What is Bromidrosi?
Bromidrosis is a chronic disorder, characterized by the bad smell of the skin due to the organic decomposition of eccrine and / or apocrine sweat by the bacterial flora, and by the maceration of products of keratinocyte derivation.
Laser therapy
The presence of hair on the skin surface helps to keep excess sweat at the site where it is produced. To achieve lasting results, many people undergo laser therapy to remove hair, limit bacterial growth and avoid odor.
An example of effective laser treatment in axillary bromidrosis uses Nd: YAG technologies (Q-Switched Nd: YAG laser, with frequency doublers).
Botox
Inhibition of sweating with botulinum toxin
As an alternative to surgical procedures, local injections of botulinum toxin A are one of the most effective treatments to reduce the production of sweat from the sweat glands of armpits, face, neck, hands and feet (also effective in the treatment of axillary hyperhidrosis). The therapy consists in performing multiple sub-dermal injections that convey minimal amounts of toxin, so as to uniformly cover the surface affected by excessive sweating. It represents an expensive, long-lasting but not definitive method: it must be repeated at regular intervals to maintain the results, but its effectiveness is scientifically proven and any side effects are in any case of a transitory nature.
In short. The inhibitory action of botulinum toxin A: the toxin of the bacterium Clostridium botulinum type A is able to block the production of sweat, inhibiting the receptors for acetylcholine (neurotransmitter released by the pre-synaptic nerve endings, responsible for stimulating the gland sudoripara) and preventing nerve transmission to the gland. Only after a few months, the nerve endings regain the ability to release the acetylcholine again with a gradual recovery of the sweating phenomenon.
Surgery
The surgical treatment has so far been used in a limited way and applied in particular to axillary bromidrosis. The principle on which the different surgical techniques are based is aimed at reducing the number of sweat glands, lowering their overall secretion. It is applied if there is histological evidence of hyperactivity of the glands that contribute to bromidrosis.
Surgical treatment improves the long-term management of the disorder, but is associated with an increase in post-operative risks, scar formation, surgical complications and the risk of recurrence.
Removal of sweat glands
Surgical techniques involve denervation and / or removal of the sweat glands; can be classified into the following categories:
- removal of cellular subcutaneous tissue (without removing the skin);
- removal of the skin and subcutaneous cellular tissue;
- removal of skin and cell tissue, as well as removal of the subcutaneous cellular tissue from the adjacent area, often performed using a shaving technique.
Depending on the depth of the surgical wound, regeneration of gland function can be observed, but by extending the excision, the results are satisfactory. The removal of skin tissue is sometimes combined with techniques of curettage, liposuction or carbon dioxide laser treatment to eliminate any glandular residues.
Superficial liposuction
Superficial liposuction is used to remove cellular tissues: a small incision is made where the aspiration device is located, which eliminates subcutaneous sections. The main advantage of this technique is that it is less traumatic than traditional surgery, as the incision is smaller and the post-operative complication rate is reduced to a minimum. However, the recurrence rate associated with the technique is higher, resulting in a decrease in patient satisfaction in long-term follow-up.
Endoscopic thoracic sympathectomy (ETS)
The ETS is a very delicate surgical procedure which consists in removing some portions of the sympathetic nervous system (ganglia, small accumulations of nerve cells), which activates inter alia the sweat glands of the body surface and contracts the vessels of the peripheral microcirculation . Thoracic endoscopic sympathectomy is a surgical procedure which consists in interrupting the nerve structures involved in the hyper-sweating. This technique is only taken into consideration in extreme clinical cases: efficacy is shown for armpits and palms (for the feet, the procedure would be more complex, as the nerves are located in different areas and complications may arise).
Alternative therapies
Phytotherapy and natural remedies
Patients with bromidrosis should be encouraged to maintain an adequate level of hygiene with the use of antibacterial and antiperspirant soaps, as well as being aware that the smell may result from sweat on clothing. For a correct management of bromidrosis it is important to act on the causes, in order to prevent an excessive development of the bacterial flora and keep the development of the odor within acceptable levels.
Preparations containing chlorophyll, rosemary and thyme essential oils are excellent natural deodorants and can be used for antibacterial washes. Sage has anti-hydrotic properties, as it helps reduce excessive sweating of hands and underarms. Sodium bicarbonate and crystallized mineral salts also play a mild antiperspirant and help control unpleasant odor, absorbing sweat.
Garments made with synthetic fibers prevent the exchange between the skin and the air. In this way, a cutaneous microclimate is created that is favorable to the microbial alterations of the secretions that contribute to determining, in turn, the unpleasantness of the body odor.
For the conditions determined by bromidrosis, it may be useful to follow some tips:
- take care of hygiene on a daily basis: wash frequently and with mild detergents and possibly with bactericidal or antifungal soaps;
- locally apply deodorants;
- change clothes often, especially underwear and socks. Wear cotton clothes that allow more evaporation of sweat than synthetic materials;
- choosing fresh footwear, made of natural fibers (shoes that are not very breathable facilitate bacterial activity);
- to dehair to eliminate excessive hair, which could retain sweat and promote the proliferation of bacteria;
- nutrition: limiting certain foods in one's diet can help isolate dietary factors that contribute to bromidrosis. These common foods include: spices, onions, garlic, caffeine and alcohol.
