Choosing the Best Surgery for Hyperhidrosis or Bromhidrosis - Dermatology

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When it comes to managing hyperhidrosis (excessive sweating) and bromhidrosis (body odor), it's important to first understand the underlying causes and the most effective treatment options available. Based on your description, it seems you are experiencing excessive sweating in the underarm area, which is often associated with an unpleasant odor. This condition can be classified as either hyperhidrosis, bromhidrosis, or a combination of both.

Hyperhidrosis is characterized by excessive sweating that can occur in specific areas, such as the underarms, palms, or soles of the feet, and is often not related to heat or exercise. Bromhidrosis, on the other hand, refers specifically to the unpleasant odor that can result from the breakdown of sweat by bacteria on the skin. In many cases, individuals with hyperhidrosis may also experience bromhidrosis due to the increased moisture in the area, which creates an environment conducive to bacterial growth.

In terms of treatment options, there are several approaches to consider, including non-surgical and surgical methods. Non-surgical options include antiperspirants, which can be effective for mild cases, as well as prescription-strength formulations that contain aluminum chloride. Other options include oral medications that reduce sweating, iontophoresis (a procedure that uses electrical currents to reduce sweating), and Botox injections, which can temporarily block the nerves responsible for sweating.

However, when these non-surgical methods are ineffective or if the condition is severe, surgical options may be considered. The two surgical procedures you mentioned—endoscopic thoracic sympathectomy (ETS) and sweat gland excision—are both viable options, but they have different indications and outcomes.

1. Endoscopic Thoracic Sympathectomy (ETS): This minimally invasive procedure involves cutting or clamping the sympathetic nerves that control sweating. It is primarily used for palmar hyperhidrosis (sweating of the hands) but can also be effective for axillary hyperhidrosis (underarm sweating). While ETS can provide significant relief from sweating, it is important to note that it may lead to compensatory sweating in other areas of the body, which can be a downside for some patients.

2. Sweat Gland Excision: This surgical procedure involves the removal of sweat glands from the underarm area. It can be performed through various techniques, including liposuction-assisted methods, which can minimize scarring and recovery time. This approach directly targets the source of the odor and sweating, potentially providing long-lasting results without the risk of compensatory sweating that can occur with ETS.

In terms of effectiveness, both procedures have their advantages and disadvantages. ETS may provide quicker results for excessive sweating, while sweat gland excision may be more effective for addressing odor specifically. The choice between these options should be made in consultation with a qualified surgeon who specializes in treating hyperhidrosis and bromhidrosis. They can assess your specific condition, discuss the potential risks and benefits of each procedure, and help you make an informed decision based on your individual needs and lifestyle.

In conclusion, whether you are dealing with hyperhidrosis, bromhidrosis, or both, there are effective treatment options available. Non-surgical methods should be explored first, but if they do not provide adequate relief, surgical options like ETS or sweat gland excision can be considered. It is essential to consult with a healthcare professional to determine the best course of action tailored to your situation.