Minimally invasive approaches to axillary osmidrosis treatment: A comparison between superficial liposuction with automatic shaver curettage, subcutaneous laser treatment, and microwave‐based therapy with a modified technique

Evaluation of Efficacy and Safety of miraDry® Procedure in the Treatment of Primary Axillary Hyperhidrosis

INTRODUCTION

Primary axillary hyperhidrosis significantly impacts the quality of life of affected individuals. miraDry®, a non-invasive local precisely controlled thermal energy procedure, represents a promising treatment option. This retrospective analysis aimed to evaluate the treatment success and patient safety following miraDry® procedure in the treatment of primary axillary hyperhidrosis.

MATERIAL AND METHODS

A total of 139 patients receiving miraDry® procedure from 2019 to 2023 with miraDry® fresh protocol for treatment of excessive axillary hyperhidrosis were analyzed. Subjective assessment was performed before and after treatment using hyperhidrosis disease severity scale (HDSS). Minor test (iodine starch test) was done before treatment and 6 months after treatment to objectively quantify sweat severity. Patients with subjective or objective unsatisfied results after first procedure were scheduled for a second treatment.

RESULTS

The majority of treated patients (84%) could effectively be treated with one single treatment, while only 16% (n = 22) required a secondary intervention. HDSS after treatment completion (single and double treatment) showed a significant improvement (p < 0.001) in subjective evaluation of the treatment success. Minor tests demonstrated a significant reduction in sweat severity (p < 0.001), with 95% of patients experiencing no or minimal sweating after treatment completion. The miraDry® procedure demonstrated a favorable safety profile with typical and transient treatment reactions that mostly resolved within 6 months (94.2%) CONCLUSION: Our data demonstrate that miraDry® procedure is an effective and safe treatment option for primary axillary hyperhidrosis, which results in an immense improvement in quality of life and high satisfaction of affected individuals.

LEVEL OF EVIDENCE II

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Negative pressure assisted rubbing suction technique for the treatment of axillary osmidrosis based on minimally invasive principle

BACKGROUND

Axillary Osmidrosis is highly prevalent and occurr in adolescents, bilateral onset, its pathogenesis is related to abnormal secretion function of apocrine glands, with a significant genetic predisposition, the patient's bilateral armpit area can smell a spicy pungent odor, although it does not affect the health, but it is inconvenient to life, socialize. Patients are often accompanied by low self-esteem and urgently require treatment, and most of them have the requirement of minimally invasive treatment and minimal scarring.

METHOD

In this study, we aimed to evaluate the efficacy of minimally invasive treatment of axillary osmidrosis with refined negative pressure-assisted rubbing suction technique. From August 2022 to August 2023, 50 patients (28 females and 22 males) with axillary osmidrosis were treated with refined negative pressure-assisted rubbing suction technique. HE staining of the tissue rubbed out of six of these patients showed a large amount of apocrine gland.

RESULTS

In the subjective evaluation of 50 (100 sides) patients, 66 sides (66 %) were very satisfied with the results of the treatment, 30 sides (30 %) were satisfied, and 4 sides (4 %) were dissatisfied. Clinical efficacy evaluation showed that 74 sides (74 %) of patients rated the results as cured, 18 sides (18 %) as significantly effective, 4 sides (4 %) as effective, and 4 sides (4 %) as ineffective. No serious surgical complications occurred except for the occurrence of Subcutaneous hydrops and hematoma on 6 sides.

CONCLUSIONS

Refined negative pressure-assisted rubbing suction technique is an easy and effective method for minimally invasive treatment of axillary hyperhidrosis and deserves clinical promotion.

