Ultrasound Characteristics of the Hair Follicles and Tracts, Sebaceous Glands, Montgomery Glands, Apocrine Glands, and Arrector Pili Muscles

OBJECTIVES

To explore the capability of very high-frequency ultrasound (US; 50-71 MHz) to detect the normal morphologic characteristics of the hair follicles and tracts, sebaceous glands, Montgomery glands, apocrine glands, and arrector pili muscles.

METHODS

A retrospective study, approved by the Institutional Review Board, evaluated the normal US morphologic characteristics of the hair and adnexal structures in a database of very high-frequency US images extracted from the perilesional or contralateral healthy skin of 1117 consecutive patients who underwent US examinations for localized lesions of the skin and 10 healthy individuals from December 2017 to June 2018. These images were matched with their counterparts from the database of normal histologic images according to the corporal region. The Cohen concordance test and regional mean diameters of the hair follicles and adnexal structures were analyzed.

RESULTS

The normal hair follicles and tracts, sebaceous glands, Montgomery glands, apocrine glands, and arrector pili muscles were observed on US images and matched their histological counterparts in all the corporal regions. There was significant US concordance (κ = 0.82; P = .0001) among observers. Regional mean diameters (millimeters) of the hair follicles, sebaceous glands, and apocrine glands are provided.

CONCLUSIONS

The hair follicles and tracts, sebaceous glands, Montgomery glands, apocrine glands, and arrector pili muscles are detectable with very high-frequency US, including some regional and anatomic variants. Knowledge of their normal US appearances is a requisite for detecting subclinical changes, understanding the physiopathologic characteristics, and supporting the early diagnosis and management of common dermatologic diseases.

Histological, chemical and behavioural evidence of pedal communication in brown bears

Most mammals rely upon scent for intraspecific communication. As most bear species have large home ranges and are non-territorial, scent deposit while walking could be an effective way to communicate with conspecifics. Here, we investigate the existence of pedal glands in brown bears and their role in chemical communication from a histological, biochemical and behavioural perspective. We found eccrine glands in footpads, and prominent apocrine and sebaceous glands in the interdigital, metacarpal and metatarsal skin sections. Pedal scent contained 26 compounds including carboxylic acids, important constituents of mammalian secretions. Six of these compounds were exclusive for males. Finally, we describe a specific marking gait recorded in the field, mostly performed by males. Our study supports the existence of chemical communication through pedal marking in brown bears and suggests sex-coding potential of pedal scent.

The secretory clear cell of the eccrine sweat gland as the probable source of excess sweat production in hyperhidrosis

Primary hyperhidrosis is characterized by excessive sweating in palmar, plantar and axillary body regions. Gland hypertrophy and the existence of a third type of sweat gland, the apoeccrine gland, with high fluid transporting capabilities have been suggested as possible causes. This study investigated whether sweat glands were hypertrophied in axillary hyperhidrotic patients and if mechanisms associated with fluid transport were found in all types of axillary sweat glands. The occurrence of apoeccrine sweat glands was also investigated. Axillary skin biopsies from control and hyperhidrosis patients were examined using immunohistochemistry, image analysis and immunofluorescence microscopy. Results showed that glands were not hypertrophied and that only the clear cells in the eccrine glands expressed proteins associated with fluid transport. There was no evidence of the presence of apoeccrine glands in the tissues investigated. Preliminary findings suggest the eccrine gland secretory clear cell as the main source of fluid transport in hyperhidrosis.

A reappraisal of eyelid eccrine and apocrine hidrocystomas: microanatomic and immunohistochemical studies of 40 lesions

PURPOSE

To establish reliable criteria for diagnosing eyelid eccrine and apocrine hidrocystomas.

DESIGN

Retrospective clinicopathologic and immunohistochemical study.

METHODS

Twenty-two specimens of normal portions of eyelids were evaluated to establish the distribution and microanatomy of eccrine and apocrine glands. Immunostaining for cytokeratin 7 (CK7), gross cystic disease fluid protein-15 (GCDFP-15), alpha-smooth muscle actin (α-SMA), epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA) was performed on these tissues and on 40 lesions in 33 patients diagnosed with eccrine or apocrine hidrocystomas by unaided light microscopy.

