Text/Taipei Linkou Chang Gung Dermatology Attending Physician Huang Yuhui
When Xiao Fang and her mother came into my clinic, they were a little shy and didn't know how to talk about Xiao Fang. "Doctor, since junior high school, my daughter always sweats under her arms in summer!" "Besides sweating, will there be a smell?" Because it's just sweating, the smell is different, so be sure to ask. "Yes, it's not just a smell. When I help her wash clothes, there will be yellow stains under her arms. It's hard to wash off. Shy Ellie nodded and said, "I feel so troubled." How should I treat it better? " 」
Symptoms: Usually, when patients with underarm problems come to see a doctor, they should first make clear whether sweating is more troublesome or taste is more troublesome, because there are still differences between the two treatments. People who usually have body odor problems, whether in summer or winter, will smell bad as long as the clothes they wear are boring, even if they don't sweat a lot. Hyperhidrosis patients may be sweating all the time under their armpits, or they may have problems of sweating profusely on their hands and feet. Some of these patients will combine the sense of taste at the same time because of excessive sweating, and some may dilute the sense of taste because of excessive sweating. There is no special instrument to diagnose bromhidrosis, mainly from the medical history and clinical use of nose smell to determine the diagnosis. According to statistics, the earwax of patients with osmidrosis is mostly wet and sticky, and about half of the patients have the problem of osmidrosis in their families.
Pathogenesis: There are two kinds of sweat glands in human skin, one is eccrine gland and the other is apocrine gland. Exocrine sweat glands are distributed all over the skin, and their main functions are to secrete sweat and regulate body temperature; Apocrine glands are only distributed in armpits, genitals, eyes and lips. It has nothing to do with thermoregulation, but only secretes oily substances originally used to attract the opposite sex.
After puberty, the apocrine glands will be influenced by hormones and begin to secrete viscous liquid. These axils are tasteless, but after reaching the skin surface, ammonia and short-chain fatty acids will be produced through the decomposition of bacteria (Corynebacterium), which will produce an uncomfortable smell.
Studies have shown that the number and volume of the parietal glands in patients with osmidrosis are significantly higher than those in the general population, and the volume is also larger, which may make patients with osmidrosis produce more secretions. In the case of sweating easily in summer, hyperhidrosis patients may soften the cuticle of the skin because of excessive sweat secretion, and bacteria will decompose the cuticle to produce odor, so some people have foot odor in summer, which is caused by this reason. Although patients with bromhidrosis don't sweat much, with sweating, the secretion of apocrine glands will increase, and axillary bacteria are easy to multiply in summer, which may aggravate the situation of bromhidrosis.
Treatment: There are many different treatments for underarm odor and underarm hyperhidrosis, and the effects are not the same. Here is a brief introduction to let everyone know more.
A. Non-invasive treatment
Apply antiperspirant: The antiperspirant contains aluminum salt (generally aluminum chloride), which makes sweat duct cells swell and blocks the outlet of sweat glands to achieve the purpose of antiperspirant. The concentration of antiperspirant is generally recommended to be 20%. Excessive concentration will cause skin redness and other * * * reactions. Because it only has a temporary effect, once you sweat too much, the antiperspirant will fail. Body deodorant only has essence. If you want to use it to overcome the odor of underarm odor, it may be counterproductive. Botulinum toxin injection: Human sweat glands only secrete sweat when stimulated by sympathetic nerve. Botulinum toxin can resist the conductive substance acetylcholine secreted by sympathetic nerve and reduce sweat secretion. Generally speaking, the curative effect of Botox is about 6 months to a year, so it must be repeated. Iontophoresis: put the sweating part into distilled water, and micro-current will introduce ions into the skin to reduce sweat discharge. A treatment takes 20 minutes. Treatment can be done once every two days at first, and it will be reduced to 1 or once every two weeks when the antiperspirant effect is achieved. This treatment has only a temporary effect, which is more suitable for treating hyperhidrosis of hands and feet, but not practical for hyperhidrosis of armpit. Microwave heat energy perspiration: this is the latest non-invasive hyperhidrosis treatment system. Hyperhidrosis treatment system uses microwave to provide heat energy at the junction of dermis and subcutaneous fat layer, which is the area where sweat glands are distributed, so microwave heat energy can be used for comprehensive treatment of sweat gland layer. Heat energy will directly destroy eccrine glands and apocrine glands, which has a certain therapeutic effect on antiperspirant and deodorization. After the microwave heat energy is transmitted, there will be a cooling system of15℃ for 20 seconds to protect the epidermis and epithelial layer from thermal damage. Clinical research shows that after one or two courses of treatment, the amount of underarm sweating can be reduced by 80% on average. Another study shows that after a course of treatment, the apocrine glands are effectively destroyed to 90%, and the sweat glands damaged by heat energy cannot regenerate, so it has a long-term therapeutic effect and will not cause compensatory sweating. There is no wound during the treatment, so there will be no scar. Only local anesthesia is needed, and postoperative care is easy. The patient can go to work normally the next day. It is the best noninvasive treatment for bromhidrosis and underarm hyperhidrosis. B. Invasive therapy
Surgery is a method to completely scrape the parietal gland directly in the skin. Early surgical methods will leave a long scar (about 5-6 cm) under the armpit. At present, a relatively new surgical method is to cut a small wound about 1- 1.5 cm under the armpit and scrape off the apocrine glands with an electric rotating scraper. The surgical wound is small and the scar is not obvious.
It must be noted that the postoperative wound needs to be fixed with pressure to avoid hematoma, and the recovery period needs at least 7 to 10 days. According to the research done by the author, the effect of this operation to improve hyperhidrosis is not as good as that of bromhidrosis, which may be because the exocrine sweat glands are located in the upper dermis and it is difficult to scrape them off with a rotating scraper, so they will continue to secrete sweat.
Home care for underarm odor has a great relationship with bacterial growth on the skin, so try to keep the armpits clean, and you can use antibacterial products to clean or shave your armpits to reduce bacterial growth. I sweated a lot after exercise, so I'd better clean it up quickly. If possible, try to stay in an air-conditioned room and reduce sweating.
Prevention: bromhidrosis and underarm hyperhidrosis are caused by physical factors and may not be prevented. However, daily care can be used to minimize perspiration and reduce the appearance of odor.
Caution: Use of antiperspirant may cause skin contact dermatitis. Therefore, if the antiperspirant is red, itchy and stinging after application, it needs to be stopped.
Dietary taboos: Some foods will aggravate the odor of underarm odor, such as onions, garlic, curry, wine, cheese and so on. We must reduce consumption.
This article is reproduced with authorization from/Dr. Huang Yuhui. Welcome to write and contribute [emailprotected]
Topic: hyperhidrosis, underarm