Axillary osmidrosis is distressing condition that can pose significant social embarrassment. Conservative treatments such as topical agents, systemic agents and botulinum toxin are only temporarily effective and may lead to surgical treatment.
However, surgical interventions using gland excision or liposuction have associated downtimes and complications that may be unacceptable for the treatment of a benign condition. We are describing subcutaneous application of pulsed neodymium: yttrium - aluminum-garnet laser for ablation of the sweat glands. The procedure is performed on an outpatient basis with local anesthesia. We are using Smart Lipo Laser (DEKA, Florence, Italy) which is pulsed neodymium: yttrium - aluminum-garnet, 1064-nm laser system. The laser light is conveyed through a microcannula with a diameter of 1,0 mm which an optical fiber is inserted. After routine tumescent anesthesia two small punctures is made with an 18-gauge needle at the anterior and distal border of each axilla. The cannula is inserted into the target layer of the dermal - sub dermal junction and depth of the cannula tip is controlled by transcutaneous guidance with a red helium-neon light. This monitoring is very important to prevent damage of deeper structures such as brachial plexus and blood vessels. The laser is applied to the tissue with repeated cannulation in a criss-cross manner. The endpoint of exposure is 200 to 300J for each grid, depending on the skin thickness and hair density. The external and internal temperature monitoring is used. Cold packs are applied to the treated area to prevent heat injury of the skin during operation. No suture is needed. The procedure in one side took 5 to 15 minutes. Compressive dressing is applied for 24 hours postoperatively. Axillary hair remained in most cases, but partial hair loss of the treated area was seen postoperatively. No hematoma, infection, skin necrosis, or hypertrophy scar occurred.
A variety of surgical interventions have been used to treat axillary osmidrosis, including manual excission of afillary tissue, liposuction, carbon dioxide laser vaporization and ultrasound-assisted succion with skin incision. Because of a number of potential complications and recurrence, they reported that the use of these techniques should be reserved for only severe cases that remain unresponsive to conservative therapy. Subcutaneous laser treatment seems to be superior with regard to downtime and postoperative immobilisation. This procedure is surgical and should be performed by surgeons who are experienced in manual surgery of axillary osmidrosis and skin laser practice.
The longevity of the procedure varies. Some gland tissues may recover from temporal damage a fibrosis and work again after year or longer. Compared with usual suction, laser-assisted suction in the axilla is more effective, suction is easier and recovery is shorter. With adequate selection of patients, subcutaneous laser-assisted treatment is very effective and safe option.