RESULTS

Eccrine glands were not present in the eyelid margins, the lower half of the upper eyelid pretarsal skin, or the pretarsal lower eyelid skin. Apocrine glands were restricted to the eyelid margins and canthi where the cysts were located. GCDFP-15, CK7, and α-SMA immunoreacted with the eccrine secretory coils but not their ducts; apocrine gland secretory spirals also stained positively for these markers throughout their extended courses, but not their short terminal ducts. Positivity was found in 37 of 40 hidrocystomas for α-SMA and 19 for GCDFP-15; lesions tested for CK7 displayed positivity.

CONCLUSIONS

Alpha-SMA-, CK7-, and/or GCDFP-15-positive apocrine hidrocystomas were the only type discovered in this series and arose from glandular secretory spirals within the marginal, perimarginal, or canthal skin. Three lesions did not stain for α-SMA, initially suggesting an absent myoepithelium and therefore an eccrine ductal origin; they manifested CK7 positivity, however, another characteristic of the apocrine secretory spiral but not ducts. Our findings disprove the contention that eccrine predominate over apocrine hidrocystomas in the eyelids.

The absence of apoeccrine glands in the human axilla has disease pathogenetic implications, including axillary hyperhidrosis

BACKGROUND

The existence of a third type of sweat gland in human axillary skin, the apoeccrine gland, with a capacity to produce much higher sweat output than the eccrine gland, was proposed from examination of microdissected glands. However, previous studies of axillary skin glands did not examine the entire individual glandular structure via serial sections and the markers used to identify the different glands gave conflicting results and, hence, the existence of the apoeccrine gland remains controversial.

OBJECTIVES

To investigate human axillary sweat glands by serial section histology and immunofluorescence.

METHODS

Human axillary sweat glands were investigated by serial sectioning of paraffin wax-embedded skin samples taken by biopsy from four male and six female volunteers (age range 20-35 years). Sections were examined by light microscopy and immunofluorescence, using antibodies to antigens reported to be markers for discriminating between eccrine and apocrine gland cells: CD15, CD44, S100 and human milk fat globulin.

RESULTS

Light microscopy demonstrated that there were hair follicles and a mean +/- SD of 76 +/- 14 sweat glands cm(-2). Eccrine and apocrine glands were found to be present; however, no glands resembling the apoeccrine glands were detected. Both types of sweat gland exhibited signs of being active, with segments of the secretory coils displaying flattened cells and dilated glandular lumina; however, this dilation did not extend to obvious changes in the width of the gland. None of the eccrine glands exhibited evidence of the presence of apocrine cells or vice versa. Immunofluorescence markers were found not to be specific and did not discriminate between the different types of glands or demonstrate the presence of apoeccrine glands.

CONCLUSIONS

This is the first time that serial sections of axillary skin have been examined by histology and immunofluorescence. The markers reported to discriminate between apocrine and eccrine glands were found to be nonspecific. No evidence of apoeccrine glands was found either by histology or by immunofluorescence.

Morphology of the intermandibular gland of the Lesser mouse deer, Tragulus javanicus

The morphology of the intermandibular gland of the Lesser mouse deer (Tragulus javanicus), which plays an important function in marking area and territory and in the reproductive behaviour of the animal, was examined using immunohistochemistry, lectin histochemistry and scanning electron microscopy. The gland was composed of sebaceous and apocrine glandular material. Sebaceous glands occupied a greater area of the total gland and consisted of many large lobules with polyhedral cells having a pale cytoplasm. The sebaceous gland, being holocrine, possessed no special secretory ducts. The apocrine gland was lined by cuboid cells and the secretory products were often seen in the apical portions of the cells. Myoepithelial cells contained actin filaments lining the basal membranes of the apocrine gland and were surrounded by nerve fibres which immunostained with protein gene product 9.5. The secretion of the gland appears to be a mixture of larger amounts of lipid material from sebaceous glands, and glycoconjugates secreted by both sebaceous and apocrine glands. Lectin histochemistry detected these as galactose, N-acetyl-D-galactosamine, N-acetyl-D-glucosamine, D-mannose and D-glucose. The male gland was larger in size and contained more N-acetyl galactosamine and N-acetyl glucosamine in its secretion than the gland of the female. This implied the presence of sexual differences in secretions in the intermandibular gland of the Lesser mouse deer.

Immunohistochemical Differentiation and Localization Analysis of Sweat Glands in the Adult Human Axilla

BACKGROUND

The classic concept of axillary glands differentiates between eccrine glands, producing abundant clear, nonodorous sweat; and apocrine glands, excreting small amounts of turbid, odorous milky sweat. A third type of sweat glands, the "apoeccrine" glands, were recently identified. To define the different types of sweat glands and their location and number, the authors carried out a prospective histologic study on adult human axillary skin, including various immunohistochemical markers.

METHODS

Forty-three consecutive Caucasian, subjectively normhidrotic patients, who underwent a surgical procedure in the axilla unrelated to the axillary glands, were included in the study. For verification of normhidrosis, the gravimetric test was carried out by measuring the amount of sweat secretion per minute. Then, a 1 x 1-cm measuring piece of skin and subcutaneous tissue was excised in the apex of the axilla, divided into three samples--altogether, 129 samples--and processed for histologic examination.

RESULTS

In the dermis, the authors found only very few eccrine (average, 0.3 gland/cm in only 12 percent of all patients) and apocrine glands (average, 0.1 gland/cm in only 4.7 percent of patients), and no apoeccrine glands in any patient. In the subcutaneous tissue, the mean number of glands per centimeter squared was 10 for the eccrine glands, nine for the apocrine glands, and six for the apoeccrine glands.

CONCLUSIONS

In the authors' Caucasian subjects, all or most of the sweat glands were found in the subcutaneous tissue near the border to the dermis and not in the dermis. For extremely hyperfunctioning sweat glands, the authors recommend less radical surgical methods, with the preservation of skin, based on the knowledge that most glands are localized in the subcutaneous tissue.

Histological Variations in Myoepithelial Cells and Arrectores Pilorum Muscles among Caudal, Metatarsal and Preorbital Glands in Hokkaido Sika Deer (Cervus nippon yesoensis Heude,1884)

The morphological characteristics of myoepithelial cells and arrectores pilorum muscles were investigated in caudal, metatarsal and preorbital glands of Hokkaido sika deer (Cervus nippon yesoensis Heude, 1884) using immunohistochemistry for alpha-smooth muscle actin. In the metatarsal, preorbital and general skin glands, myoepithelial cell layers continuously embraced the secretory epithelium, while in the caudal gland, discontinuous myoepithelial cell rows surrounded the apocrine tubules. There was a trend that the widths of the myoepithelial cells of the caudal and preorbital glands appeared to be thinner than those of the metatarsal and general skin glands. In the metatarsal gland, the arrectores pilorum muscles were highly developed and considerably larger than those in other skin glands.

[Unknown hepatoid glands of some species of cats and deer]

Our histological description of the fourth type of mammalian skin glands--hepatiod glands--allowed us to revise the obtained and published data mistaking the alveolar glands of the anal sacs in cats and the limb glands in deers as sebaceous. Large clusters of hepatiod glands were discovered in the anal sacs of the cat, lynx, and tiger, interdigital gland of elk, and the tarsal gland of reindeer. These glands secrete considerable amounts of protein to the clearance of the intercellular canaliculi and contain hydrophobic lipids. The available data substantiate revision of the data on the structure of many skin glandular organs with atypical sebaceous glands.

Structure and function of human sweat glands studied with histochemistry and cytochemistry

The basic structure and the physiological function of human sweat glands were reviewed. Histochemical and cytochemical techniques greatly contributed the elucidation of the ionic mechanism of sweat secretion. X-ray microanalysis using freeze-dried cryosections clarified the level of Na, K, and Cl in each secretory cell of the human sweat gland. Enzyme cytochemistry, immunohistochemistry and autoradiography elucidated the localization of Na,K-ATPase. These data supported the idea that human eccrine sweat is produced by the model of N-K-2Cl cotransport. Cationic colloidal gold localizes anionic sites on histological sections. Human eccrine and apocrine sweat glands showed completely different localization and enzyme sensitivity of anionic sites studied with cationic gold. Human sweat glands have many immunohistochemical markers. Some of them are specific to apocrine sweat glands, although many of them stain both eccrine and apocrine sweat glands. Histochemical techniques, especially immunohistochemistry using a confocal laser scanning microscope and in situ hybridization, will further clarify the relationship of the structure and function in human sweat glands.

