Subcutaneous Laser Treatment of Axillary Osmidrosis: A New Technique

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.

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

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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.

Excision of apocrine glands with preservation of axillary superficial fascia for the treatment of axillary bromhidrosis

BACKGROUND

Axillary bromhidrosis is a distressing problem, which has a strong negative effect on one's social life.

OBJECTIVE

To evaluate the effects and complications of the surgical modality for the treatment of axillary bromhidrosis.

METHODS

One hundred fifteen patients with axillary bromhidrosis were treated. Two incisions were made transversely along the marked lines on the axillary crease. Subdermal undermining of the marked area with a depth of 0.3 to 0.5 cm and transverse detachment were performed, allowing the exposure of the skin flaps. Skin flaps were carefully separated from the skin. The apocrine glands, follicles, and fats were dissected, and the axillary superficial fascia was maintained.

RESULTS

All patients achieved good results in terms of malodor elimination during the follow-up period. All patients reported reduction in axillary sweating. Postoperative complications were minor, including small hematoma (3 cases), delayed wound healing (5 cases), pressure blister (5 cases), and slightly wound scar (2 cases). No infection, skin necrosis, malodor, or recurrence was observed. One hundred eleven patients (96.5%) were very satisfied and 4 (3.5%) patients satisfied with the procedure, with none regretful.

CONCLUSION

The procedure has the advantage of a high success rate in radical elimination of the malodor with minor complications.

Surgical treatment of axillary hyperhidrosis by suction-curettage of sweat glands

Suction curettage is a dermatologic surgery technique for the treatment of axillary hyperhidrosis, which is becoming more popular.

OBJECTIVE

The purpose of this study is to describe the current technique of removal of axillary sweat glands, and evaluate its efficacy and safety.

CONCLUSION

Suction-curettage of sweat glands is a minimally invasive surgical technique that is easy to perform, safe, has high rates of success and relatively few side-effects. It is generally well tolerated by patients and requires shorter time away from daily activities, when compared with other surgical modalities.

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.

Management of hyperhidrosis

Primary hyperhidrosis (HH), a condition of sweating in excess of thermoregulatory requirements, affects nearly 3% of the US population and carries significant emotional and psychosocial implications. Unlike secondary HH, primary HH is not associated with an identifiable underlying pathology. Our limited understanding of the precise pathophysiologic mechanism for HH makes its treatment particularly frustrating. However, a wide array of interventions for the treatment of HH have been implemented throughout the world. Herein, we discuss the most extensively studied therapeutic options for primary HH, including systemic oxybutynin, botulinum toxin injections, skin excision, liposuction–curettage, and sympathotomy/sympathectomy. We conclude with a discussion of possible future therapies for HH, including the applications of laser, microwave, and ultrasound technologies.

A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis

BACKGROUND

Surgery for bromhidrosis has a high risk of complications such as hematoma and necrosis. New nonsurgical methods may reduce the burden on surgery and the risks for the patient.

OBJECTIVE

This study was performed to evaluate the efficacy and side-effects of the 1,444 nm Nd:YAG interstitial laser for treating axillary bromhidrosis.

METHODS

Eighteen bromhidrosis patients were treated with a 1,444 nm Nd:YAG laser at Korea University Ansan Hospital. The post-treatment follow-up was 6 months. After the procedure, we confirmed apocrine gland destruction through histopathological examination. At each follow-up, we measured the severity of the remaining odor, postoperative pain, degree of mobility restriction, and overall satisfaction.

RESULTS

After 180 days of follow-up, malodor elimination was good in 20 axillae, fair in 12 axillae, and poor in four axillae. At the end point of the study, 14 patients were totally satisfied with the laser treatment, three patients were partially satisfied, and one patient was disatisfied. Pain and limitation of mobility were significantly reduced within 1 week post-operatively, and were almost resolved within 4 weeks post-operatively. A histopathological examination revealed decreased density and significant alterations to the apocrine glands.

CONCLUSION

Subdermal coagulation treatment with a 1,444 nm Nd:YAG interstitial laser may be a less invasive and effective therapy for axillary bromhidrosis.

[Dermatosurgical therapy of hyperhidrosis]

Among the various forms of focal hyperhidrosis, axillary hyperhidrosis is treatable by dermatologic surgery. The historical development of the methods is presented and reflects the desire to achieve maximum effect with minimum tissue defects. The current status and the indications of the individual methods are demonstrated in study data.

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

Background

Axillary osmidrosis is characterized by an unpleasant odor, profuse sweating, and in some instances, staining of clothes that may socially and psychologically impair affected individuals. Various types of surgical procedures have been developed for the treatment of axillary osmidrosis. This study was undertaken to evaluate the effectiveness of subcutaneous pulsed neodymium: yttrium-aluminum-garnet (Nd-YAG) laser treatment for the treatment of axillary osmidrosis.

Methods

Twenty-nine patients with axillary osmidrosis were included in this study. Patients were categorized according to the results of an axillary malodor grading system, and a subcutaneous pulsed Nd-YAG laser was applied to all patients. The treatment area for the appropriate distribution of laser energy was determined using the iodine starch test (Minor's test) against a grid pattern composed of 2×2 cm squares. The endpoint of exposure was 300 to 500 J for each grid, depending on the preoperative evaluation results. The results were evaluated by measurement of axillary malodor both pre- and postoperatively using the grading system and iodine starch test.

Results

The average follow-up period was 12.8 months. Nineteen patients had a fair-to-good result and ten patients had poor results. The postoperative Minor's test demonstrated that there were remarkable improvements for patients with mild to moderate symptoms. Complications including superficial second degree burns (n=3) were treated in a conservative manner. A deep second degree burn (n=1) was treated by a surgical procedure.

Conclusions

Subcutaneous pulsed Nd-YAG laser has many advantages and is an effective noninvasive treatment for mild to moderate axillary osmidrosis.

Surgical subcision as a cost-effective and minimally invasive treatment for axillary osmidrosis

BACKGROUND

Axillary osmidrosis, characterized by unpleasant odor and occasional staining of clothing, is a personal discomfort and social impairment for people who suffer from it. Various types of surgical procedures involving instrumented-assisted tools (lasers, ultrasonic, endoscope, and others) have shown relatively positive results; however, for patients in developing countries, especially in China, these treatments are inconvenient and cost-ineffective.

OBJECTIVE

To introduce a minimal incision surgical procedure with skin flap treatment that removes the apocrine sweat glands in the subcutaneous tissue through a 1-cm-long incision without instrument-assisted tools.

METHOD

From July 2005 to October of 2007, 108 patients (68 women and 40 men) were treated with the minimal incision and cost-effective surgical treatment by manual excision. A 1-cm-long incision is made in the axillary crease. Subcutaneous tissue and glands were removed with scissors through this incision. This procedure is repeated throughout the entire axilla until the axilla has essentially become a super-thin flap.

RESULT

Malodor elimination was good in 206 out of 215 axillae (95.8%) treated, fair in nine (4.2%), and poor in zero (0%). The resulting scar is small and virtually invisible because it is only 1-cm long and located in the axillary crease.

CONCLUSION

Treatment of axillary osmidrosis by manual excision through a 1-cm incision is a convenient, efficient, cost-effective, and relatively safe technique that results in high patient satisfaction and benefits patients and surgeons in developing countries. Axillary osmidrosis, a non-life-threatening condition characterized by unpleasant odor and occasional staining of clothing, is an annoying problem, particularly in Asian societies. For many people who suffer from this problem, this condition is a personal discomfort, a social impairment, and discourages patients from enjoying social or personal activities, especially young women. They are usually embarrassed by the smell during their daily activities and communication with other people.