What is Body Odor?
Body odor or lousy body is known as bromhidrosis, osmidrosis, fetid sweat, body smell, or malodorous sweating. The body odor primarily results from the apocrine sweat glands, which secrete most chemical compounds needed for the skin flora to metabolize it into odorant substances.
Humans have two types of sweat glands: eccrine sweat glands and apocrine sweat glands. Eccrine sweat glands are present from birth, while the apocrine glands become activated during puberty. Body odor is most likely to occur in the following places: feet, groin, armpits, genitalia, pubic hair and other hair, belly button, anus, behind the ears, and the rest of the skin, to a lesser extent.
Body odor is usually accompanied by excessive sweating and managed in the same manner. Botox is injected intradermally to treat hyperhidrosis and inhibits the release of acetylcholine at the neuromuscular junction and from the sympathetic nerves that innervate eccrine sweat glands.
A new bipolar radiofrequency device can destroy the eccrine glands by thermolysis at the deep dermis and subcutis interface. When medical treatment fails, ultrasound and power-assisted liposuction of armpits can gently remove both eccrine and apocrine sweat glands.
What are the Causes of Body Odor?
Dermatologists estimate that 3% of people in the United States have excessive sweating. People of all races get hyperhidrosis. Excessive sweating can begin at any age. Researchers have learned that most people have one of the following:
- Have a family member who sweats excessively.
- Have a Medical condition that causes sweating?
- They are taking medicine or food supplements, which can cause excessive sweating.
- People who sweat too much, such as those with hyperhidrosis, may also be susceptible to body odor.
Most people have several million sweat glands distributed over their bodies, including the underarm axilla, thus providing plenty of opportunities for underarm odors to develop. The skin has two sweat glands: eccrine glands and apocrine glands.
Eccrine glands open directly onto the skin’s surface and exude sweat in the underarm, subsequently contributing to odor formation. These glands are located in the middle layer of the skin called the dermis, which is also made up of nerve endings, hair follicles, and blood vessels.
Sweat is produced in a long coil embedded within the dermis, where the long part is a duct that connects the gland to the opening (pore) on the skin’s surface. When body temperature rises, the autonomic nervous system stimulates these glands to secrete fluid onto the skin’s surface, where it then cools the body as it evaporates.
The composition of the eccrine gland secretion is about 55–60% fluid, mainly water with various salts (primarily: sodium chloride and potassium chloride) and various electrolytic components (ammonia, calcium, copper, lactic acid, potassium, and phosphorus).
The warmth and limited airflow allow for rapid decomposition of organic matter made up of primarily low molecular weight volatile fatty acids. These fatty acids and the steroidal compounds produce recognizable body odors.
Emotions trigger the apocrine glands. These glands are dormant until puberty when they start to secrete. Apocrine glands secrete a fatty substance. When under emotional stress, the wall of the tubule glands contracts to push the fatty exudates to the skin’s surface, where bacterial flora begin breaking it down.
Body odor is the perceived unpleasant smell our bodies can give off when bacteria that live on the skin break down sweat into acids. Body odor is known medically as bromhidrosis, apocrine bromhidrosis, osmidrosis, ozochrotia, smelly sweat, body smell, or malodorous sweating. Body odor can have a pleasant and specific smell to the individual and identify people, especially dogs and other animals. Diet, gender, health, and medication can influence each person’s unique body odor.
A foul body odor defines osmidrosis or bromhidrosis as a water-rich environment that supports bacteria caused by an abnormal increase in perspiration (hyperhidrosis). Body odor is particularly strong in the axillary region (underarms). In this case, the body odor may be referred to as axillary osmidrosis.
Humans have two types of sweat glands: eccrine sweat glands and apocrine sweat glands.
Eccrine sweat glands are present from birth, while the apocrine glands become activated during puberty. The body odor is primarily the result of the apocrine sweat glands, which secrete most chemical compounds needed for the skin flora to metabolize it into odorant substances. This happens mainly in the axillary (armpit) region, although the gland can also be found in the areola, anogenital area, and navel.
