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Bromhidrosis Treatment & Management

  • Author: Wingfield Rehmus, MD, MPH; Chief Editor: William D James, MD  more...
Updated: Jun 21, 2016

Medical Care

Several therapeutic modalities are available to treat body odor. When a treatment method is chosen, it is important to consider the cultural implications and the degree of impairment in quality of life, as well as the patient's expectations and goals of treatment.

Hygiene and topical antibacterial agents

Conservative measures, which aim to reduce bacterial florae and maintain a dry environment, include improved hygiene and topical therapy. Hygienic measures, such as adequate washing of the axillary vault, prompt removal of sweaty clothing, and the use of topical deodorant (which covers the odor and decreases bacterial counts) are beneficial in cases of apocrine bromhidrosis. Regular shaving of axillary hair prevents the accumulation of sweat and bacteria on the hair shafts. Electrolysis might also be considered for hair removal to minimize bacterial growth.

Use of topical antibiotics such as clindamycin and erythromycin and antiseptic soaps may yield clinical benefit by limiting the growth of the contributory bacteria that decompose apocrine secretions, liberating fatty acids that have peculiar smells. Topical antibiotics should only be used when other antiseptics are ineffective because they are associated with a greater risk of bacterial resistance. Treatment of coexisting skin conditions, such as intertrigo, erythrasma, and trichomycosis axillaris, is important.

Drying agents

Measures to enhance drying and limit maceration, such as the use of antiperspirants including aluminum chloride, may improve bromhidrosis of either apocrine or eccrine origin, particularly if hyperhidrosis is a contributing factor. Antiperspirants, unlike deodorants, contain aluminum salts, which inhibit sweat production.

Iontophoresis, which disrupts sweat production, has a role in the treatment of eccrine bromhidrosis. With this method, a small electric current is passed through the skin while the affected area is placed under tap water. Typically used only for volar skin, this treatment is time intensive and should be considered only if excessive eccrine sweating contributes to the patient's body odor. Amelioration of hyperhidrosis does not reduce apocrine sweat production.

Conservative methods are ideal for mild cases. However, they do not offer a definitive cure, and results may be unsatisfactory if odor reduction is short lived and incomplete. Systemic anticholinergic agents decrease sweating, but their use can be limited by their adverse effect profile.

Lasers and botulinum toxin

For patients who desire more long-lasting treatment, a few nonsurgical options have been developed, although the data on these options are limited. A frequency-doubled, Q-switched Nd:YAG laser (1064 nm) has been effective in axillary bromhidrosis.[24] More recently, the 1444-nm Nd:YAG laser has been used to achieve subdermal coagulation and destruction of apocrine glands, leading to effective management of bromhidrosis.[25, 26] Over 75% of patients reported satisfaction with the procedure up to 6 months afterward.[27]

The inhibitory action of botulinum toxin A to decrease sweat production by denervating eccrine sweat glands has also been applied to successfully treat axillary hyperhidrosis.[28, 29] The effect on axillary apocrine gland secretion is unknown; however, local injections of botulinum toxin A reduced axillary body odor in a small sample of healthy subjects, and 1 case of improved genital bromhidrosis after botulinum toxin A treatment is reported.[30] It is particularly effective for patients who have a strong correlation between malodor and sweating.[31]


Surgical Care

Surgical treatment for axillary bromhidrosis has been used in a limited fashion in the United States; however, several surgical techniques are used more widely in Asian countries, where axillary odor causes more social and psychological distress.[32]

Clearly, surgical reduction in the number of apocrine glands diminishes apocrine secretion, and because some histologic evidence to suggest overactive apocrine sweat glands contributes to bromhidrosis, surgical techniques may be the most satisfactory methods of treatment. Surgical treatment improves the long-term management of bromhidrosis, but it is associated with an increased risk of morbidity, including scarring, surgical complications, and risk of recurrence. In recent years, new minimally invasive techniques with less morbidity have been developed. These include procedures with smaller incisions, which leave the vascular plexus as well as superficial fascia intact and may lead to satisfactory results with fewer adverse effects.[33, 34]

