Apocrine glands are mainly found in the armpit, genital periphery, and areola. They are not actual sweat glands but frequently secrete some mildly alkaline substances with lipids and proteins such as sweat. Apocrine secretions attain their special or bad odor, also called osmidrosis, on being degraded by microbes and bacteria hidden in the dense hair (follicle). Osmidrosis primarily originates from genetic factors and in some cases is caused by hormonal secretions, diets, or drugs. Symptoms commonly start to show during puberty, and patients mostly have heavy viscous sweat under the armpit or yellow sweat stains on the underwear, which may be aggravated by profuse sweating. Severe osmidrosis not only undermines patients’ confidence but also causes social and interpersonal disturbances, so patients usually consider undergoing treatment at an early time to redress the odor.
Many patients confuse hyperhidrosis with osmidrosis, which are quite different in their pathogenesis and treatment method. Hyperhidrosis is increased sweating stimulated by the over-activity of the sympathetic nerves governing the eccrine sweat glands that cause the sole or palm to frequently sweat and feel clammy. It has a predilection for the palms or soles and seldom occurs at the armpit. The sweat is commonly clear, colorless, and odorless, which therefore can be easily differentiated from the symptoms of osmidrosis. Treatment should proceed from the nerve to directly block the sympathetic nerve governing sweat secretion at the affected site with the assistance of a thoracoscope. Despite the fact that it causes diversion of the sweating site, the surgery generally effectively and rapidly mitigates sweating at the treatment site. Besides, surgery for hyperhidrosis is conducted by a thoracic surgeon rather than a plastic surgeon, so patients should understand their differences to choose the correct treatment.
Treatments for osmidrosis are available in two categories. One is a non-surgical botoxin injection, which temporarily inhibits the secretion of regional apocrine glands but only provides short-term results and limited improvement of the severe odor. Therefore, it is only suitable for patients with mild osmidrosis due to strenuous activities or profuse sweating. The other is surgery for the radical treatment of bad odor, which is the primary treatment for osmidrosis. The surgery comes in the following two methods: