From the Guidelines
Bromhidrosis treatment options are primarily focused on reducing odor and managing underlying conditions, with an emphasis on hygiene and antimicrobial therapy.
Treatment Approaches
- Nasal hygiene: Continuous nasal lavage with saline or sodium bicarbonate solution is a mainstay of treatment, helping to reduce crusting and alleviate foul odor 1.
- Crust debridement: Periodic debridement of crusts may be necessary to manage symptoms 1.
- Topical antibiotics: Adding antibiotics such as mupirocin to the lavage solution can help manage purulent secretions 1.
- Systemic antibiotics: Indicated when an acute infection is present, to help manage symptoms and prevent further complications 1.
Important Considerations
- Primary vs secondary atrophic rhinitis: Treatment approaches may vary depending on the underlying cause of bromhidrosis, with primary atrophic rhinitis often requiring more aggressive management 1.
- Lack of controlled trials: While observational data is limited, current treatment approaches are based on best available evidence and clinical experience 1.
From the Research
Treatment Options for Bromhidrosis
The treatment options for bromhidrosis can be divided into several categories, including:
- Conservative management: This includes the use of topical antiperspirants, systemic agents, and iontophoresis 2
- Surgical therapy: This can include excisional surgery, endoscopic transthoracic sympathectomy, liposuction/curettage, and other surgical methods to remove axillary sweat glands 3, 2, 4, 5
- Minimally invasive procedures: This includes the use of VASER ultrasound 3, microwave treatment 6, and suction-curettage with subdermal undermining 4
- Other treatments: This includes the use of botulinum toxin type A, which is effective for axillary hyperhidrosis but not for bromhidrosis 6
Efficacy of Treatment Options
The efficacy of these treatment options varies, with some studies showing significant reduction in sweat and odor, while others show more moderate results. For example:
- A study using VASER ultrasound showed significant reduction in sweat and odor in 11 out of 13 patients 3
- A study using microwave treatment showed clinical effectiveness and safety, with possibly permanent results 6
- A study using suction-curettage with subdermal undermining showed significant malodor eradication in 87.5% of axillae 4
- A study using a double W incision approach with tumescent technique showed excellent results in 80% of axillae and good results in 20% 5
Complications and Side Effects
The complications and side effects of these treatment options also vary, with some studies showing significant complications, while others show minimal side effects. For example:
- A study using VASER ultrasound showed no significant complications 3
- A study using microwave treatment showed transient local inflammation as a side effect 6
- A study using suction-curettage with subdermal undermining showed a higher complication rate compared to suction-curettage alone 4
- A study using a double W incision approach with tumescent technique showed no serious complications 5