Patient satisfaction after miraDry® treatment for axillary hyperhidrosis. Results of an online patient survey after miraDry® treatment to reduce excessive axillary sweating

Hyperhidrosis, with a prevalence of 1 to 2% of the population, primarily affects young people under 40 years of age. The individually perceived burden of odor and amount of sweat leads to a reduced quality of life. In recent years, conservative and surgical measures have been used to treat hyperhidrosis. The miraDry® method based on microwave technology is a non-invasive treatment that enables comparable results in terms of effectiveness while at the same time reducing the burden. In the Park-Klinik Birkenwerder, 282 hyperhidrosis patients were treated with the miraDry® method between 2017 and 2024. An online survey was conducted in May and June 2024. 220 patients were contacted, the results of 80 patients are available (response rate: 36.4%). Changes in the restrictions caused by increased sweating in various areas of life were asked before and after the treatment. In addition, the assessment of general quality of life before and after the treatment was compared. There is a significant reduction in restrictions and a corresponding increase in quality of life after treatment with miraDry®. Satisfaction with the method is high, which is reflected in a high recommendation rate of over 80%.

New developments in cosmetic applications of electromagnetic fields: Client and occupational hazard assessment

Energy-based devices are used to improve features of appearance for aesthetic reasons while avoiding more invasive methods. Examples of treatment targets are the reduction of wrinkles, sagging, unwanted skin lesions, body hair and excess fatty tissue, and the enhancement of muscle tissue. One treatment modality is the use of electromagnetic fields (EMF, 0‒300 GHz). The present work aims to give an up-to-date survey of cosmetic applications of EMF for professional use with an assessment of client and worker exposure and possible adverse effects. A systematic search was conducted for peer-reviewed articles (2007-2022), patents, premarket notifications, manufacturer data, and adverse effects reports. Five categories of cosmetic EMF device with increasing frequency were identified: sinusoid low frequency magnetic fields for lipolysis; pulsed low frequency magnetic fields for skin rejuvenation; pulsed low frequency magnetic fields for muscle building; radiofrequency EMF for lipolysis or skin rejuvenation; microwaves for hair removal or hyperhidrosis. In the vicinity of the last four device categories, there is a potential for exceeding the occupational exposure limits in the European Union EMF Directive, which could lead to nerve or muscle stimulation, burns or overheating. There are also potential hazards for clients or workers wearing active or passive medical devices. The severity of reported adverse effects increases with EMF frequency.

Comparison of Microwave-Based Therapy and Negative-Pressure Suction-Curettage for Axillary Hyperhidrosis and Bromhidrosis: A Retrospective Analysis

BACKGROUND

Axillary hyperhidrosis and bromhidrosis are common clinical diseases, affecting the patients' work and life. Negative-pressure suction-curettage is the most popular treatment now, but challenged by a new microwave-based therapy (MiraDry). We intend to compare the safety and efficiency of the 2 treatments.

METHODS

A retrospective analysis of 39 female patients with both primary hyperhidrosis and bromhidrosis was conducted. Seventeen patients were treated with MiraDry, and 22 underwent negative-pressure suction-curettage. The postoperative follow-up program included sweat and odor assessments, satisfaction measurement, safety evaluation, and recurrence assessment at different time points until 12 months.

RESULTS

Both treatments showed a significant reduction (P < 0.05) in HDSS score and odor level at 6 and 12 months compared with the baseline. No significant difference in relative reduction was observed between the 2 groups. The satisfaction score of the microwave-based therapy group was higher than that of the negative-pressure suction-curettage group, but no statistical difference was found. The difference in the recurrence rate and complication rate between the groups did not reach significance.

CONCLUSIONS

Microwave-based therapy is a noninvasive treatment with durable effects, low risks, shorter downtime, good appearance, and high satisfaction for axillary hyperhidrosis and bromhidrosis.

Clinical Efficacy, Safety, and Complications of the Arthroscopic Cartilage Shaving Procedure for Secondary Osmidrosis Treatment

BACKGROUND

Axillary osmidrosis is a common disease with negative psychosocial impact on patients. Further, many treatment modalities are not sufficient and result in recurrence.

OBJECTIVE

We aimed to evaluate the effectiveness and safety of using a cartilage shaver in patients with recurrent osmidrosis to remove tightly attached apocrine glands and subdermal scars.

METHODS

We retrospectively evaluated 24 patients with secondary axillary osmidrosis who underwent cartilage shaving surgery between January 2013 and May 2022. We analyzed the incidence of complications, including seroma, infection, pigmentation, wound dehiscence, skin necrosis, scarring, shoulder movement limitation, comedones/sebaceous cysts, and nerve injury. Clinical effectiveness was also evaluated.

