Is it the plastic surgeon who must treat bromhidrosis?
Raphael de Faria Carmo
Conflict of interest
What is bromhidrosis?
I declare that I have no conflict of interest
What is bromhidrosis?
- Predominates in the axillary and groin regions
- Patients usually exaggerated in their daily hygiene
- Difficult clinical control
Epidemiology
- The incidence of bromhidrosis is unknown
Histopathology
- Usually results from bacterial degradation of apocrine secretions or keratin.
- Bacterias: Corynebacterium, Staphylococcus and Cutibacterium
- The numbers of apocrine and eccrine glands were about equal (Normal: 1:8)
Diagnosis
- Defined by the impact caused:
- self view
- social interactions
- quality of life
- Worse with exercise and heat (sweat)
- Intact skin or alterations due to excessive hygiene or sweating
Differential diagnosis
- Differential diagnosis with olfactory hallucinations, body dysmorphic disorder
- It is important to evaluate the odor in the consultation
- If the smell is noticed by others
Treatment - General approach
Treatment
- Improve hygiene and reduce bacteria:
- Daily cleaning, no excess
- Antibacterial soaps
- Ph-altering formulations
- Reduce sweating:
- Botulinum toxin
- Use of antiperspirants
- Transthoracic sympathectomy
- Hair Removal:
- Reduced local bacterial colonization
Treatment - refractory bromhidrosis
Refractory bromhidrosis
- Liposuction with or without technologies