Summary

The condition can be known medically as bromhidrosis, osmidrosis, fetid sweat, body smell, or malodorous sweating. Humans have two types of sweat glands: eccrine sweat glands and apocrine sweat glands. Eccrine sweat glands are present from birth, while the apocrine glands become activated during puberty.  The body odor primarily results from the apocrine sweat glands, which secrete most chemical compounds needed for the skin flora to metabolize it into odorant substances. Body odor is most likely to occur in the following places: feet, groin, armpits, genitalia, pubic hair and other hair, belly button, anus, behind the ears, and the rest of the skin, to a lesser extent. Body odor is usually accompanied by excessive sweating and managed in the same manner. Botox is injected intradermally to treat hyperhidrosis and inhibits the release of acetylcholine at the neuromuscular junction and from the sympathetic nerves that innervate eccrine sweat glands. A new bipolar radiofrequency device can destroy the eccrine glands by thermolysis at the interface of the deep dermis and subcutis. When medical treatment fails, ultrasound and power-assisted liposuction of armpits can gently remove both eccrine and apocrine sweat glands.

Dermatologists estimate that 3% of people in the United States have excessive sweating. People of all races get hyperhidrosis. Excessive sweating can begin at any age. Researchers have learned that most people have one of the following:

• Have a family member who sweats excessively.
• Have a Medical condition that causes the sweating
• They are taking a medicine or food supplement, which can cause excessive sweating.
• People who sweat too much, such as those with hyperhidrosis, may also be susceptible to body odor.

The condition can be known medically as bromhidrosis, apocrine bromhidrosis, osmidrosis, ozochrotia, smelly sweat, body smell, or malodorous sweating. Body odor is the perceived unpleasant smell our bodies can give off when bacteria that live on the skin break down sweat into acids. Body odor can have a pleasant and specific smell to the individual and identify people, especially dogs and other animals. Diet, gender, health, and medication can influence each person’s unique body odor. A foul odor defines osmidrosis or bromhidrosis as a water-rich environment that supports bacteria caused by an abnormal increase in perspiration (hyperhidrosis). This can be particularly strong when it happens in the axillary region (underarms). In this case, the condition may be referred to as axillary osmidrosis. Humans have two types of sweat glands; eccrine sweat glands and apocrine sweat glands. Eccrine sweat glands are present from birth, while the apocrine glands become activated during puberty.  The body odor is primarily the result of the apocrine sweat glands, which secrete most chemical compounds needed for the skin flora to metabolize it into odorant substances. This happens mainly in the axillary (armpit) region, although the gland can also be found in the areola, anogenital area, and around the navel. The genital and armpit areas also contain light hairs that help diffuse body odors. Body odor is most likely to occur in the following places: feet, groin, armpits, genitalia, pubic hair and other hair, belly button, anus, behind the ears, and the rest of the skin, to a lesser extent.

Body odor is caused by bacteria breaking down sweat and is mainly linked to the apocrine glands. These glands are found in the breasts, genital area, eyelids, armpits, and ear. They are scent glands. Most of the apocrine glands in the skin are located in the groin, armpits, and around the nipples. Body odor is influenced by the actions of the skin flora, including members of Corynebacterium, which manufacture enzymes called lipases that break down the lipids in sweat to create smaller molecules like butyric acid. More significant bacteria populations of Corynebacterium jeikeium are, for example, found more in the armpits of men.

In contrast, higher population numbers of Staphylococcus haemolyticus are located in the armpits of women. This causes male armpits to give off a rancid/cheese-like smell, whereas female armpits give off a more fruity/onion-like smell. Staphylococcus hominis is also known for producing thioalcohol compounds that contribute to odors. These smaller molecules smell and give body odor its characteristic aroma. Propionic acid (propanoic acid) is present in many sweat samples. This acid is a breakdown product of some amino acids by propionibacteria, which thrive in the ducts of adolescent and adult sebaceous glands. Because propionic acid is chemically similar to acetic acid with similar characteristics, including odor, I may identify body odors as having a vinegar-like smell by certain people.

