Osmidrosis or bromhidrosis is a condition of abnormally offensive axillary odor. Osmidrosis is more pronounced when people sweat: in summer or after intense exercise, but it yields a foul smell even when patients do not sweat.
Bacteria decompose apocrine secretions from apocrine sweat glands, an axillary sweat gland, liberating fatty acids with peculiar smells (ammonia.) According to incidence figures, about 10% of Koreans are believed to have osmidrosis and even if only one parent has the condition, the likelihood of hereditary transmission is as high as 50%.
Apocrine sweat gland excision has been employed as a therapy and although there are two main methods, there are numerous transformations which have merits and demerits. The latest pivotal method is Gobayasi insulating needle.
1. Surgical care
Armpit skin is incised with a scalpel to remove apocrine sweat glands. Even with the smallest incisions, surgical scars of 2~3 cm remain and a large compress has to be worn over the shoulders for 1~2 weeks which is uncomfortable. The advantage of this surgery is remarkable results with one procedure, but recurrence, which is difficult to treat, has been reported. Female patients are bothered by remaining scars.

2. Gobayasi insulating needle

Gobayasi insulating needle for permanent hair removal (an average of 5 visits is needed) is used, followed by Gobayasi insulating needle used to correct osmidrosis. This remarkable surgery does not use a scalpel and is therefore scarless. The patient can have a shower the day after the procedure and enjoy everyday activities. Other merits include simultaneous permanent hair removal and easy treatment in the case of recurrence.
* Gowoon Sesang Clinic¡¯s osmidrosis surgery using Gobayasi insulating needle can correct past osmidrosis surgeries which have gone wrong.

The cause of osmidrosis, apocrine sweat glands, is located right next to the root of hair and secretes sweat through pores, so it is vital to destroy hair follicles instead. Gobayasi procedure inserts insulating needle for hair removal into each and every hair follicle and applies low-voltage current to these hair follicles, permanently removing hair. Apocrine sweat glands and pores are destroyed alongside the root of hair, which is why Gobayashi procedure also works on osmidrosis. Gobayasi surgery injects a specially designed insulating needle into the subcutaneous fat layer and direct current is passed across the skin. Only the subcutaneous fat layer, where apocrine sweat glands are located, is destroyed without harming the skin.
There are two types of sweat in humans: apocrine secretion, from apocrine sweat glands in armpits, which assumes a characteristic stench when decomposed by bacteria and eccrine sweat from eccrine sweat glands all over our body (palms, soles, on the trunk, etc.)
Hyperhidrosis is a term for excessive sweating without any discernible cause. Out of the two, it is caused by active eccrine sweat glands. It most commonly involves the axillae, palms and soles but may also involve any part of the body.
Hyperhidrosis is divided into localized or generalized hyperhidrosis by affected region and essential and secondary hyperhidrosis by cause.
Etiology of essential hyperhidrosis (mostly localized) is unknown. Generalized hyperhidrosis may be secondary to numerous diseases such as chronic infection, hyperthyroidism, diabetes, autoimmune disease and malignant tumor. Olfactory hyperhidrosisa and gustatory hyperhidrosis are rare, but exist.
Sweat secretion is controlled by autonomic nerves called sympathetic nerves. Hyperhidrosis results from abnormal hypersecretion, for various reasons, of neurotransmitters (acetylcholine) from tips of these nerves which in turn stimulate the sweat glands.
1. Localized care
- Aluminum chloride is a topical agent applied to regions affected by hyperhidrosis. It is an easy method to block the sweat pores, but has a short-lasting effect.
- Lontophoresis stops the function of sweat glands. The demerit is temporary and can only be used for specific regions.
2. Generalized care
Various medications are available, but because of high complication rate, seldom recommended.
3. Surgical care
A method to block the sympathetic nerves that control sweat secretion, the surgery involves incising the spinal cord and severing the appropriate nerves. Effects last, but since sympathetic nerves can affect other internal organs as well, numerous complications are possible. Success rate differs by affected areas. Compensatory sweating in previously unaffected areas of the body has been reported after surgery.
4. Botox injection
A drug called Botox is injected into sweaty areas to block acetylcholine at tips of nerves and suppress sweat secretion. While the procedure is very simple and the results long-lasting (4~6 months), it is relatively costly. This technique is especially effective at treating axillary hyperhidrosis.
5. Gobayasi procedure (for armpits)
The newly upgraded Gobayasi surgery is a remarkable treatment for not only osmidrosis and permanent hair removal, but also for hyperhidrosis. The procedure is simple and short (one side takes about 15 minutes.)
First of all, five visits are required for Gobayasi hair removal needle procedure and then sweat glands are destroyed using the Gobayasi insulating needle over 1~3 visits at six-month intervals.
The great thing about combined Gobayasi hair removal and insulating needle procedure for hyperhidrosis is the absence of scalpel or scar. It is painless thanks to localized anesthesia and you can enjoy your everyday activities right after the surgery and can shower the next day.