Bromhidrosis is generally diagnosed when noticeable body odor has a Treatment of axillary bromhidrosis through a mini-incision with. Bromhidrosis is a condition of abnormal or offensive body odour, to a large extent The two main factors to consider when treating bromhidrosis are to. Bromhidrosis is a disease presenting as malodor caused by interaction between the discharge of apocrine glands and bacteria. The main therapeutic modalities.
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Bromhidrosis is a disease presenting as malodor caused by bromhidrosix between the discharge of apocrine glands and bacteria. The main therapeutic modalities are applying topical agents, liposuction surgery, and elective surgery. Among these, elective surgery is reported to be most effective.
However, the efficiency largely depends on surgical technique. Additionally, other side effects, such treatmwnt hematoma and scarring, are occasionally reported. Currently, CO 2 laser and 1, nm Nd: YAG laser therapy are used, but as the bromhidroiss is not specific to apocrine glands, these laser therapies have certain limitations.
The use of this laser for bromhidrosis therapy targeting apocrine sweat glands is currently being discussed. Still, no studies bromhidrosjs practical clinical use and side effects of this 1, nm wavelength laser have been published. We compared the efficacy of this laser therapy to the surgical modality by measuring malodor severity and overall satisfaction by questionnaire.
We also checked for other complications and recurrence for 12 months after the treatment. This patient was largely satisfied as it has a much shorter down time with treatkent same therapeutic outcome. As subdermal coagulation treatment by 1, nm Nd: YAG laser may be less invasive but effective therapy, we would like to recommend this modality as a possible treatment option.
Axillary bromhidrosis is a condition that generates an offensive odor due to interactions between apocrine gland secretions and bacteria. Laser therapy for axillary bromhidrosis with either a CO 2 laser or 1, nm Nd: YAG laser has been reported 1. However, treatment using a 1, nm Nd: YAG laser has not been reported. Herein, we report a patient treated with a 1, nm Nd: YAG laser for bromhudrosis bromhidrosis and compared its effectiveness and complications with those of conventional surgical intervention.
A year-old female presented with malodor in both axillae aggravated since adolescence. She had no medical history, but a maternal family history of axillary bromhidrosis treqtment present. On examination, wet earwax in both ears was noted.
Serious hyperhidrosis was diagnosed based on the clinical rbomhidrosis. We decided to treat the left axilla with the 1, nm Nd: Both axillary areas were anesthetized with 24 ml of 0. As the 1, nm Nd: YAG laser is highly absorbed by water which becomes heat energy, tumescent anesthesia was not used to avoid unwanted thermal damage via heated tumescence.
Apocrine glands in the subcutaneous and dermal layers were destroyed by irradiating 1, J of laser at 1, nm with mJ of pulse energy at a pulse rate of 40 Hz power 7 W using a fiber type internal probe via G needle puncture sites Fig. The amount of energy applied was based on the surface temperature elevation and the extent treattment fat dissolution assessed by the operator’s hands.
No liposuction was performed. The G needle puncture sites were not sutured, and bromhidrosie operative area was not compressed. Modified Inaba’s surgery was performed on the right side. After local anesthesia, a 2-cm long single incision line was made, and subdermal dissection was done. Subdermal apocrine glands were manually shaved with a modified Inaba’s shaver, and a compression dressing was applied to avoid hematoma or seroma formation.
The patient revisited our broomhidrosis on postoperative days 3 and 10 and after 6 and 12 months. Relatively less ecchymosis and scars were observed on the left axilla treated with the laser Fig.
The right and left axillae, including acute complications, were compared at long-term follow-up Table 1. Other than a serious bruise in the right axilla lasting about 2 weeks and a mild bruise in the left axilla lasting less than 1 week, no major complications were noted.
Pain score was measured on a scale of 0 to 10, and the patient experienced no pain in the left axilla.
Treatment for Bromhidrosis
However, the patient experienced moderate to severe pain 7 to 8 out of 10 with activity limitations on the modified Inaba’s operation side. As the postoperative compression dressing had to be applied for 2 weeks, activity limitations continued for 2 weeks on the right side. Nromhidrosis, postoperative pain continued for 7 to 10 days. The remnant malodor in the left axilla was deemed ‘tolerable’ scale 3 and the right axilla was deemed ‘none’ scale 0.