RESULTS

Excellent or good efficacy with improved malodor was achieved in 24 patients (47 axillae [100%]). Complications were observed in 16 (36.17%) axillae, including hematomas (n = 2), pigmentation (n = 7), skin necrosis (n = 3), and comedones/sebaceous cysts (n = 4); one patient (2.13%) required local debridement. Mean Vancouver Scar Scale scores were markedly low (5.41 to 4.67). Scar tissue did not interfere with the shaving surgery, allowing for successful removal of the apocrine glands.

CONCLUSIONS

Secondary osmidrosis treatment using a cartilage shaver system yielded satisfactory and better scar results than the patients' previous treatments.

Effect of optimizing the use of endoscope on the efficiency of microdynamic bromhidrosis removal operation

BACKGROUND

Bromhidrosis, also known as body odor, is a common disease in life, which often occurs in young adults. The histological basis of bromhidrosis is the hyperplasia of apocrine sweat glands.

OBJECTIVE

To compare the effects of different methods of endoscopy in microdynamic axillary osmidrosis removal on curative effect, complications, and surgical efficiency.

METHODS

A total of 149 patients with axillary osmidrosis were treated in our hospital from January 2020 to December 2021. They were treated with endoscopic assistance in the whole process of operation (Group A) and endoscope-assisted exploration after blind rotary cutter suction (Group B), respectively, and the curative effect, complication rate, and surgical efficiency were evaluated.

RESULTS

There was no significant difference in the curative effect and complication rate between the two groups, but the endoscope-assisted exploration group after suction with rotary cutter (Group B) had higher surgical efficiency.

CONCLUSION

On the basis of professional use of rotary cutter, it is efficient to choose endoscope to check the excision of sweat gland in the operation area and stop bleeding in time after blind suction.

Impact of microwave thermolysis energy levels on patient-reported outcomes for axillary hyperhidrosis and osmidrosis

OBJECTIVE

Microwave thermolysis (MWT) is an emerging treatment for axillary hyperhidrosis reducing both sweat and odor. No prior studies have investigated and compared the different available energy settings of the MWT device. This study evaluated patient-reported outcome measures (PROMs) for axillary hyperhidrosis and osmidrosis following MWT treatment with two different energy levels.

METHODS

Twenty adults with axillary hyperhidrosis and osmidrosis reported sweat on Hyperhidrosis Disease Severity scale (HDSS: 1-4) and odor on Odor scale (OS: 1-10), respectively, supplemented by overall Dermatology Life Quality Index (DLQI: 0-30). This was a prospective, randomized, patient-blinded and intraindividually controlled study with 3 months follow-up (FU). Randomization comprised MWT treatment of one axilla with a standard medium energy setting (energy level 3) and the contralateral axilla with a standard high energy setting (energy level 5).

RESULTS

At baseline, patients reported substantial sweat and odor, negatively affecting their quality of life. At 3 months FU, PROMs showed improved quality of life with significantly reduced odor and sweat. Overall DLQI was reduced from a median of 10 to 4, with a median 6.5-point reduction (p = 0.0002). HDSS was reduced from a median of 4 to 2 on both sides, with a median reduction of 1 for medium energy level and 2 points for high energy level (p = 0.014). OS was reduced from a median of 8 to 3 for both energy levels, with a median reduction of 3.5 and 4.5 points for the medium and high energy level, respectively (p = 0.017). Local skin reactions were mild and transient, but slightly more pronounced following treatment with the high energy level.

CONCLUSION

MWT effectively improved patients' quality of life, axillary sweat, and odor 3 months after on baseline treatment. Treatment with the high energy level presented a subtle but significant increase of efficacy based on PROMs for both sweat and odor. Patients were willing to accept a higher amount of temporary local skin reactions from a higher energy setting when experiencing greater odor and sweat reduction.

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.

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.

Comparison of Long-Term Effectiveness and Safety of Microwave and Surgery in the Treatment of Axillary Osmidrosis: A Single-Center Retrospective Study

BACKGROUND

A microwave-based device is a newly developed method for treating axillary osmidrosis. Few studies have compared the difference between microwave therapy and subcutaneous curettage for axillary osmidrosis.

