1. 奇美醫院 外科部整形外科1 皮膚科2 洪章桂1 賴豐傑2 黃國峯1
Comparison of outcomes of direct subdermal excision and microwave-based device in patients with bromhidrosis
奇美醫院 外科部整形外科1 皮膚科2
洪章桂1 賴豐傑2 黃國峯1

2. Introduction Human sweat glands Eccrine Apocrine Apoeccrine
over the majority of skin surface
Apocrine
axillary region, perineum, around the nipples
initially odorless, degraded by the resident bacteria.
individual pheromonal body odor
Apoeccrine
Higher sweat secretion rate
abundance in the axillary region
Semkova K et.al. Hyperhidrosis, bromhidrosis, and chromhidrosis: fold (intertriginous) dermatoses. Clinics in Dermatology (2015) 33, 483–491

3. Axillary bromidrosis is often accompanied by axillary hyperhidrosis.
Bromhidrosis
an abnormal and excessively unpleasant body odor
apocrine bromhidrosis is the most common form
Axillary bromidrosis is often accompanied by axillary hyperhidrosis.
Semkova K et.al. Hyperhidrosis, bromhidrosis, and chromhidrosis: fold (intertriginous) dermatoses. Clinics in Dermatology (2015) 33, 483–491

4. Axillary bromhidrosis is a common troublesome and disturbing social problem
In Asian countries
ask for treatment of bromidrosis rather than hyperhidrosis
In western countries
control of axillary hyperhidrosis is of primary concern to most patients
J.G. Qian et.al. Effectiveness and complications of subdermal excision of apocrine glands in 206 cases with axillary osmidrosis.
Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, 1003e1007

5. Treatment Topical treatment Systemic medication Laser Surgery
Sympathectomy
Subdermal excision
Curratage
Shaver
Liposuction
J.G. Qian et.al. Effectiveness and complications of subdermal excision of apocrine glands in 206 cases with axillary osmidrosis.
Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, 1003e1007

7. Microwave-based device
“MiraDry”
The first and only one FDA-approval device for permanent treatment of excessive underarm sweat.
It has the potential effect in reducing axillary bromhidrosis

10. Aim
Comparison of outcomes of direct subdermal excision and microwave-based device in patients with bromhidrosis
Elimination of odor
10-point scale (Odor-10), where 1 stands for completely no odor and 10 for severe odor
Sweat reduction
HDSS score
Complication

11. HDSS
YY Chang et.al. A prospective clinical and histologic study of axillary osmidrosis treated with the microwave-based device.
DERMATOLOGICA SINICA 33 (2015)

12. Methods Direct subdermal excision group Microwave thermolysis group
53 patients
May 2004 to May 2010
by a single surgeon
Microwave thermolysis group
50 patients
Augest 2015 to Augest 2016
by a single dermatologist
Inclusion criteria
Hyperhydrosis (HDSS>3)
Bromhidrosis (Odor-10 score >6)

14. Microwave setting Energy level: 5
Size of targeted area: 80x60 mm – 140x80mm
All patients received one session and additional treatment
3-month follow-up

15. Evaluation of outcomes
Questionnaire or telephone visit (3 months later)
Patients with Odor-10 score reduction to
<2 : good
3-5: fair
>6: poor
Patients with HDSS reduction to
1 : significant
2 : improved
No change

16. Scar evaluation (surgery group)
Reduced hair
Much : >75%
Moderate : 50-75%
Mild : <50%
Scar evaluation (surgery group)
Inconspicuous
Acceptable
Unacceptable ugly

17. Results

21. Conclusion Microwave-based device is effective to treat hyperhidrosis.
Surgical treatment is a good method to treat bromhidrosis due to lasting and definite outcome with low complication rate.

22. We propose surgical treatment in patients with severe bromhidrosis and microwave-based device in patients with mainly hyperhidrosis and mild bromhidrosis.

23. Thanks for your listening~