Other complications, such as restriction of movement and pain, were completely cleared. The patient’s level of satisfaction with the left, laser treated side, was generally high in terms ttreatment quality of life.
A Right axilla, 3 days following modified Inaba’s operation.
B Left axilla, 10 days following laser operation; mild ecchymosis was observed. C Right axilla, 10 days following modified Inaba’s operation; scar or crust was observed. D Left treatmsnt, 10 days following laser operation; only mild crust without scarring was observed. Comparison of modified Inaba’s method right axilla and 1, nm Nd: YAG laser treatment left axilla.
Histological examinations were also done on the subcutaneous fat layer of the laser-irradiated side immediately after the bromhidroosis and at 6 months postoperatively Fig.
Immediately after the procedure, the exam showed ablated adipose tissue and apocrine glands. The 6 month histologic examination showed more ablated apocrine glands than previously, which resulted in decrease in malodor. A Increased density of apocrine glands. Ablated adipocytes and apocrine glands are observed.
B Decreased density of apocrine glands is observed. Surgical intervention for bromhidrosis such as Inaba’s operation nromhidrosis hypodermic fat cells and reduces the number of bromhidrosus apocrine glands 2 – 4. Surgical intervention can lead to higher complete treatment rates and lower recurrence rates but bromhidroais result in complications, such as axillary nerve plexus damage, postoperative pain, hemorrhage, edema, hematoma, and serious limitations in postoperative mobility 3.
In addition, the outcome of surgery is surgeon-dependent. For these reasons, no consensus exists on the appropriate surgical method 34. In our experience, Inaba’s method results in the lowest rate of complications bro,hidrosis recurrence 3.
Minimally invasive therapies have been introduced as patients prefer to be teeatment by minimally invasive techniques when possible 14. Among them, laser therapy, which dissolves hypodermic fat and removes apocrine glands, has been highlighted. A 1, nm and 1, nm Q-switched Nd: However, these two wavelengths are not highly specific for fat cells, and wavelengths of 1, nm are more markedly absorbed in fat more than water compared to other wavelengths 5. We therefore hypothesized that apocrine glands in fatty tissues would be more specifically destroyed by the 1, nm laser.
Data show that epidermal temperature is elevated less with 1, nm beam therapy, which gives identical energy at the same depth in the hypodermic fat layer as other wavelengths 5. We compared post-laser treatment side effects, recurrence, and patient satisfaction with that of surgical intervention and noted no significant differences between trreatment. Except for crusting and mild ecchymosis on the laser-treated side due to heat-induced skin injury, the patient did not experience other side effects.
Although no skin necrosis or other injuries were noted, over-treatment or over-coagulation increases the risk of skin necrosis. Bromhidrosia, laser operators should assess superficial skin color changes and measure the superficial temperature in real-time.
We recommend this modality as a possible treatment of choice of osmidrosis because acute phase complications such as pain and restriction of movement were much less than the surgical method. However, if a prepubertal patient strongly hopes for total removal of malodor without recurrence, tteatment would recommend that the patient treatmrnt the surgical method, as apocrine glands proliferate during puberty.
In conclusion, subdermal coagulation treatment with a 1, nm Nd: YAG laser may be the least invasive but most effective therapy for axillary bromhidrosis. We are now performing a prospective clinical study in a larger cohort population to investigate the ideal laser configuration and to define systematic and standardized protocols. National Center for Biotechnology InformationU.
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Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Bromhidrosis is a disease presenting as malodor caused by interaction between the discharge of apocrine glands and bacteria.
YAG, Subdermal coagulation, 1, nm. Open in a separate window. Left axilla of the patient size: Table 1 Comparison of modified Inaba’s method right axilla and 1, nm Nd: Histologic evaluation of interstitial lipolysis comparing aand nm laser in an ex vivo model. Tumescent liposuction with dermal curettage for treatment of axillary osmidrosis and hyperhidrosis. Minimally invasive surgery for axillary osmidrosis: Ablation of apocrine glands with the use of a suction-assisted cartilage shaver for treatment of axillary osmidrosis: Superior lipolytic effect of the 1, nm Nd: