Comparison of Outcomes Between Direct Subdermal Excision and Microwave -Based Device in Patients with Bromhidrosis

手術和非侵入性的治療對於狐臭病人之比較

徐詣(I Hsu) ； 顏肇吾(Chao-Wu Yen) ； 李佳珍(Chia-Chen Lee) ； 洪章桂(Chang-kuei Hong) ； 黃國峯(Kuo-Feng Huang)

《臺灣整形外科醫學會雜誌》 28卷4期 (2019/12) Pp. 279-288

摘要

Background: Axillary bromhidrosis is a disease presenting as body odor that is induced by the interaction between apocrine or eccrine glands secretion and bacteria. The condition is common among postpubertal adults and may carry psychosocial burdens. Surgical intervention has been the mainstay for treating bromhidrosis. It provides the most effective outcomes but it also has the risk of hematoma or tissue necrosis. As a result, non-invasive treatment such as topical deodorant, microwave therapy, laser therapy, ultrasonic liposuction curettage has been proposed as the alternative choices of treatment. Aim and Objectives: In this study, we aim to compare the outcome between direct subdermal excision and microwave -based device (MiraDry) for treating bromhidrosis. Materials and Methods: We retrospectively reviewed the medical data, survey questionnaire, and postoperative photography of patients who underwent treatment of bromhidrosis in our institution, between May 2014 and May 2017. Patients with which 1) Hyperhidrosis (HDSS score ＞3), 2) Bromhidrosis (Odor-10 score ＞6) before treatment were enrolled into study. Cases with missing data or underwent treatment other than subdermal excision or MiraDry were excluded. 116 patients with bromhidrosis were treated in our institution. 66 patients underwent subdermal apocrine gland excision and another 50 patients were treated by with microwave therapy. The elimination of odor, axillary sweat reduction, HDSS score (hyperhidrosis disease severity scale) and complications were recorded to assess the treatment outcomes. Results: Statistical analysis demonstrated no significant difference in overall axillary sweat reduction, HDSS score, and complication between these two interesting groups. However, the rate of malodor elimination was significantly higher in the surgical group than that of the microwave group. Conclusion: Subdermal excision has a better palliation of malodor over microwave based device without increasing complication. On the other hand, the sweat reduction of the microwave therapy was comparable to surgical method in sweat reduction. We propose surgical treatment in patients with mainly bromhidrosis (odor-10 score＞6) and microwave-based device treatment in patients who focuses on hyperhidrosis.

關鍵字

axillary bromhidrosis ； subdermal excision ； MiraDry

並列摘要

背景：狐臭是一個常見而令人困擾的問題，甚至會影響到社交生活。在我們醫院，局部手術切除頂漿腺是一個良好的治療方式，但是同時，微舒淨（微波熱能除汗）最近也漸漸被使用，成為治療的另一個選擇。目的及目標：在這篇文章中，我們比較了用皮下切除與微淨舒兩個方式治療狐臭的結果。材料及方法：從2014年5月到2017年5月，我們找出術前符合多汗症（HDSS score＞3）或狐臭（Odor-10 score＞6）條件且接受局部頂漿腺切除手術或微舒淨治療的病人。若不是由這兩者治療或者資料不齊全則是沒有收案到討論之中。局部頂漿腺切除手術均由單一資深醫師執行，66個病人接受手術，而50個病人則經由微舒淨治療，由單一資深皮膚科醫師執行。我們討論了術後狐臭消除、排汗改善、多汗症嚴重程度還有常見的併發症。結果：兩個族群在排汗改善、多汗症嚴重程度還有常見的併發症上都沒有明顯的差異，然而在術後狐臭味道消除的比較上，手術組會有較好的效果。結論：經過比較，手術在狐臭味道消除部分效果好且併發症少，另一方面，微舒淨對於多汗症的治療成果和手術相同。根據得到的結果，我們建議狐臭問題較嚴重的病人接受手術治療，而狐臭症狀較輕微、較專注於處理多汗症的病人，則由微舒淨處理即可。