Surgical removal

A multitude of surgical methods have been reported to date, which can be categorized into the following 3 classic types[35, 36, 37, 38, 39, 40, 41] :

  • Removing only subcutaneous cellular tissue without removing skin: In some reports, axillary superficial fascia is removed in addition to the apocrine glands, with good results. [42] In minimally invasive procedures, this fascia is left intact. One novel technique used subcutaneous curettage combined with fat trimming to create a smooth surface on the axillary skin flap while removing the apocrine glands. Ninety eight percent of subjects reported good-to-excellent results, and no significant complications occurred. [43]
  • Removing skin and subcutaneous cellular tissue en bloc
  • Removing skin and cellular tissue en bloc, as well as removing the subcutaneous cellular tissue of the adjacent area: This is often performed by using a shaving technique on the subcutaneous tissue. [44]

Depending on the depth of the surgical injury, regeneration of gland function over a period of years may be observed. Subcutaneous tissue removal has also been combined with carbon dioxide laser to vaporize the residual apocrine glands.[45]

Superficial liposuction curettage

The superficial liposuction curettage technique is an outpatient procedure that has the advantage of being less traumatic than open surgery. Small incisions are made in the axilla, and a suction device is inserted that removes the subcutaneous tissue. This procedure offers a smaller incision, lower complication rates, and minimal postoperative care.[46, 47, 48, 49] However, its associated recurrence rate is higher than that of open surgery, leading to decreased patient satisfaction on long-term follow-up. A similar procedure, ultrasound-assisted suction aspiration, liquefies fat and sweat glands.[50, 51, 52] This treatment has recurrence rates lower than those of traditional superficial liposuction curettage and results in similarly small scars.

Upper thoracic sympathectomy has also been performed for axillary bromhidrosis, and one study in Taiwan reported a satisfaction rate of 70.6%; however, this therapeutic modality has more frequently been used for axillary and palmar hyperhidrosis.[53]



Omission of certain foods may be of value if these factors can be isolated or identified as contributory factors to the bromhidrosis. Common culprits include curry spices, onions, garlic, and alcohol.

Contributor Information and Disclosures

Wingfield Rehmus, MD, MPH Dermatologist, BC Children's Hospital, Vancouver, British Columbia

Wingfield Rehmus, MD, MPH is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie; Valeant Canada<br/> Received honoraria from Valeant Canada for advisory board; Received honoraria from Pierre Fabre for advisory board; Received honoraria from Mustella for advisory board; Received honoraria from Abbvie for advisory board.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.


Katherine Brown Stanford University School of Medicine

Katherine Brown, is a member of the following medical societies: American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Carol E Cheng, MD Attending Physician, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School

Disclosure: Nothing to disclose.

Nelly Rubeiz, MD Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon

Disclosure: Nothing to disclose.

Shereen S Timani, MD Staff Physician, Department of Dermatology, American University of Beirut, Lebanon

Disclosure: Nothing to disclose.

  1. He J, Wang T, Dong J. A close positive correlation between malodor and sweating as a marker for the treatment of axillary bromhidrosis with botulinum toxin A. J Dermatolog Treat. 2011 Jul 31. [Medline].

  2. Guillet G, Zampetti A, Aballain-Colloc ML. Correlation between bacterial population and axillary and plantar bromidrosis: study of 30 patients. Eur J Dermatol. 2000 Jan-Feb. 10(1):41-2. [Medline].

  3. Leyden JJ, McGinley KJ, Holzle E, Labows JN, Kligman AM. The microbiology of the human axilla and its relationship to axillary odor. J Invest Dermatol. 1981 Nov. 77(5):413-6. [Medline].