The genital and armpit areas also contain light hairs that help diffuse body odor. Body odor is most likely to occur in the following places: feet, groin, armpits, genitalia, pubic hair and other hair, belly button, anus, behind the ears, and the rest of the skin, to a lesser extent.
Body odor is caused by bacteria breaking down sweat and is linked to apocrine glands. These glands are found in the breasts, genital area, eyelids, armpits, and ear. They are scent glands. Most of the apocrine glands in the skin are in the groin, armpits, and around the nipples.
Body odor is influenced by the actions of the skin flora, including members of Corynebacterium, which manufacture enzymes called lipases that break down the lipids in sweat to create smaller molecules like butyric acid. More significant bacteria populations of Corynebacterium jeikeium are, for example, found more in the armpits of men.
In contrast, higher population numbers of Staphylococcus haemolyticus are in women’s armpits. This causes male armpits to give off a rancid/cheese-like smell, whereas female armpits give off a fruitier/onion-like smell. Staphylococcus hominis is also known for producing thioalcohol compounds that contribute to odors.
Propionic acid (propanoic acid) is present in many sweet samples. This acid is a breakdown product of some amino acids caused by propionibacteria, which thrive in the ducts of adolescent and adult sebaceous glands. These smaller molecules smell and give body odor its characteristic aroma. Because propionic acid is chemically like acetic acid with similar characteristics, including odor, I may identify body odors as having a vinegar-like smell by certain people.
What is Excessive Sweating (hyperhidrosis)
The word “hyperhidrosis” means too much (hyper) sweating (hidrosis). Excessive sweating happens when a person sweats more than is necessary. Yes, it’s essential to sweat. Sweating cools the body, which prevents us from overheating — people who have hyperhidrosis, however, sweat when the body does not need cooling.
Many people who have hyperhidrosis sweat from one or two areas of the body. They often sweat from their palms, feet, underarms, or head. While the rest of the body remains dry, one or two areas may drip with sweat. This excessive sweating can interfere with everyday activities.
- Visible sweating: When you are not exerting yourself, do you often see beads of sweat on your skin or have sweat-soaked clothing? Do you sweat when you’re sitting? If you have this medical condition, you may notice:
- Sweating interferes with everyday activities: Does sweating cause difficulty holding a pen, walking, or turning a doorknob? Does sweat drip slowly onto your papers or computer?
- The skin turns soft, white, and peels in specific areas: Does your skin stay wet for extended periods?
- Skin infections: Do you get frequent skin infections on the parts of your body that sweat heavily? The athlete’s foot and jock itch are common skin infections.
How Do Dermatologists Diagnose Body Odor and Excess Sweating?
To diagnose body odor condition, a dermatologist gives the patient a physical exam. This includes looking closely at the areas of the body that sweat excessively. A dermatologist also asks questions. This helps the doctor understand why the patient has excessive sweating. Sometimes medical testing is necessary. Some patients require a test called the sweat test. This involves coating some of their skin with purple powder when the skin gets wet. More medical tests are needed to discover an underlying medical condition.
What Are My Treatment Options for Body Odor?
Body Odor Treatment. Antiperspirants
The consumer typically confuses what antiperspirants and deodorants cause mainly by misunderstanding marketing claims and product positioning. For the most part, antiperspirants are based on aluminum-based cationic salt chloride complexes (and complexes with zirconium acid salts). They are referred to as “actives” on the back label of consumer antiperspirant products.
A theory of wetness control that has been accepted over the years is that the hydrated aluminum or aluminum–zirconium cationic salt chloride is transported to the eccrine gland, interacting with the protein contained within the gland.
The antiperspirant activity is reduced in this essential protein environment, producing a gelatinous proteinaceous plug. Sweat is prohibited from transporting to the surface by plugging the gland, causing osmotic pressure. Eventually, this plug is pushed out of the eccrine gland, and the gland is allowed to operate again in a typical fashion. This can take 14–21 days for all the eccrine glands to begin firing, a wash-out period.
Deodorants cover odor through various mechanisms, including neutralizing or counteracting odoriferous axilla odor through the retardation of the odor development or the reduction in perception of odor through masking of the odor.
Masking is accomplished via the use of fragrances and other volatile components. Neutralization is the chemical reaction to modify low molecular weight fatty acids excreted from the apocrine gland. One type of neutralization agent is antimicrobials that disrupt cell barrier viability causing the bacterial microbes to perish (triclosan is one famous example).
Deodorants are designed to minimize underarm axilla odor, not reduce or eliminate sweat. So, deodorants are best for those people who do not have a problem with sweating yet want to feel fresh and odor-free.
It is important to note that deodorants have no antiperspirant physiologic activity, but antiperspirants can function both as antiperspirants and deodorants; thus, consumers needing odor and wetness control will require the use of antiperspirants to achieve their needs.
Based on information from the International Hyperhidrosis Society, over 87% of people with hyperhidrosis say that OTC antiperspirants do not provide sufficient relief. Thus, the medical community needs to understand the other options available to treat excessive sweating.
Body Odor Treatment. Iontophoresis (the no-sweat machine)
If excessive sweating affects your hands, feet, or both areas, this may be an option. You will use this treatment at home. It requires you to immerse your hands or feet in a shallow pan of tap water. A medical device sends a low-voltage current through the water as you do this. The electric current shuts down the treated sweat glands temporarily.
Most people need about 6 to 10 treatments to shut down the sweat glands. First, you may need 2 or 3 treatments per week. This can range from once a week to once a month. A treatment session usually takes 20 to 40 minutes. Once you see results, you can repeat the therapy as necessary to maintain results. If this treatment is right for you, your dermatologist will teach you how to use the device and give you a prescription so that you can buy one.
Body Odor Treatment. Prescription medicine
Some patients receive a prescription for a drug that temporarily prevents them from sweating. These medicines work throughout the body. These medicines prevent the sweat glands from working. Athletes, people who work in a hot place, and anyone who lives in a warm climate should use extreme caution when using this treatment. The body may not be able to cool itself.
Body Odor Treatment. Botox Injections
Botox is approved for the treatment of hyperhidrosis in the United States. It is injected intradermally to treat hyperhidrosis and inhibits the release of acetylcholine at the neuromuscular junction and from the sympathetic nerves that innervate eccrine sweat glands. Your dermatologist can inject a weak form of this medicine into your underarms.
To treat excessive sweating, a patient will need to have very tiny amounts injected in many areas of the underarms. When performed correctly, patients have little pain or discomfort. Findings suggest that this treatment may be helpful in other areas of the body. It may help post-menopausal women who sweat excessively on the head. It may be helpful for excessive sweating that affects the hands and feet.
Body Odor Treatment. Fractional Radiofrequency
Proudly at MSI, a newer bipolar RF device effectively reduces the amount of sweating. New bipolar RF devices can destroy the eccrine glands by thermolysis at the deep dermis and subcutis interface while minimizing damage to the surrounding tissue. Fractional radiofrequency treatment is a safe and effective alternative for moderate to severe primary axillary hyperhidrosis. Prof Moawad suggests That repeated sessions of FR be considered to achieve a complete response.
Body Odor Treatment. Microwave Device (miraDry)
The mechanism of action of the procedure causes non-invasive focused heating of the tissue at a depth of the sweat glands with the resulting thermolysis of the sweat glands. In the same way, fractional radiofrequency exerts its effect. However, I cannot use it to treat excessive sweating in other areas such as hands or feet because the procedure has been optimized to consider the physical attributes of the underarms.
Body Odor Treatment. Surgical Treatment
A surgical operation is an option for people who have not been helped much by other treatments or if other therapies cause unacceptable side effects or problems. Surgical ablation of eccrine glands is the only way to eliminate or reduce axillary osmidrosis and hyperhidrosis permanently. Local surgical treatment for axillary hyperhidrosis can be divided into three broad categories:
- Excision of subcutaneous glandular tissue only without skin removal.
- excision of skin with its glandular tissue attached; and
- selective sweat gland ablation using superficial, ultrasonic liposuction, laser liposuction, radiofrequency liposuction, or microwave sweat gland ablation. Liposuction should be combined with another technique to scrape the sweat glands from the underside of the skin through a small hole cut in the skin. This combination gives excellent results with less risk of complications.
Power-assisted Liposuction
All types of energy have been combined with liposuction to improve patient experience and results. The “power” in power-assisted/power-tumescent liposuction uses a tiny mechanical tube (cannula) that efficiently removes fatty tissue. The mechanical vibrations produced by the power unit are soothing and may decrease procedure time.
Powered liposuction can increase fat extraction by 30% over non-powered liposuction. Patients love the vibration sensation of powered liposuction or traditional non-powered liposuction. Prof. Moawad was the first to use this technique in the Middle East 10 years ago. In power-assisted liposuction, a cannula with a back-and-forth motion of the tip passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort.
Ultrasound Power-Assisted Tumescent Liposuction with Curettage
The use of external ultrasound before liposuction is a technique that requires the transcutaneous application of high-frequency ultrasonic fields delivered into wetted tissue, followed by traditional aspirates liposuction, to improve the mechanical removal of sweat glands. Ultrasound causes tissue destruction via three mechanisms: (1) cavitation, (2) micromechanical disruption, and (3) thermal damage.
Ultrasound reports suggest that the disruptive biologic effects of external ultrasound are due to a micromechanical outage or tissue heating. Other stories postulate that external UAL loosens adipose cell attachments, facilitating aspiration. The manifestations of the effects of external ultrasound appear to be directly proportional to the intensity delivered, with simple cellular detachment at 1 MHz to complete adipose cellular destruction at 2-3 MHz.
Recently, high-intensity focused ultrasound (HIFU) was used to treat and ablate subcutaneous adipose tissue before abdominoplasty cases with histologically proven success. This represents a new potential use for external ultrasound technology as a pretreatment regimen for ablating and remodeling subcutaneous deposits.
Prof Moawad uses the technologies above to ensure sweat glands’ gentle and complete removal in a novel approach. The patients were placed in a supine position with the arms abducted 90%. The hair-bearing area of bilateral axillae was marked and infiltrated with a 200 to 300mL of a tumescent solution consisting of 1,000mL of normal saline, 1mL of 1:1,000 epinephrine, 500mg of 2% lidocaine, 15mL of 8.4% sodium bicarbonate, and 1mL of 10 mg/mL triamcinolone using an infiltrating pump. A starch-iodine test is done, and photos of the results are taken.
Two or three tiny stab incisions (3mm-4mm) were made at each axilla’s anterior and distal border, a special cannula attached to the power machine was inserted through them, and subcutaneous tunnels were made by it. By placing the cannula in subcutaneous tunnels with its three holes turned upward to face the sub-dermis, a back-and-forth vibrating movement is performed in a crisscross pattern and aided by the other hand to compress the skin for effective subdermal scraping.
The role of vacuum and vibration (mechanical) is to functionally eliminate possible remaining sweat glands and help achieve excellent results. At the end of suction and curettage, the skin pinched up quickly like a piece of cloth. The procedure in one axilla took about 15 to 20 minutes. The stab incisions are closed with Steri-Strips.
Bulky compressive dressings are applied to bilateral axillae and kept for 24-48 hours. Afterward, the patient comes back to MSI to remove the bandage and wear his compression garment for the next two weeks. However, patients recovered their daily activities within 3–7 days.