submitted to laser-assisted liposuction in this series have resulted in no clinical thermal burns injury to the skin. There was improvement in the bulk of fats, skin tightening, skin textures, and cellulites.

Conclusion:

This study is proposing a simple method for calculations of safe and effective laser lipolysis. Skin burn injury could be highly prevented by following up the proposed detailed basic parameters for laser lipolysis treatment.

Histopathological Evidence of the Efficacy of Percutaneous Ethanol Injection in the Treatment of Axillary Osmidrosis: A Promising New Procedure

Axillary osmidrosis (AO) is a common disease, affecting patients psychologically and influencing their quality of life. The medical approach to AO remains controversial, ranging from conservative medical to surgical choices. We describe the successful treatment of AO and axillary hyperhidrosis (AH) using percutaneous ethanol injection (PEI) in a 30-year-old patient with AO and AH who did not respond to topical and systemic medication. We also describe the clinical efficacy of PEI by presenting our experience with histopathological evidence of necrosis of the sweat glands.

Percutaneous ethanol injection as a promising and minimally invasive treatment for axillary osmidrosis: Double-blinded randomized controlled trial

Background

Axillary osmidrosis is a common problem with a strong negative impact on the professional and social quality of life. Several options are available for its treatment. But there are no treatment guidelines. The objective of this study was to evaluate efficacy and safety of percutaneous ethanol injection for treatment of axillary osmidrosis.

Methods

A randomized, double-blind, placebo-controlled clinical trial to assess clinical efficacy and postoperative complications of percutaneous ethanol injection was performed among 60 patients (12-35 years of age) with axillary osmidrosis. The active agent used in the experimental group (n = 30) was sterile 90% ethanol and the placebo used in the control group (n = 30) was sterile normal saline administered in an identical syringe. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. All patients were followed-up for 10 months.

Results

Malodor elimination was graded as good by 15 (50%) patients treated with percutaneous ethanol injection. A significant difference in the improvement of axillary osmidrosis was found between the experimental and control groups (P < 0.001). The most common post-procedure complication was transient subjective skin stiffness in the experimental group, which regressed spontaneously. There were no serious permanent side effects.

Limitations

Relatively short duration of follow-up; and lack of histopathological evidence of destruction of the apocrine glands after treatment in most patients.

Conclusions

Percutaneous ethanol injection is an effective and safe treatment method for axillary osmidrosis and does not have permanent side effects.

Negative Pressure Wound Therapy as Effective and Comfortable Management After Treatment of Osmidrosis

Although osmidrosis has been widely discussed in respect to its treatment modalities, there has been no definite consideration of postoperative management after the treatment of osmidrosis. We have tested the 40-125 mmHg range of negative pressure. We present negative pressure wound therapy (NPWT) of 70 mmHg for postoperative management in osmidrosis because NPWT has a role in removing fluid, such as blood or seroma, and diminishing the dead space between the skin and subcutaneous tissue. Patients who receive NPWT have shown successful treatment outcomes and no skin necrosis or hematoma formation. Additionally, NPWT could improve postoperative daily activity compared with conventional compressive dressings.

LEVEL OF EVIDENCE V

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Minimally Invasive Surgery for Axillary Osmidrosis Using a Combination of Subcutaneous Tissue Removal and a 1,444-nm Nd:YAG Laser

Many treatment modalities have been developed for axillary osmidrosis. It is well known that the surgical treatment has the best results. However, there is a high possibility of side effects. The 1,444-nm lipolysis laser has been recently introduced to remove the apocrine glands. So far, subdermal coagulation treatment with a 1,444-nm Nd:YAG laser may be the least invasive and most effective therapy for axillary osmidrosis. However, according to our previous experience, the recurrence rate was 20%~30%. This emphasizes the need for combination of surgical method and non-surgical method and we combined subcutaneous tissue removal and photothermocoagulation with a 1,444-nm Nd:YAG laser. Three patients for bilateral axillary osmidrosis were enrolled. After an incision of about one-third the length of the widest transverse diameter, the apocrine glands were separated from the skin. And then apocrine glands within the marked area were destroyed by irradiation with a 1,444-nm Nd:YAG laser thereafter. All patients exhibited no relapse of axillary osmidrosis and were satisfied with the treatment results. A combination of subcutaneous tissue removal and Interstitial laser photothermocoagulation with a 1,444-nm Nd:YAG laser could be an effective treatment for mild to moderate axillary osmidrosis.