  4. Lindsay SL, Holmes S, Corbett AD, Harker M, Bovell DL. Innervation and receptor profiles of the human apocrine (epitrichial) sweat gland: routes for intervention in bromhidrosis. Br J Dermatol. 2008 Sep. 159(3):653-60. [Medline].

  5. Natsch A, Derrer S, Flachsmann F, Schmid J. A broad diversity of volatile carboxylic acids, released by a bacterial aminoacylase from axilla secretions, as candidate molecules for the determination of human-body odor type. Chem Biodivers. 2006 Jan. 3(1):1-20. [Medline].

  6. Spielman AI, Sunavala G, Harmony JA, et al. Identification and immunohistochemical localization of protein precursors to human axillary odors in apocrine glands and secretions. Arch Dermatol. 1998 Jul. 134(7):813-8. [Medline].

  7. Zeng C, Spielman AI, Vowels BR, Leyden JJ, Biemann K, Preti G. A human axillary odorant is carried by apolipoprotein D. Proc Natl Acad Sci U S A. 1996 Jun 25. 93(13):6626-30. [Medline]. [Full Text].

  8. Sato T, Sonoda T, Itami S, Takayasu S. Predominance of type I 5alpha-reductase in apocrine sweat glands of patients with excessive or abnormal odour derived from apocrine sweat (osmidrosis). Br J Dermatol. 1998 Nov. 139(5):806-10. [Medline].

  9. Mao GY, Yang SL, Zheng JH. Cause of axillary bromidrosis. Plast Reconstr Surg. 2009 Feb. 123(2):81e-82e. [Medline].

  10. Mao GY, Yang SL, Zheng JH. Etiology and management of axillary bromidrosis: a brief review. Int J Dermatol. 2008 Oct. 47(10):1063-8. [Medline].

  11. Nakano M, Miwa N, Hirano A, Yoshiura K, Niikawa N. A strong association of axillary osmidrosis with the wet earwax type determined by genotyping of the ABCC11 gene. BMC Genet. 2009 Aug 4. 10:42. [Medline]. [Full Text].

  12. Shang D, Zhang X, Sun M, Wei Y, Wen Y. Strong association of the SNP rs17822931 with wet earwax and bromhidrosis in a Chinese family. J Genet. 2013. 92(2):289-91. [Medline].

  13. Eun HC, Kim KH, Lee YS. Unusual body odour due to a nasal foreign body in a child. J Dermatol. 1984 Oct. 11(5):501-3. [Medline].

  14. Golding IM. An unusual cause of bromidrosis. Pediatrics. 1965 Nov. 36(5):791-2. [Medline].

  15. Katz HP, Katz JR, Bernstein M, Marcin J. Unusual presentation of nasal foreign bodies in children. JAMA. 1979 Apr 6. 241(14):1496. [Medline].

  16. Lucky AW. Acquired bromhidrosis in an 8-year-old boy secondary to a nasal foreign body. Arch Dermatol. 1991 Jan. 127(1):129. [Medline].

  17. Moriarty RA. Nasal foreign body presenting as an unusual odor. Am J Dis Child. 1978 Jan. 132(1):97-8. [Medline].

  18. Mancini M, Panasiti V, Devirgiliis V, Pietropaolo V, Fioriti D, Nicosia R, et al. Bromhidrosis induced by sphingomonas paucimobilis: a case report. Int J Immunopathol Pharmacol. 2009 Jul-Sep. 22(3):845-8. [Medline].

  19. Michaud T, Tack B. [Laser hair removal]. Ann Dermatol Venereol. 2009 Oct. 136 Suppl 6:S330-4. [Medline].

  20. Helou J, Haber R, Kechichian E, Tomb R. A case of generalized bromhidrosis following whole-body depilatory laser. J Cosmet Laser Ther. 2015. Vol 17(6):318-20.

