Axillary osmidrosis (underarm odor) is a condition in which sweat secreted by the apocrine glands located under the arms is broken down by bacteria normally present on the skin, producing a distinctive odor. The number and size of apocrine glands are genetically determined and vary according to individual constitution. Symptoms often appear after puberty, and it is estimated that approximately 10–15% of Japanese people have a constitution prone to axillary osmidrosis.

Axillary osmidrosis tends to be hereditary. The number and size of apocrine glands, which are the underlying cause, are genetically determined. It is said that if one parent has axillary osmidrosis, the likelihood of passing it on to a child is approximately 50%, and if both parents have it, the likelihood rises to approximately 80%. However, even when inherited, the severity of symptoms varies among individuals.

Self-check indicators for axillary osmidrosis include: having wet earwax (wet-type cerumen), yellowing of the underarm area of white clothing, white powder-like deposits on underarm hair, and having family members with axillary osmidrosis. If several of these apply to you, there is a possibility you may have axillary osmidrosis. However, because people often become accustomed to their own odor and find it difficult to notice, we recommend visiting a medical institution for an accurate diagnosis.

Axillary osmidrosis and general body odor differ in the sweat glands responsible for each. Axillary osmidrosis is caused by sweat from the apocrine glands and is characterized by a sharp, distinctive odor, sometimes described as sulfurous. General body odor (sweat odor) is caused by sweat from the eccrine glands and tends to have a sour smell. Axillary osmidrosis is a constitutional condition and is distinct from ordinary sweat odor.

Because axillary osmidrosis is rooted in constitutional factors such as the number and size of apocrine glands, it does not generally resolve on its own. That said, apocrine gland activity tends to decline with age, which may lead to some reduction in odor. Lifestyle improvements—such as dietary changes and stress management—may also help reduce symptoms in some cases, but medical treatment is needed for more fundamental improvement.

Axillary osmidrosis can be treated in plastic surgery, dermatology, or cosmetic surgery departments. Plastic surgery specializes in surgical treatments and also performs insurance-covered procedures. Dermatology offers treatments such as topical medications and botulinum toxin injections. At our clinic, a board-certified plastic surgeon oversees everything from consultation to surgery, and we handle both insurance-covered and self-pay treatments.

Axillary osmidrosis in children can be treated. Symptoms often begin to appear during puberty (upper elementary school through junior high school age), and some families consider treatment during this period. However, because the apocrine glands are still developing during the growth phase, surgery is often deferred until physical growth has stabilized. During the growth phase, less invasive options such as botulinum toxin injections or topical medications may be considered.

Scientific evidence that specific foods directly worsen axillary osmidrosis is limited; however, diets high in animal fats (meat, dairy products), strongly spiced foods, alcohol, garlic, and chives are said to have the potential to intensify odor. Maintaining a balanced diet centered on vegetables and Japanese-style cuisine may help reduce odor in some cases.

Hyperhidrosis is a condition in which a person sweats excessively, beyond the amount needed for temperature regulation. It is classified as generalized hyperhidrosis, which affects the entire body, and focal hyperhidrosis, which is limited to specific areas such as the palms, soles of the feet, underarms, or face. It is further divided into primary (cause unknown) and secondary (caused by another condition or hormonal abnormality) types. Primary hyperhidrosis is often worsened by emotional stress.

Hyperhidrosis and axillary osmidrosis are different conditions. Hyperhidrosis refers to an excessive amount of sweat produced by the eccrine glands; the sweat itself is nearly odorless. Axillary osmidrosis is caused by sweat from the apocrine glands, which produces a distinctive odor. However, many people have both underarm hyperhidrosis and axillary osmidrosis simultaneously, in which case both the amount of sweat and the odor are concerns. Because the treatments differ, an accurate diagnosis is important.

If the amount of underarm sweating is great enough to interfere with daily life, axillary hyperhidrosis (underarm hyperhidrosis) may be a possibility. Specific indicators include: being bothered by underarm sweating at least once a week, onset at age 25 or younger, sweating symmetrically on both sides, not sweating during sleep, and having family members with hyperhidrosis. If several of these apply to you, hyperhidrosis may be suspected. We recommend a consultation to confirm the diagnosis.

Palmar sweating (palmar hyperhidrosis) can be treated. Treatment options include aluminum chloride topical solution, iontophoresis (a treatment using a mild electric current), botulinum toxin injections, oral medications (anticholinergic agents), and surgery (thoracoscopic sympathectomy). The most suitable treatment is selected based on the severity of symptoms and the patient’s lifestyle. Treatment often begins with topical medication.