OBJECTIVE

To compare the long-term effectiveness, complications, and recurrence of osmidrosis after microwave therapy and subcutaneous curettage.

METHODS AND MATERIALS

Medical records of 155 patients with osmidrosis treated with microwave therapy or subcutaneous curettage were reviewed retrospectively. Demographic data, visual analog scale for odor, hyperhidrosis disease scale, complications, and recurrence were analyzed.

RESULTS

Osmidrosis improved significantly in both treatment groups at 6 months. Effective improvement was observed in 90% and 23% of the patients in the surgery and microwave groups, respectively, after 3 years postoperatively. The recurrence rates were 39% and 21% in the microwave and surgery groups, respectively. The transient complication rate was higher in the microwave group, and long-term complications only occurred in the surgery group.

CONCLUSION

Subcutaneous curettage is a more effective approach for axillary osmidrosis. However, microwave therapy is recommended for patients with cosmetic concerns.

Effectiveness and safety of the improved mini-incision surgery for osmidrosis treatment

BACKGROUND

As the mainstream treatment of axillary osmidrosis, surgical treatment is still limited by various complications, such as paresthesia, scars, local infection, hematoma, flap necrosis, and long recovery time. In this study, we tried to adopt the improved mini-incision surgery for osmidrosis treatment.

OBJECTIVES

The paper aims to evaluate the clinical effectiveness and safety of the improved mini-incision surgery for axillary osmidrosis treatment.

PATIENTS/METHODS

Clinical series of patients underwent improved mini-incision surgery were retrospectively reviewed. Dates of complications, including paresthesia, scars, infection, hematoma, skin necrosis, and recurrence were analyzed.

RESULTS

Among 61 cases, 58 cases had a preoperative osmidrosis score of 3 and 3 cases had a preoperative score of 2; while 13 cases had a postoperative osmidrosis score of 0, 43 cases had a postoperative score of 1 and 5 cases had a postoperative score of 2, significantly lower than that before (p < 0.001). A total of 12 axillae complications occurred, 2 axillae (1.6%) had paresthesia; 5 axillae (4.1%) had hematoma; 2 axillae (1.6%) had local flap necrosis due to hematoma; and 3 axillae (2.4%) had hypertrophic scars.

CONCLUSIONS

The results showed that the improved mini-incision surgery was safe and effective for osmidrosis treatment.

A case series evaluating microwave-based therapy for axillary hyperhidrosis and bromhidrosis

INTRODUCTION

Axillary hyperhidrosis and bromhidrosis have serious social, emotional, and professional consequences. There are several treatments of axillary hyperhidrosis. We present a case series evaluating the efficacy and safety of microwave device for axillary hyperhidrosis and bromhidrosis.

MATERIALS AND METHODS

Seven patients were included in our case series. Four patients had both hyperhidrosis and bromhidrosis. Three patients had only hyperhidrosis. To evaluate the degree of hyperhidrosis and degree bromhidrosis a self-reported Hyperhidrosis Disease Severity Scale (HDSS) score and 4-point malodor grade were assessed. All patients underwent 1 or 2 microwave treatments. Patients underwent a survey on treatment outcomes and adverse effect conducted through telephone 12 months after their last procedure.

RESULTS

Six of seven patients had a 2-point drop in HDSS score. The four patients with bromhidrosis had a 2-point drop on the self-reported malodor measurement 12 months post treatment. Minor adverse effects related to the therapy occurred.

CONCLUSION

This novel microwave-based treatment was effective for the treatment of axillary hyperhidrosis and bromhidrosis. Patient satisfaction with the procedure is high, and adverse events are typically transient and well tolerated.

Open versus Closed Surgery for Axillary Osmidrosis: A Meta-Analysis of Articles Published in Four Languages

Background

Individuals with axillary osmidrosis suffer detrimental effects to their psychosocial functioning. In Asian nations, major operations for axillary osmidrosis include subdermal excision (open surgery) and suction-curettage (closed surgery).

Objective

The aim of this meta-analysis was to determine which of these two procedures is most favorable in terms of safety and efficacy.