  21. Helou J, Habre M, Soutou B, Maatouk I, Ibrahim T, Tomb R. Reversibility of hyperhidrosis post axillary depilatory laser. Lasers Med Sci. 2014 Mar. Vol 29(2):717-21. [Medline].

  22. Miranda-Sivelo A, Bajo-Del Pozo C, Fructuoso-Castellar A. Unnecessary surgical treatment in a case of olfactory reference syndrome. Gen Hosp Psychiatry. 2013 Nov-Dec. 35(6):683.e3-4. [Medline].

  23. Bang YH, Kim JH, Paik SW, Park SH, Jackson IT, Lebeda R. Histopathology of apocrine bromhidrosis. Plast Reconstr Surg. 1996 Aug. 98(2):288-92. [Medline].

  24. Kunachak S, Wongwaisayawan S, Leelaudomlipi P. Noninvasive treatment of bromidrosis by frequency-doubled Q-switched Nd:YAG laser. Aesthetic Plast Surg. 2000 May-Jun. 24(3):198-201. [Medline].

  25. Lee KG, Kim SA, Yi SM, Kim JH, Kim IH. Subdermal Coagulation Treatment of Axillary Bromhidrosis by 1,444 nm Nd:YAG Laser: A Comparison with Surgical Treatment. Ann Dermatol. 2014 Feb. 26(1):99-102. [Medline].

  26. Jung SK, Jang HW, Kim HJ, Lee SG, Lee KG, Kim SY. A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis. Ann Dermatol. 2014 Apr. 26(2):184-8. [Medline].

  27. Jung SK, Jang HW, KIm HJ et al. A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis. Ann Dermatolog. 2014 Apr. 26(2):184-8. [Full Text].

  28. Heckmann M, Teichmann B, Pause BM, Plewig G. Amelioration of body odor after intracutaneous axillary injection of botulinum toxin A. Arch Dermatol. 2003 Jan. 139(1):57-9. [Medline].

  29. Heckmann M, Kutt S, Dittmar S, Hamm H. Making scents: improvement of olfactory profile after botulinum toxin-A treatment in healthy individuals. Dermatol Surg. 2007 Jan. 33(1 Spec No.):S81-7. [Medline].

  30. Lee JB, Kim BS, Kim MB, Oh CK, Jang HS, Kwon KS. A case of foul genital odor treated with botulinum toxin A. Dermatol Surg. 2004 Sep. 30(9):1233-5. [Medline].

  31. He J, Wang T, Dong J. A close positive correlation between malodor and sweating as a marker for the treatment of axillary bromhidrosis with Botulinum toxin A. J Dermatolog Treat. 2012 Dec. 23(6):461-4. [Medline].

  32. He J, Wang T, Dong J. Excision of apocrine glands and axillary superficial fascia as a single entity for the treatment of axillary bromhidrosis. J Eur Acad Dermatol Venereol. 2011 Jun 21. [Medline].

  33. Zhao J, Li S, Nabi O, Hu L, Gao X, Luo F. Treatment of axillary bromhidrosis through a mini-incision with subdermal vascular preservation: a retrospective study in 396 patients. Int J Dermatol. 2016 May 21. [Medline].

  34. Li Z, Sun C, Zhang J, Qi Y, Hu J. Excision of apocrine glands with preservation of axillary superficial fascia for the treatment of axillary bromhidrosis. Dermatol Surg. 2015 May. 41(5):640-4. [Medline].

  35. Battal NM, Hata Y. A classic surgical method for the treatment of axillary osmidrosis. Plast Reconstr Surg. 1997 Aug. 100(2):550-1. [Medline].

  36. Born G. Surgical treatment of axillary osmidrosis. Plast Reconstr Surg. 1995 Dec. 96(7):1753. [Medline].

  37. Fan YM, Wu ZH, Li SF, Chen QX. Axillary osmidrosis treated by partial removal of the skin and subcutaneous tissue en bloc and apocrine gland subcision. Int J Dermatol. 2001 Nov. 40(11):714-6. [Medline].

  38. Grazer FM. A noninvasive surgical treatment of axillary hyperhidrosis. Clin Dermatol. 1992 Jul-Sep. 10(3):357-64. [Medline].

  39. Park DH, Kim TM, Han DG, Ahn KY. A comparative study of the surgical treatment of axillary osmidrosis by instrument, manual, and combined subcutaneous shaving procedures. Ann Plast Surg. 1998 Nov. 41(5):488-97. [Medline].

  40. Wang HJ, Cheng TY, Chen TM. Surgical management of axillary bromidrosis--a modified skoog procedure by an axillary bipedicle flap approach. Plast Reconstr Surg. 1996 Sep. 98(3):524-9. [Medline].

  41. Wu WH, Ma S, Lin JT, Tang YW, Fang RH, Yeh FL. Surgical treatment of axillary osmidrosis: an analysis of 343 cases. Plast Reconstr Surg. 1994 Aug. 94(2):288-94. [Medline].

  42. He J, Wang T, Dong J. Excision of apocrine glands and axillary superficial fascia as a single entity for the treatment of axillary bromhidrosis. J Eur Acad Dermatol Venereol. 2012 Jun. 26(6):704-9. [Medline].

  43. Wang R, Yang J, Sun J. A minimally invasive procedure for axillary osmidrosis: subcutaneous curettage combined with trimming through a small incision. Aesthetic Plast Surg. 2015 Feb. 39(1):106-13.

  44. Inaba M, Anthony J, Ezaki T, Mackinstry C. Regeneration of axillary hair and related phenomena after removal of deep dermal and subcutaneous tissue by a special "shaving" technique. J Dermatol Surg Oncol. 1978 Dec. 4(12):921-5. [Medline].

  45. Kim IH, Seo SL, Oh CH. Minimally invasive surgery for axillary osmidrosis: combined operation with CO2 laser and subcutaneous tissue remover. Dermatol Surg. 1999 Nov. 25(11):875-9. [Medline].

  46. Lillis PJ, Coleman WP 3rd. Liposuction for treatment of axillary hyperhidrosis. Dermatol Clin. 1990 Jul. 8(3):479-82. [Medline].

  47. Ou LF, Yan RS, Chen IC, Tang YW. Treatment of axillary bromhidrosis with superficial liposuction. Plast Reconstr Surg. 1998 Oct. 102(5):1479-85. [Medline].

  48. Tung TC. Endoscopic shaver with liposuction for treatment of axillary osmidrosis. Ann Plast Surg. 2001 Apr. 46(4):400-4. [Medline].

  49. Seo SH, Jang BS, Oh CK, Kwon KS, Kim MB. Tumescent superficial liposuction with curettage for treatment of axillary bromhidrosis. J Eur Acad Dermatol Venereol. 2008 Jan. 22(1):30-5. [Medline].

  50. Chung S, Yoo WM, Park YG, Shin KS, Park BY. Ultrasonic surgical aspiration with endoscopic confirmation for osmidrosis. Br J Plast Surg. 2000 Apr. 53(3):212-4. [Medline].

  51. Hong JP, Shin HW, Yoo SC, et al. Ultrasound-assisted lipoplasty treatment for axillary bromidrosis: clinical experience of 375 cases. Plast Reconstr Surg. 2004 Apr 1. 113(4):1264-9. [Medline].

  52. Park S. Very superficial ultrasound-assisted lipoplasty for the treatment of axillary osmidrosis. Aesthetic Plast Surg. 2000 Jul-Aug. 24(4):275-9. [Medline].

  53. Kao TH, Pan HC, Sun MH, Chang CS, Yang DY, Wang YC. Upper thoracic sympathectomy for axillary osmidrosis or bromidrosis. J Clin Neurosci. 2004 Sep. 11(7):719-22. [Medline].

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