Clinical Study Of Treating Osmidrosis By CO₂ Laser Vaporization, Excision Of Cutaneous Tissue And Subdermal Curettage

BackgroundAxillary osmidrosis is a troublesome and distressing problem that causes a serious personal and social handicap, is an annoying, although not life-threatening, problem that includes unpleasant odor and the occasional staining of clothing. People who suffer from this problem are usually embarrassed by the smell during their daily activities and contact with other people.The offensive odor associated with axillary osmidrosis is believed to be caused by secretions from the apocrine and eccrine glands.The apocrine glands play a more important role in osmidrosis. In hyperhidrosis, the eccrine glands, which make up the majority of sweat glands and typically produce thin secretions, become overstimulated. Apocrine glands, which are fewer in number and mainly found in axilla and urogenital regions, produce viscid secretions. An unpleasant odor is generated when bacteria decompose the apocrine secretion. In China, we see mostly patients with osmidrosis rather than hyperhidrosis.In mild cases, topical astringents or aluminum deodorants may be effective butfrequent application is necessary. In severe cases, topical antiperspirants or deodorants are inadequate. Systemic medication with anticholinergics, which can block sympathetic nerve supply to sweat glands, may decrease the sweat secretion but cause major side effects, including excessive dryness and drowsiness , and long-term usage is not possible. A more permanent solution is sought. Surgical treatment of axillary osmidrosis was first described in 1962. Several different surgical methods have been proposed, such as subcutaneous shaving or curettage, laser treatment, superficial or ultrasonic liposuction, and excision of cutaneous tissue , and they can be classified into three categories : excision of only the axillary subcutaneous tissue, en bloc excision of the axillary skin and subcutaneous tissue, and reservation of the axillary skin and the subcutaneous tissue. The purpose of this study was to seek a more effective surgical procedure by comparing the CO₂ laser vaporization, excision of cutaneous tissue and subdermal curettage.MethodsFrom july 1995 to August 2004, a total of 113 patients underwent surgery for axillary osmidrosis via CO₂ laser vaporization (N = 37), and excision of cutaneous tissue (N = 21), subdermal curettage (N = 55), including manual subdermal curettage (N = 34) and endoscope-assisted subdermal curettage(N = 21). All patients were followed up for 6-24months. All patients were evaluated by odor, scar, operation time immobilization period, expense and other surgical complications such as hematoma, flap necrosis, infection, recurrence,and wound dehiscence. Compared of the results among the three groups and between manual and endoscopic-assisted subdermal curettage.Result1 Compared with excision of cutaneous tissue and subdermal curettage, CO₂ laser vaporization had smaller improvement in the malodor.2 excision of cutaneous tissue had results similar to subdermal curettage in the malodor statistically3 endoscope-assisted subdermal curettage had results similar to subdermal curettage in the malodor statistically.4 Compared with excision of cutaneous tissue (0%) and subdermal curettage (0. 9%) ,CO₂ laser vaporization had higher recurrence rate for malodor (29. 7%) .5 excision of cutaneous tissue had a high rate of limitation in arm abduction. (32/42) .6 CO2 laser vaporization had advantages such as a short-term operative time and immobilization period less total cost. excision of cutaneous tissue was moderate and subdermal curettage highest.ConclusionsIn mild cases, CO2 laser vaporization may be effective, economic and. Aesthetics. Subcutaneous tissue remover had the disadvantages of a high complication rate of limitation in arm abduction and scar contracture , it was not a suitable routine. In severe cases , Subdermal curettage is the treatment of choice for axillary osmidrosis, with a low recurrence rate and less cases of surgical complications. Endoscope-assisted subdermal curettage helped to shorten the incision.