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

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.

Comparison of Effectiveness and Associated Complications Between Conventional Subdermal Excision and Hydrosurgery (VersajetTM) for Osmidrosis

BACKGROUND

Recent studies have shown hydrosurgery (Versajet TM II) is a simple and effective tool with reduced complications in surgical treatment of osmidrosis. Since then, hydrosurgery has been widely used for osmidrosis. However, we have experienced that some complications often occur in patients treated with hydrosurgery.

OBJECTIVE

We hypothesized that using a hydrosurgery could lead to excessive resection of the tightly attached apocrine glands and thus more complications. We aimed at evaluating the effectiveness and associated complications of the hydrosurgery method for osmidrosis were compared with those of conventional methods with two parallel incisions.

METHODS & MATERIALS

We retrospectively analyzed 31 and 16 patients who underwent conventional and hydrosurgery methods, respectively, for osmidrosis from 2010 to 2020. Two parallel long incisions were identical in both groups. Early complications (hematoma, seroma, wound dehiscence, skin necrosis, revision, scar contracture), late complications (scar, pigmentation, comedones/milia, and sebaceous cysts), and effectiveness (subjective satisfaction, malodor elimination, reduced hair growth, and sweating elimination) were evaluated.

RESULTS

Skin necrosis was significantly more frequent in the hydrosurgery group than in the conventional group (p = 0.036). No other significant differences were found between the two groups in terms of other complications and effectiveness. As a result of comparing effectiveness, subjective satisfaction (p = 0.306), malodor elimination (p = 1.000), reduced hair growth (p=1.000), and sweating elimination (p = 0.742) did not show any significant difference between the two groups.

CONCLUSION

Osmidrosis treatment with the use of VERSAJET™ Hydrosurgery System yielded similar and satisfactory results as the conventional subdermal excision method. The incidence of skin necrosis was higher in the hydrosurgery group than in the conventional group with two parallel incisions.

LEVEL OF EVIDENCE III

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.

Treatment of Axillary hyperhidrosis

BACKGROUND

Axillary hyperhidrosis characterized by excessive sweating in the axillary regions is a frustrating chronic autonomic disorder leading to social embarrassment, impaired quality of life and usually associated with palmoplantar hyperhidrosis. Identifying the condition and its cause is central to the management.

AIM

The aim of this article is to discuss treatment options for axillary hyperhidrosis.

METHODS

Comprehensive literature search using PubMed and Google Scholar was performed to review relevant published articles related to diagnosis and treatment of axillary hyperhidrosis.

RESULTS

Treatment modalities for axillary hyperhydrosis vary from topical and systemic agents to injectables, newer devices and surgical measures. None except for physical measures using devices or surgery, which destroys the sweat glands to remove them, is possibly permanent and most are associated with attendant side effects.

CONCLUSION

Several treatments including medical and surgical option are available for the treatment of axillary hyperhydrosis. Patient education is important component of its management. Individualized approach of management is necessary for optimal outcome of treatment.

Shortening of Incision by "Pinch and Turn-Over Technique" in the Treatment of Axillary Osmidrosis

BACKGROUND

The pinch and turn-over technique was developed to minimize the incision in the manual subdermal excision of apocrine glands in axillary osmidrosis for the best cure and fewest complications.

METHODS

Through a 2-cm-long incision, peripheral subdermal tissue was excised by the technique under direct vision using intravenous anesthesia and tumescent technique. Ninety-nine axillae in 50 patients including seven secondary cases were operated on from 2009 to 2018. Long-term follow-up (average 30.3 months) could be done on 40 patients with questionnaires consisting of four-point ordinal-scale questions regarding osmidrosis grade, hyperhidrosis grade and satisfaction. For systematic review regarding incision length, 220 articles from 1962 to 2018 were reviewed with the search terms "osmidrosis" or "bromhidrosis."

RESULTS

Thirty-five and 30 of 40 respondents (87.5% and 75.0%) had excellent or good postoperative results in osmidrosis and hyperhidrosis grade. Postoperative improvement of osmidrosis grade (from 2.53 to 0.80) and hyperhidrosis grade (from 1.88 to 0.95) was statistically significant (p < 0.01). Thirty-four patients (85.0%) reported very satisfactory or satisfactory. Hematoma (2.0%), hyperpigmentation (5.0%), infection (5.0%) and noticeable scar (2.5%) were rare. Necrosis of flap margins was frequent (27.3%) but necessitated revision in two cases (2.0%). Among eleven articles found to describe incision length in pure manual subdermal excision, this technique provided the shortest incision compared with eight direct subdermal excision methods with an average incision length of 5.0 cm.

CONCLUSIONS

This technique offers an open, direct and selective approach with a short incision. It could maintain the best efficiency while neutralizing negative side effects of conventional manual subdermal excision for 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 .

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.

A Minimally Invasive Procedure for Axillary Osmidrosis: Subcutaneous Curettage Combined with Trimming Through a Small Incision

BACKGROUND

Though minimally invasive procedures often yield excellent esthetic results for axillary osmidrosis, the high recurrence rates of malodor limit its further application. Incomplete removal of the apocrine glands would lead to recurrence of the axillary bromhidrosis, while excessive resection of the apocrine glands firmly attached to the dermis would easily result in local skin necrosis. Therefore, accurate management of the apocrine glands is extraordinarily important, particularly with a limited access. Herein, we would like to introduce an effective and minimally invasive procedure combining subcutaneous curettage and trimming for the treatment of axillary osmidrosis.

METHODS

A 5-mm incision was marked at the inferior pole of the central axillary crease. Subcutaneous undermining was done clinging to the axillary superficial fascia. The whole procedure was performed in the following sequence of "scraping-trimming-scraping" against the undermined skin flap until the remaining hairs were easily pulled out.

RESULTS

All the wounds healed primarily without significant complications. Out of 300 axillae, 294 (98 %) showed good to excellent results for malodor elimination. Scars were invisible in 280 axillae (93.3 %) and slightly visible in 18 axillae (6 %). The dermatology life quality index score decreased significantly after the operation.

CONCLUSION

The procedure is an efficacious and minimally invasive method for the treatment of axillary osmidrosis.