[Morphology of sweat glands]

There are two types of sweat glands: eccrine glands, which do not show cytological changes during secretion and apocrine glands, characterised by decapitation secretion, in which part of the cell is pinched off and released into the lumen. Eccrine glands play a major role in thermoregulation and electrolyte balance. They are present everywhere in the human skin and are composed of a secretory portion, an intradermal duct and an upper intraepidermal part, called acrosyringium. The acrosyringium has a unique symmetrical and helicoidal course, which length is correlated to the thickness of the epidermis. Apocrine glands are located only on genital, axillary and mammary areas, where they are always connected to a hair follicle. Their exact role in humans is unknown. A third type of intermediate sweat glands, the apoeccrine glands, was recently described in axillary areas. Sweat glands can be involved in various inflammatory processes and can lead to a large range of both benign and malignant tumors.

[The structure of the skin of the ear in domesticated pigs, with special reference to their use for human dermatological research. 2. Specific histology of the integument]

Based on light microscopy, the study describes the specific histology of the ear integument of the white domesticated pig. After careful tissue fixation and embedding, routine histological staining, collagen fibre staining, fat demonstration based on frozen sections, and ink injection of the integumental blood vessel system were applied. A detailed description is presented of the structure of the skin layers (epidermis, dermis, hypodermis), the ear cartilage envelopes (fascia, perichondrium), the plica scaphae, the blood vessel distribution, the architecture of the collagen fibre bundles, as well as the hair follicles and the skin glands (sebaceous glands, apocrine tubular glands). The results are discussed with regard to a direct comparison with the histological structure of the human integument, and the advantages and disadvantages of the use of the porcine ear skin as model system in human dermatological research are emphasized.

Histo-physiology of the scent-marking glands of the penile pad, anal pouch, and the forefoot in the aardwolf (Proteles cristatus)

The scentmarking glands of the anal pouch, penile pad, and the forefoot of the aardwolf (Proteles cristatus) were studied by histological, histochemical, immunohistochemical methods, and by electron microscopy. The morphological observations are correlated with eco-ethological aspects of this nocturnal animal. In all studied regions there was a superficial layer of holocrine sebaceous glands and a deeper layer of apocrine scent glands; these two types of glands apparently function in concert. Only in the forefoot were additional tubular glands, resembling eccrine sweat glands found, which may improve the frictional capacities of the paw, while apocrine and holocrine glands serve scent-marking functions of the forefoot. Penile pad and anal pouch are exclusively scent marking organs. The secretion modus of the apocrine glands is both via exocytosis and apocrine mechanism. Homogeneous apical, secretory granules, which contain glycoproteinaceous material, represent evidence for exocytosis. In the anal pouch, additional variably sized granules contain endogenous pigments which are probably responsible for the brownish coloration of the secretory product of the male animals. Variable heights of the glandular cells, frequent apical tall protrusions as well as pinched-off pieces of cytoplasm in the glandular tubules support the concept of an apocrine secretion in the scent glands. The immunohistochemical staining pattern of actin points to the involvement of actin filaments in the pinching-off process of the apical cell protrusion, which does not contain any cell organelles. The variable actin staining patterns suggest a dynamic process during which actin filaments form a ring or sheet at the basis of the pinching-off bleb. Proliferative and apoptotic phenomena show no preference for active and inactive glandular cells suggesting that replacement of cells occurs independently of the functional status of the glands.

Apocrine epithelium of the breast: does it result from metaplasia?

Benign and malignant breast lesions may show an apocrine epithelium considered to be the result of metaplasia. In an attempt to clarify the histogenesis of the breast apocrine epithelium we searched for the presence of apocrine cells or cells with apocrine differentiation during human breast development. We analysed 10 autopsy specimens of female breasts from fetuses between 28 and 40 weeks of gestational age and tissue from 6 normal breasts, obtained after breast reduction in nulliparous young women between 22 and 28 years of age. Formalin-fixed, paraffin-embedded sections were stained with haematoxylin-eosin, PAS-diastase and a monoclonal antibody (BRST-2) anti-GCDFP-15, which is a specific apocrine marker. A 40-week fetal breast was analysed by electron microscopy. No cells with histological and ultrastructural apocrine features were found in the ducts of fetal breasts. All fetal breasts showed some ducts with sparse GCDFP-15-immunoreactive cells; the number of these cells increased with gestational age. PAS-diastase was negative. No cells with apocrine morphology were found in ducts and lobules of normal adult breasts. Scattered GCDFP-15-positive luminal epithelial cells and rare PAS-diastase-positive cells were observed in some lobules of all adult breasts. Cells with biochemical characteristics (GCDFP-15 expression) of apocrine differentiation are evident during human fetal breast development and persist in adult mammary glands. Unknown stimuli may induce these cells to take on an apocrine morphology. Apocrine epithelium of the breast may be a normal process of differentiation rather than metaplasia. We suggest the term "apocrine differentiation precursor cells" for GCDFP-15-positive breast epithelial cells with no apocrine morphology.