The word “hyperhidrosis” means too much (hyper) sweating (hidrosis).  Excessive sweating happens when a person sweats more than is necessary. Yes, it’s essential to sweat. Sweating cools the body, which prevents us from overheating — people who have hyperhidrosis, however, sweat when the body does not need cooling. Many people who have hyperhidrosis sweat from one or two areas of the body. Most often, they sweat from their palms, feet, underarms, or head. While the rest of the body remains dry, one or two areas may drip with sweat. This excessive sweating can interfere with everyday activities.

If you have this medical condition, you may notice:

• Visible sweating: When you are not exerting yourself, do you often see beads of sweat on your skin or have sweat-soaked clothing? Do you sweat when you’re sitting?
• Sweating interferes with everyday activities: Does sweating cause difficulty holding a pen, walking, or turning a doorknob? Does sweat drip slowly onto your papers or computer?
• The skin turns soft, white, and peels in specific areas: Does your skin stay wet for long periods?
• Skin infections: Do you get frequent skin infections on the parts of your body that sweat heavily? The athlete’s foot and jock itch are common skin infections.

How Do Dermatologists Diagnose Excessive Sweating?

To diagnose this condition, a dermatologist gives the patient a physical exam. This includes looking closely at the areas of the body that sweat excessively. A dermatologist also asks questions. This helps the doctor understand why the patient has excessive sweating. Sometimes medical testing is necessary. Some patients require a test called the sweat test. This involves coating some of their skin with a powder that turns purple when the skin gets wet. More medical tests are needed to discover an underlying medical condition.

Antiperspirants

This may be the first treatment that a dermatologist recommends. It is affordable. When applied as directed, an antiperspirant can be helpful. Your dermatologist may recommend a regular or clinical-strength antiperspirant. Some patients need a stronger antiperspirant and receive a prescription for one. The antiperspirant sits on top of your skin. As you sweat, the antiperspirant is pulled into your sweat glands. This plugs the sweat glands. When your body senses that its sweat glands are occluded, this should signal your body to stop producing so much sweat.

Iontophoresis (the no-sweat machine)

If excessive sweating affects your hands, feet, or both areas, this may be an option. You will use this treatment at home. It requires you to immerse your hands or feet in a shallow pan of tap water. As you do this, a medical device sends a low-voltage current through the water.  The electric current shuts down the treated sweat glands temporarily. Most people need about 6 to 10 treatments to shut down the sweat glands. At first, you may need 2 or 3 treatments per week. A treatment session usually takes 20 to 40 minutes.  Once you see results, you can repeat the therapy as necessary to maintain results. This can range from once a week to once a month. If this treatment is right for you, your dermatologist will teach you how to use the device and give you a prescription so that you can buy one.

Prescription medicine

Some patients receive a prescription for a drug that temporarily prevents them from sweating. These medicines work throughout the body.  These medicines prevent the sweat glands from working. Athletes, people who work in a hot place, and anyone who lives in a warm climate should use extreme caution when using this treatment. The body may not be able to cool itself.

Botox Injections

Botox is approved for the treatment of hyperhidrosis in the United States. It is injected intradermally to treat hyperhidrosis and inhibits the release of acetylcholine at the neuromuscular junction and from the sympathetic nerves that innervate eccrine sweat glands.  Your dermatologist can inject a weak form of this medicine into your underarms. To treat excessive sweating, a patient will need to have very tiny amounts injected in many areas of the underarms. When performed correctly, patients have little pain or discomfort. Findings suggest that this treatment may be helpful in other areas of the body. It may help post-menopausal women who sweat excessively on the head. It may be helpful for excessive sweating that affects the hands and feet.

Fractional Radiofrequency

Proudly at MSI, a newer bipolar RF device are effective in reducing the amount of sweating. New bipolar RF devices can destroy the eccrine glands by thermolysis at the deep dermis and subcutis interface while minimizing damage to the surrounding tissue.  Fractional radiofrequency treatment appears to be a safe and effective alternative for moderate to severe primary axillary hyperhidrosis. Prof Moawad suggests It is repeated sessions of FR be considered to achieve a complete response.

Microwave Device (miraDry)

The mechanism of action of the procedure causes non-invasive focused heating of the tissue at a depth of the sweat glands with the resulting thermolysis of the sweat glands. In the same way, fractional radiofrequency exert its effect. However, I cannot use it to treat excessive sweating in other areas such as hands or feet because the procedure has been optimized to consider the physical attributes of the underarms.

Surgical Treatment

A surgical operation is an option for people who have not been helped much by other treatments or if other therapies cause unacceptable side effects or problems. Surgical ablation of eccrine glands is the only way to eliminate or reduce axillary osmidrosis and hyperhidrosis permanently. Local surgical treatment for axillary hyperhidrosis can be divided into three broad categories:

1. Excision of subcutaneous glandular tissue only without skin removal.
2. excision of skin with its glandular tissue attached; and
3. selective sweat gland ablation using superficial, ultrasonic liposuction, laser liposuction, radiofrequency liposuction, or microwave sweat gland ablation. Liposuction should be combined with another technique to scrape the sweat glands from the underside of the skin through a small hole cut in the skin. This combination gives excellent results with less risk of complications.

Power-assisted Liposuction

All types of energy have been combined with liposuction to improve patient experience and results. The “power” in power-assisted/power-tumescent liposuction uses a tiny mechanical tube (cannula) that efficiently removes fatty tissue. The mechanical vibrations produced by the power unit are soothing and may decrease procedure time. Powered liposuction can increase fat extraction by 30% or more over non-powered liposuction. Patients love the vibration sensation of powered liposuction or traditional non-powered liposuction. Prof. Moawad was the first to use this technique in the Middle East 10 years ago. In power-assisted liposuction, a cannula with a back-and-forth motion of the tip passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort.

Ultrasound Power-Assisted Tumescent Liposuction with Curettage

The use of external ultrasound before liposuction is a technique that requires the transcutaneous application of high-frequency ultrasonic fields delivered into wetted tissue, followed by traditional aspirates liposuction, to improve the mechanical removal of sweat glands. Ultrasound causes tissue destruction via three mechanisms: (1) cavitation, (2) micromechanical disruption, and (3) thermal damage. Ultrasound reports suggest that the disruptive biologic effects of external ultrasound are due to a micromechanical outage or tissue heating. Other stories postulate that external UAL loosens adipose cell attachments, facilitating aspiration. It seems that the manifestations of the effects of external ultrasound appear to be directly proportional to the intensity delivered, with simple cellular detachment at 1 MHz to complete adipose cellular destruction at 2-3 MHz.

Recently, high-intensity focused ultrasound (HIFU) was used to treat and ablate subcutaneous adipose tissue before abdominoplasty cases with histologically proven success. This represents a new potential use for external ultrasound technology as a pretreatment regimen for ablating and remodeling subcutaneous deposits. In a novel approach, Prof Moawad uses the above mention technologies to ensure gentle and complete removal of sweat glands. The patients were placed in a supine position with the arms abducted 90%. A starch-iodine test is done, and photos of the results are taken. The hair-bearing area of bilateral axillae was marked and infiltrated with a 200 to 300mL of a tumescent solution consisting of 1,000mL of normal saline, 1mL of 1:1,000 epinephrine, 500mg of 2% lidocaine, 15mL of 8.4% sodium bicarbonate, and 1mL of 10 mg/mL triamcinolone using an infiltrating pump.

Two or three tiny stab incisions (3mm-4mm) were made at each axilla’s anterior and distal border, a special cannula attached to the power machine was inserted through them, and subcutaneous tunnels were made by it. By placing the cannula in subcutaneous tunnels with its three holes turned upward to face the sub-dermis, a back-and-forth vibrating movement is performed in a crisscross pattern and aided by the other hand to compress the skin for effective subdermal scraping. The role of vacuum and vibration (mechanical) is to eliminate possible remaining sweat glands functionally and help in achieving excellent results.  At the end of suction and curettage, the skin pinched up quickly like a piece of cloth. The procedure in one axilla took about 15 to 20 minutes. The stab incisions are closed with Steri-Strips. Bulky compressive dressings are applied to bilateral axillae and kept for 24-48 hours. Afterward, the patient comes back to MSI to remove the bandage and wear his compression garment for the next two weeks. However, patients recovered their daily activities within 3–7 days.