A new osmidrosis procedure, the scrape and suction technique: review of 4,322 patients

BACKGROUND

Axillary osmidrosis causes unpleasant odors and profuse sweating, resulting in social and psychological problems. Many treatment modalities have been attempted and liposuction is preferred because of the minimal scar, although the problem of a high recurrence rate still exists. The aim of this study was to introduce and evaluate the efficacy of a new technique to treat axillary osmidrosis using a liposuction machine.

METHODS

From January 2002 to December 2012, a total of 4,322 patients with axillary osmidrosis were treated with a new technique that combines suction with aggressive scraping. Treatment outcomes were assessed by a patient survey in the outpatient clinic at least 6 months after surgery. Permanent tissue biopsies were obtained from the left axilla before surgery and from the right axilla after surgery and compared to each other.

RESULTS

Ninety-five percent of the patients (n=4,092) were very satisfied with the result, including the postoperative scars, and responded that they never or hardly ever experienced symptoms of axillary osmidrosis postoperatively. Recurrences occurred in 230 patients (5%) and most resolved after additional procedures, except 36 cases (0.8%). The tissue biopsy showed complete excision of the apocrine glands and a well-cut cross-sectional view of the dermis. Superficial epidermal necrosis occurred in 41 patients, probably due to hematoma, and 32 patients of the 41 (78.0%) were treated successfully without any revisional procedures.

CONCLUSION

The new technique of scraping and suctioning with a newly designed liposuction machine achieved minimal scars, low recurrence rates, and very high patient satisfaction. This technique can be a simple and effective treatment modality for the treatment of axillary osmidrosis.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Modified tumescent superficial suction with curettage treatment for axillary bromidrosis: clinical experience of 280 cases

BACKGROUND

Axillary bromidrosis adversely affects patients' social and personal life with excessive malodor. Although surgical resection of the apocrine glands is one effective and irreversible method for treating axillary bromidrosis, the postoperation complications cannot be ignored. This study aimed to evaluate the long-term outcome of the authors' modified tumescent superficial suction with a curettage procedure for axillary bromidrosis treatment.

METHODS

From January 2010 to December 2012, 450 patients with axillary bromidrosis visited the authors' plastic surgery outpatient department and received the modified treated using tumescent superficial suction with a curettage procedure. A total of 170 patients were lost to follow-up evaluation and eliminated from this study.

RESULTS

The follow-up period ranged from 5 to 35 months (mean 15.5 months). Among 280 patients, 261 (93.2 %) showed excellent to good results. Reoperation with the same procedure was performed for 15 patients, and all had excellent results afterward. The most common postoperative complication was transient ecchymosis (23.6 %).

CONCLUSION

The modified suction and curettage procedure is an optimal therapeutic strategy for axillary bromidrosis treatment.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Minimal subdermal shaving by means of sclerotherapy using absolute ethanol: a new method for the treatment of axillary osmidrosis

Background

Axillary osmidrosis is characterized by unpleasant odors originating from the axillary apocrine glands, resulting in psychosocial stress. The main treatment modality is apocrine gland removal. Until now, of the various surgical techniques have sometimes caused serious complications. We describe herein the favorable outcomes of a new method for ablating apocrine glands by minimal subdermal shaving using sclerotherapy with absolute ethanol.

Methods

A total of 12 patients underwent the procedure. The severity of osmidrosis was evaluated before surgery. Conventional subdermal shaving was performed on one side (control group) and ablation by means of minimal subdermal shaving and absolute ethanol on the other side (study group). Postoperative outcomes were compared between the study and control groups.

Results

The length of time to removal of the drain was 1 day shorter in the study group than in the control group. There were no serious complications, such as hematoma or seroma, in either group, but flap margin necrosis and flap desquamation occurred in the control group, and were successfully managed with conservative treatment. Six months after surgery, we and our patients were satisfied with the outcomes.

Conclusions

Sclerotherapy using absolute ethanol combined with minimal subdermal shaving may be useful for the treatment of axillary osmidrosis. It can reduce the incidence of seroma and hematoma and allow the skin flap to adhere to its recipient site. It can degrade and ablate the remaining apocrine glands and eliminate causative organisms. Furthermore, since this technique is relatively simple, it takes less time than the conventional method.