Infraorbital glands of a male Formosan serow (Capricornis crispus swinhoei)

The morphology of the infraorbital glands of a male Formosan serow was examined. The glands consisted of an inner sebaceous portion and an outer apocrine portion. The inner sebaceous portion was much larger than that of the male Japanese serow. The sebaceous portion of the gland consisted of the ordinary and modified types of tissue that are present in the infraorbital gland of the female Japanese serow, and the modified tissue contained some melanin granules and melanocytes. The apocrine portion of the glands was composed of tubules in which the myoepithelial cells stained intensely to very weakly upon immunohistochemical staining with antibody against a smooth muscle actin. Nerve fibers that contained calcitonin gene-related peptide were scattered in the apocrine portion. These findings indicate that the sebaceous gland of the male Formosan serow is different from that of the male Japanese serow but rather similar to that of the female Japanese serow. Moreover, the apocrine gland is innervated by peptide-containing nerve fibers.

Morphology of the interdigital glands of a Formosan serow (Capricornis crispus swinhoei)

The morphology of the interdigital glands of a male 9-year-old Formosan serow was examined. The glands were sock-shaped depression of the skin and were present in four feet. The glands were composed of a neck and a body. The epidermis of inner wall of the glands was keratinized stratified squamous epithelium. Apocrine glands were developed, while the sebaceous glands and hair follicles were very poorly developed. Contents, probably dirt, were small in the interdigital glands. These findings resemble to the interdigital glands of the Japanese serow and suggest that the interdigital glands have very low activity of secretion.

[The histological and histochemical characteristics of the hepatoid circumanal glands in the dog: the features of similarity and difference with the skin glands of other types]

Three types of skin glands, the derivatives of the outer root sheath of the hair follicle, have been compared, which are represented by hepatoid, sebaceous and apocrine sweat glands. There are three characteristic properties inherent to hepatoid glands, existence of a network of intercellular secretory tubules, lysis of some secretory cells during the duct formation which is not the fatty transformation and cyst formation.

Morphologic measurements of the external horizontal ear canal of dogs

Microscopic anatomy of the horizontal part of the external ear canal was evaluated in 24 dogs. Sixteen dogs were from breeds known to have a predisposition to otitis externa. The remaining 8 dogs were from breeds that do not have a predisposition to otitis externa. Dogs were separated into groups according to predisposition to otitis externa: group 1-predisposed dogs without otic inflammation, group 2-predisposed dogs with otic inflammation, and group 3-nonpredisposed dogs without otic inflammation. Qualitative microscopic evaluation of distribution of hair follicles revealed hair within proximal, middle, and distal regions of the horizontal ear canal in all breeds. The degree of keratinization was directly proportional to the presence of otic inflammation and was excessive in group-2 dogs. Quality of sebaceous glands within the horizontal ear canal was similar among dogs with and without otitis externa, whereas the quantity of apocrine tubular glands was significantly increased (P less than 0.05) in dogs with otitis. Quantity of apocrine tubular glands was also greater in group-1 dogs than in group-3 dogs. Thickness of the soft tissue in the external ear canal increased in direct proportion to the progression of disease and was greatest in the proximal region of the affected ear canal. Soft tissue located caudally between nonopposing ends of the annular cartilage, within the proximal region of the horizontal ear canal, contained few glands and hair follicles in dogs without otitis externa. In dogs with otitis externa, this region was infiltrated by distended apocrine tubular glands.

Immunohistochemical staining of normal sweat glands

Sweat glands from normal skin obtained at autopsy or as routine biopsies were examined using a panel of immunoperoxidase-linked antibodies. The results indicate that such a panel of antibodies defines all known functional regions of the eccrine sweat gland and provides a reliable distinction from all other skin elements.

