Axillary oedema (commonly known as axillary odor or fox odor) is mainly caused by the secretion of axillary sweat glands by the action of epithelial bacteria (mainly staphylococci), which produce unsaturated fatty acids and release an abnormal odor. Its incidence varies with race and individual, and seasonal and climatic differences exist but are not significant. It is more common in women than in men, and has a relationship with heredity, so it can still be inherited to the next generation after treatment. The lighter cases cause a lot of psychological pressure on the patient, the heavier cases not only pollute the environment, but also affect the patient’s daily life, marriage and family and physical and mental health.
There are many treatment methods for axillary odor, including medication, X-ray, freezing, laser, surgical treatment and local injection therapy, all of which are used to achieve the purpose of treatment by destroying sweat glands, and surgical treatment is considered to be the most thorough treatment method, but there are more postoperative complications of surgical treatment, and the healing time after surgery takes 7 to 10 days. Laser and cryotherapy have a greater blindness and the efficacy is not certain. Although the external application of drugs can temporarily inhibit the secretion of glands and bacterial reproduction and reduce odor, but can not fundamentally remove the lesion, only the symptoms can not cure the root cause, and the effect is short-lived, requiring long-term, frequent medication to maintain the efficacy of the patient often difficult to adhere to. Therefore, the search for a minimally invasive, safe and reliable treatment for axillary odor is the goal of plastic surgeons’ continuous exploration.
I. Clinical data
There were 256 cases in this group, aged 16 to 50 years old, with an average age of 28.5 years. There were 86 male cases and 170 female cases. There were 190 cases treated for the first time and 66 cases treated again (including 36 cases of relapse after laser treatment, 25 cases of relapse after minimally invasive sweat gland scraping surgery, and 5 cases of ineffective long-term topical medication).
II. Diagnostic criteria
According to the degree of odor, axillary odor is divided into three degrees: mild, medium and severe.
Mild: the odor can be smelled within 1 meter or the patient himself can smell.
Moderate: the odor can be smelled within 2 meters.
Severe: the odor can be smelled beyond 2 meters.
In this group, there were 96 cases of mild, 144 cases of moderate and 16 cases of severe.
Third, the treatment method
1.Injectable drugs.
Botulinum toxin type A for injection (Hengli), produced by Lanzhou Institute of Biological Products, approval number: S10970037, specification: 100IU/bottle.
Botulinum toxin type A for injection (BOTOX), produced by GlaxoSmithKline, with the approval number: Pharmacopoeia S20070023, specification: 100IU/bottle.
2.Injection method.
Botulinum toxin type A will be injected into both sides of the armpit respectively.
Fourth, the effect of judgment
256 cases after injection treatment, according to the disappearance of odor and the length and degree of recurrence for the results of judgment.
Cured: the odor disappeared completely after injection and kept for more than 2 years.
Effective: odor eliminated after surgery, and a year later there is a mild odor (patients can smell themselves).
Effective: no odor after treatment, significant odor within 1 year, but less than before treatment.
Ineffective: the odor did not diminish after treatment.
V. Results
The group began to take effect after one week of treatment, and the effect was obvious after one month. Cured 248 people (6 cases injected three times, 96 cases injected twice, 146 cases injected once, the interval between multiple injections ranging from 6 months to 1 year), accounting for 96.9%, 5 cases of significant effect, accounting for 2.0%, effective 3 cases, 1.2%. None of the cases had complications and adverse reactions.
VI. Discussion
(A) The pathogenesis of axillary odor
The sweat glands in the axillary area are usually divided into two types, one is the exocrine sweat glands, also known as small sweat glands, which secrete a lot of colorless and odorless sweat and regulate body temperature. Axillary odor is mainly due to abnormal sweat glands in the armpit area. These patients produce axillary odor even when the flora of the axillary region is the same as that of normal people.
(ii) Principle of application
Botulinum toxin is an exotoxin produced by Gram-positive anaerobic bacterium Clostridium botulinum in the process of reproduction, which can be divided into 8 types: A, B, C1, C2, D, E, F, G. Type A botulinum toxin is non-heat resistant and more sensitive to changes in pH. Therefore, botulinum toxin is packed in an empty vial under vacuum and stored at -5°C. Botulinum toxin type A is a biological agent with unstable properties and should be used as soon as possible if dissolved in physiological saline, and can be stored in the refrigerator for 4 hours after dilution at 2 to 8°C.
Botulinum toxin type A weakens skeletal muscle by cleaving the presynaptic membrane of the synapse-associated protein SNAP25, which blocks the release of acetylcholine from motor neurons and repolarizes the posterior membrane, blocking muscle contraction and causing flaccid paralysis of muscles. However, the blocking effect of botulinum toxin does not affect the production of acetylcholine, and after several months, the nerve junction and axon produced replace the non-functional neuromuscular junction, and the nerve function is restored again. The treatment of axillary odor in this group is to apply the pharmacological effect of botulinum toxin to make the axillary area of the sweat glands atrophy, the axillary secretion of sweat is reduced, that is, the sweat gland secretion is reduced and the purpose of treating axillary odor.
In conclusion, local injection of botulinum toxin for the treatment of axillary odor has long-lasting and precise efficacy, low recurrence rate of treatment, easy operation, light tissue damage, little pain and no effect.