Methods

According to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guideline, we searched electronic databases for articles published in English, Japanese, Korean, and Chinese languages. Fixed-effects model meta-analyses of odds ratios (OR) and 95% confidence intervals (CI) were conducted, and the I² was used to assess heterogeneity. Complication rates, recurrence/ineffectiveness rates, and patient satisfaction data were extracted and compared between open and closed surgeries.

Results

Our search yielded 8 articles that include 1,179 patients; 560 underwent open surgery, and 619 underwent closed surgery. Our meta-analysis revealed that suction-curettage had a significantly lower risk of acute adverse events than open excision (OR, 0.15; 95% CI, 0.07~0.32), whereas open excision was significantly superior to suction-curettage for recurrence/ineffectiveness rate (OR, 2.90; 95% CI, 1.37~6.15). Patient satisfaction was equally high with both treatments (OR, 1.58; 95% CI, 0.69~3.60).

Conclusion

Since surgical treatments for axillary osmidrosis have been performed mostly in East Asian nations, it was meaningful to review articles published in four languages. This meta-analysis revealed that closed surgery was safer but less effective than open surgery. However, both patient groups expressed high satisfaction with the outcomes. Our results may be helpful for deciding surgical treatment options.

Removing the apocrine sweat glands with nasal endoscope assisted suction cutter: a new technique in the treatment of axillary odor

OBJECTIVE

Removing the apocrine sweat glands with nasal endoscope assisted suction cutter is a new technique that we have explored for the treatment of axillary odors. The aim is to introduce this new technique, compare it with traditional treatment and study the efficacy and patients satisfaction it brought about.

METHOD

A total of 82 patients (164 sides) with axillary odor were treated, 49 patients (98 sides) were treated with subcutaneou endoscopic assisted suction cutter, and 33 patients (66 sides) were treated with small-cut trimming. The efficacy of postoperative recovery was evaluated according to Tung grading method, and postoperative complications and satisfaction rate were also included in the comparative evaluation.

RESULT

The combined efficiency of nasal endoscope assisted suction cutter [100% (98/98)] was significantly higher than that of small-cut trimming [89.39% (59/66)] χ² = 10.857, p < .01. The complications in the nasal endoscope assisted suction cutter group [4.08% (4/98)] were significantly lower than those in the small-cut trimming group [25.76% (17/66)]. χ² = 16.596, p < .01. Patients satisfaction of nasal endoscope assisted cutting aspirator group was higher.

CONCLUSION

Remove the apocrine sweat glands with nasal endoscope assisted suction cutter, as a new feasible technology, is more effective than small-cut trimming method in the treatment of axillary odor.

A retrospective study on comparing the surgery and microneedles radiofrequency and microwaves treatment in axillary osmidrosis

Objective: To compare the traditional treatment of minimally invasion surgery with the evolving treatments of microneedles radiofrequency and microwaves, this study mainly focused on the clinical efficacy and the incidence rate (IR) of complications among three treatments.Methods: From August 2017 to August 2018, a total of 76 patients with bilateral axillary osmidrosis were enrolled respectively underwent minimally invasion surgery, microneedles radiofrequency and microwaves treatment. All these subjects were evaluated the clinical outcomes and collected the complications by themselves or physicians. The difference of objective recovery or effective rate, subjective effective rate, the intense of sweat secretion or armpits hair, IR of complications among these three groups were studied.Results: The baseline characteristics of 33 patients in surgery group, 24 patients in microneedles group and 19 patients in microwaves group were similar. Firstly, the objective clinical efficacy was similar, but the subjective effective rate in surgery group was the soundest. In addition, the reduction of sweat secretion was homologous in three group, but the intense of armpits hair reduction in microneedles group was the minimum in three groups. Moreover, surgery treatment caused the highest IR of complications and the broadest types of complications, especially for the IR of 87.9% in postoperative scar formation. Meanwhile, the microwaves treatment had the best safety profile. At last, the recurrence rate on 6 months postoperatively was also identical with no significant difference.Conclusions: For the advantages and disadvantages of these three treatments, axillary osmidrosis patients should choose the proper therapy with comprehensive considerations.