An enlarged aggregate of apocrine glands on the chest of karyotype I owl monkeys

A firm circumscribed umbilicated mass in the middle of the chest, overlying the cephalad portion of the sternum, was an incidental finding in the skin of three males and one female from a group of eight (four male and four female) aged karyotype I owl monkeys (Aotus trivirgatus) released to our laboratory from the breeding colony of the Walter Reed Army Institute of Research (WRAIR). Light microscopic examination of each mass revealed an enlarged aggregate of apocrine glands which was interpreted to be the result of hyperplasia. Some degree of enlargement of the aggregate of glands was observed on all adult male karyotype I owl monkeys recently examined at WRAIR.

Changes in sweat glands morphology in cattle before and during heat stimulation

The morphology of apocrine sweat glands in two breeds of cattle, the White Fulani and Friesian was studied histologically using biopsy midside skin samples obtained from the animal at 6.00 a.m. (period 1), 2.30 p. m. (period 2) and 4.00 p. m. (period 3), respectively. Sweat glands with three morphologic types of epithelium were observed. Type 1 consisted of flattened low cuboidal epithelium. Type 2 had tall cuboidal epithelium with cell apical borders slightly indented and the gland lumen narrower than in type 1. A third group of glands had tall columnar epithelial cells (type 3) with bleb-like protuberances on their luminal surfaces. There were also corresponding changes in the morphology of myoepithelial cells from an elongated form in type 1 to a contracted form in types 2 and 3. The morphology of secretory cell surfaces was found to vary with the sampling period; a greater percentage of type 1 glands was seen in period 1 and a preponderance of types 2 and 3 glands (in varying proportions) in periods 2 and 3. Breed differences in the distribution of type of epithelium at various sampling periods were observed. These results are discussed in relation to the functional activity pattern of the sweat glands on stimulation by heat.

Metabolism of testosterone by forehead skin of the roebuck (Capreolus capreolus)

Roebucks have a specialized region of skin on the forehead which contains sebaceous and apocrine glands that produce secretions used in territorial marking. These glands enlarge during the breeding season and regress after the rut as the testes regress. The metabolism of testosterone by this forehead skin in vitro was studied in two captive roebucks over the period of glandular enlargement and subsequent regression, and compared with that of dorsal skin. In May, June and July, both areas of skin actively metabolized testosterone and the metabolites detected were androstenedione, androstanedione, dihydrotestosterone, epiandrosterone, androsterone and 5alpha-androstanediols. There were no major differences in testosterone metabolism between the two body sites, although dorsal skin appeared to be more active in total metabolism than forehead skin. There was a peak in the extent of metabolism in June/July, with a subsequent gradual decline to December. The decline in metabolism occurred at a time when the associated glands were still enlarged, which suggests that the availability of androgen to the skin glands is determined not only by the amount of testosterone in the circulation, but also by a decrease in the metabolizing capacity of the tissue.

The skin of the giraffe

The skin of the giraffe has the same general histological structure as that of other mammals, but there are notable features. The skin is heavily pigmented with the epidermis, pilary canals, and the outer cell layer of the apocrine duct richly melanized. Furthermore, melanotic dendritic cells are frequently found in the sebaceous glands, the entire length of the external root sheath, and the secretory tubules of the apocrine glands. The thick skin has a papillary dermis that extends to just beneath the secretory coils of the apocrine glands and bulbs of hair follicles and an equally thick reticular layer below these structures. The hair follicles do not grow in clusters, and with some regional variations, have associated sebaceous glands, apocrine glands, and arrectores pilorum muscles. Only the large hairs have a prominent medulla. In such specialized regions as the eyelids, nose, and lips, the apocrine glands are surrounded by cholinesterase-reactive nerves but the glands on the general body surface are not. The only specialized nerve receptors are hair follicle end organs found on every hair of the eyelids, nose, and lips, but only rarely elsewhere.

Axillary hidradenitis

The magnitude of the social, economic, and medical problems confronting patients with chronic suppurative axillary hidradenitis is not generally recognized. Nonoperative treatment is disappointing. Total excision of all apocrine-bearing axillary tissue with primary closure is the treatment of choice. Operative treatment can be safely accomplished even when draining sinuses are present. Twenty-six patients representing 47 operated axillae are presented.