Beyond odor: treatment for axillary bromhidrosis

Axillary bromhidrosis, a chronic condition marked by foul-smelling sweat, continues to challenge both clinicians and patients due to its social and psychological burden. A 2024 review in Skin Research and Technology provides an extensive overview of emerging surgical and non-surgical interventions aimed at improving treatment precision and minimizing complications.

The authors emphasize that bromhidrosis originates from apocrine gland hyperactivity and bacterial metabolism of secreted fatty acids, with genetic links such as the ABCC11 gene polymorphism influencing odor formation. Mild cases can be managed with topical agents, including deodorants, antiperspirants, and antimicrobial preparations, though these approaches rarely achieve lasting relief. Botulinum toxin type A injections remain the most reliable minimally invasive option, producing symptomatic improvement for up to nine months.

Among physical modalities, laser therapy (Nd:YAG, CO₂, semiconductor), radiofrequency, and microwave ablation demonstrate effective gland destruction with short recovery times but variable recurrence rates. Surgical innovations—from small-incision gland excision and ultrasonic emulsification to liposuction-assisted curettage and endoscopic removal—offer radical and durable outcomes. Notably, FUE (follicular unit extraction) technology is emerging as a low-trauma technique with encouraging early results.

The review concludes that while no single therapy is universally ideal, treatment should be tailored to symptom severity, skin type, and patient preference. Advances in minimally invasive procedures and precision devices are steadily transforming the management of bromhidrosis, bridging cosmetic expectations with durable clinical results.