Percutaneous Interstitial Nd:YAG Laser Therapy for Axillary Osmidrosis

Contemporary Algorithm for Treating Bromhidrosis: A Review of Treatment Available

Bromhidrosis significantly impacts individuals' social, professional, and emotional well-being. Traditional treatments such as en bloc excision and alcohol injections are now less favored due to associated complications and suboptimal outcomes. Current evidence identifies botulinum toxin A (BTX-A) as the first-line treatment for mild to moderate cases (Grade 0-2), attributed to its high efficacy, excellent safety profile, and minimally invasive nature. BTX-A achieves effectiveness rates exceeding 90%, with results persisting for 3-8 months. A standardized grading system guides treatment selection, reserving surgical interventions for severe cases (Grade 3) or situations where BTX-A is contraindicated. Modern surgical approaches, such as hydrosurgery and endoscopic-assisted procedures, have shown improved outcomes and significantly fewer complications compared to traditional methods. Energy-based therapies, including laser, radiofrequency, and microwave treatments, also provide viable alternatives for patients unsuitable for BTX-A, demonstrating documented efficacy and minimal invasiveness. This review proposes an evidence-based treatment algorithm for bromhidrosis management, highlighting the central role of BTX-A while detailing alternative strategies. The framework integrates disease severity assessment, patient preferences, and cost considerations to support optimal clinical decision-making. By adopting this systematic approach, clinicians can enhance treatment selection and improve patient outcomes.Level of Evidence V 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 .

Experience of negative pressure fractional microneedle radiofrequency therapy for axillary osmidrosis: a case study

BACKGROUND

Negative pressure fractional microneedle radiofrequency (NPFMR) therapy has emerged as a potential minimally invasive treatment for axillary osmidrosis (AO), a condition characterized by persistent strong body odor from the armpit area.

METHODS

This case study aims to assess the efficacy and safety of NPFMR for AO treatment. From January to September 2024, 30 patients with AO were recruited, with a gender distribution of 19 females and 11 males, aged 17-34 years (mean 23). AO was diagnosed based on the presence of strong armpit odor in the absence of significant hyperhidrosis. The severity of AO was classified into four grades. All patients were followed up at 3 months, 6 months and 1 year post-treatment. The efficacy and complications were recorded and assessed.

RESULTS

The efficacy rates observed at 3 months and 6 months post-treatment were 83.67% and 76.67% respectively, with the efficacy rate remaining the same as that at 6 months after 1 year of follow-up. There were four cases of complications, At the 3-month follow-up, three patients developed punctate scars in the treated area, with the largest scar measuring 0.5 cm in diameter. One patient reported a numbness in their upper limb at the 3-month follow-up, which resolved after oral administration of mecobalamin at the 6-month follow-up. The total complication rate for this group was 13.3%.

CONCLUSION

NPFMR therapy demonstrates promising short-term efficacy for AO treatment. However, caution should be exercised due to potential complications, and comprehensive patient education is necessary. Longer-term follow-up studies are needed to evaluate the durability of the therapeutic effects and to monitor for any delayed adverse effects. Strategies for managing complications should also be explored to improve patient care outcomes.

Attempted treatment of primary axillary hyperhidrosis with one session of either Neodymium YAG laser or Intense Pulsed Light: A within patient randomized trial of treated versus untreated contralateral axilla

BACKGROUND

Primary axillary hyperhidrosis (PAH) affects 1-5% of the world's population who has an unmet need for improved treatments. The heating of sweat glands with specific microwave therapy has shown promising results, yet, treatment with widely available devices such as long-pulsed Neodymium Yttrium Aluminum Garnet (Nd:YAG) lasers, diode lasers or Intense Pulsed Light (IPL) may serve as pragmatic alternatives.

OBJECTIVES

To compare sweat secretion of treated versus untreated contralateral control axilla 1-3 months after one session of Nd:YAG laser or IPL in patients with PAH.

METHODS

A within-person randomized controlled trial. Patients were randomized to receive either one session of Nd:YAG laser or IPL in one axilla with the contra-lateral serving as control. Sweat production was assessed by gravimetry, trans-epidermal water loss, hyperhidrosis disease severity scale and dynamic optical coherence tomography. Mixed-effects models were used to handle the within-person design, containing both fixed effect factors (side, group, and subgroup), and random effects (patients), while also adjusting for the level at baseline.

RESULTS

A total of 20 patients were enrolled. At follow-up 1-3 months after treatment, sweat secretion was not affected in the treated axilla when compared to the control axillae (0.01 [95%CI: -0.04 to 0.05]; p = 0.68). In the Nd:YAG subgroup (10 patients), least squares means for sweat secretion was 0.18 mg/5 min in the treated versus 0.15 mg/5 min in the control axilla, respectively, corresponding to a statistically insignificant mean difference of 0.02 mg/5 min (95% CI: -0.06 to 0.11; p = 0.54). In the IPL subgroup (10 patients), sweat secretion was 0.06 mg/5 min in the treated axilla versus 0.07 mg/5 min in the control axilla with a statistically insignificant difference of -0.01 points (95% CI: -0.03 to 0.02; p = 0.46). Likewise, none of the secondary outcomes were significantly affected by treatment. However, both treatments appeared safe and well tolerated with no adverse effects reported at follow-up.

CONCLUSIONS

One treatment with external 1064 nm Nd:YAG laser or 640 nm IPL at commercially available settings, failed to demonstrate clinical benefit in treating PAH, with narrow confidence intervals implying that this was not due to a type-2 error.

Clinical efficacy of microwave in the treatment of axillary osmidrosis and primary hyperhidrosis

BACKGROUND

Axillary osmidrosis(AO) and primary hyperhidrosis(PH) are common diseases, but there are still difficulties in treatment. Microwave therapy may become a new method.

OBJECTIVE

To evaluate long-time efficacy of patients with AO or PH treated by microwave. To discuss possible mechanism of microwave therapy by combining results of clinical and pathological.

METHODS

Ten AO or PH patients with moderate or severe level were selected as subjects, and each subject received microwave treatment of bilateral armpits. The follow-up period lasted two years,and the changes of perspiration and odor were evaluated in subjective and objective ways. Each subject took skin biopsy in the treatment area before and after treatment or each follow-up. HE and immunohistochemical staining were performed.

RESULTS

Both subjective and objective index reflected the significant improvement of AO and PH after treatment(P<0.05). Dermatology life quality index score decreased by 10.4±4.6(P<0.05). The number of apocrine glands decreased significantly after treatment, and most of them changed from secretory phase to quiescent phase.

CONCLUSIONS

Microwave therapy can destroy apocrine sweat glands, reduce number of functional glands, so as to improve symptoms of AO and PH and elevate quality of life, which is safe, effective and stable. This article is protected by copyright. All rights reserved.

The Lipocalin Apolipoprotein D Functional Portrait: A Systematic Review

Apolipoprotein D is a chordate gene early originated in the Lipocalin protein family. Among other features, regulation of its expression in a wide variety of disease conditions in humans, as apparently unrelated as neurodegeneration or breast cancer, have called for attention on this gene. Also, its presence in different tissues, from blood to brain, and different subcellular locations, from HDL lipoparticles to the interior of lysosomes or the surface of extracellular vesicles, poses an interesting challenge in deciphering its physiological function: Is ApoD a moonlighting protein, serving different roles in different cellular compartments, tissues, or organisms? Or does it have a unique biochemical mechanism of action that accounts for such apparently diverse roles in different physiological situations? To answer these questions, we have performed a systematic review of all primary publications where ApoD properties have been investigated in chordates. We conclude that ApoD ligand binding in the Lipocalin pocket, combined with an antioxidant activity performed at the rim of the pocket are properties sufficient to explain ApoD association with different lipid-based structures, where its physiological function is better described as lipid-management than by long-range lipid-transport. Controlling the redox state of these lipid structures in particular subcellular locations or extracellular structures, ApoD is able to modulate an enormous array of apparently diverse processes in the organism, both in health and disease. The new picture emerging from these data should help to put the physiological role of ApoD in new contexts and to inspire well-focused future research.