Hyperhidrosis treatment may be covered by health insurance if certain conditions are met. Botulinum toxin injections for primary axillary hyperhidrosis are covered by insurance when the condition is sufficiently severe and interferes with daily life. There are also topical medications (Ecclock Gel, Rapifort Wipes) that became insurance-covered in 2020. Surgery may also be eligible for insurance coverage in some cases.

Sweating in response to nervousness or stress is a normal physiological reaction; however, if the amount of sweat is excessive and interferes with daily life, hyperhidrosis may be a possibility. Emotional sweating tends to appear on the palms, soles of the feet, and underarms, and people with primary hyperhidrosis often experience worsening symptoms with emotional stress. If you are troubled by stress-related sweating, we recommend consulting a specialist.

Treatment options for axillary osmidrosis and hyperhidrosis include topical medications (aluminum chloride solution, Ecclock Gel, etc.), botulinum toxin injections (to reduce sweating), miraDry (microwave-based sweat gland treatment), and surgery (excision method, suction method, etc.). For mild cases, topical medications or botulinum toxin injections are often chosen; for those seeking more fundamental improvement, miraDry or surgery may be considered. We will suggest a suitable treatment approach based on your symptoms and preferences.

Botulinum toxin injections are primarily used for hyperhidrosis and can also provide some benefit for axillary osmidrosis. Because botulinum toxin suppresses sweating from the eccrine glands, reducing sweat volume may also indirectly lessen odor. However, as it does not destroy the apocrine glands that cause axillary osmidrosis, it does not address the root cause. Effects typically last approximately 4–6 months, and repeat treatments are needed.

miraDry is a treatment that uses microwave energy to destroy sweat glands (both eccrine and apocrine glands). Because no incision is made, there are no scars, and downtime is relatively short. A single session is reported to reduce both sweating and odor by approximately 70–80%. The effects are long-lasting, as the treated sweat glands do not regenerate.

The main surgical approaches for axillary osmidrosis are the excision method (senjyo-ho) and the suction method. The excision method involves making an incision under the arm so the surgeon can directly visualize and remove the apocrine glands; it offers a high level of effectiveness and is eligible for insurance coverage. The suction method involves inserting a cannula through a small opening to suction out the sweat glands; scarring is minimal, but effectiveness is generally lower than the excision method. The appropriate approach is selected based on the severity of symptoms.

The likelihood of recurrence after axillary osmidrosis surgery varies depending on the surgical method. With the excision method, the surgeon removes the apocrine glands under direct visualization, resulting in a relatively low recurrence rate of approximately 5–10%. With the suction method, the procedure is performed without direct visualization, making it easier for glands to remain, which may result in a somewhat higher recurrence rate. Additionally, glands that were not fully removed during surgery may grow and cause symptoms to return. If recurrence occurs, re-operation or alternative treatments are available.

Aluminum chloride solution is a topical medication that suppresses sweating by blocking the openings of the sweat glands. It is widely used as an initial treatment for hyperhidrosis and axillary osmidrosis. The typical usage is to apply it to the affected area before going to bed and rinse it off the following morning. Over-the-counter products are available, but higher-concentration formulations (approximately 20%) prescribed by a medical institution tend to be more effective. Contact dermatitis or itching may occur, so those with sensitive skin should use it with caution.

Ecclock Gel (generic name: sofpironium bromide) is a medication for primary axillary hyperhidrosis that received insurance approval in Japan in 2020. Applied to the underarms once daily, it suppresses sweating from the eccrine glands. It works through an anticholinergic mechanism to reduce sweat gland activity, and is characterized by a low incidence of systemic side effects. It can be prescribed regardless of disease severity and offers a more accessible starting point than botulinum toxin injections.

Axillary osmidrosis surgery (excision method) is covered by health insurance. With a 30% co-payment, the cost for both underarms is approximately ¥40,000–¥50,000 as a general reference. This includes the surgical fee, anesthesia, and post-operative care. Self-pay treatments or newer procedures such as miraDry are not covered by insurance and generally cost approximately ¥200,000–¥400,000 for both underarms. Detailed cost information will be provided at the time of your consultation.

Axillary osmidrosis surgery is covered by health insurance. Axillary osmidrosis (bromhidrosis) is a recognized insurance diagnosis, and surgery using the excision method (flap method) can be performed under insurance coverage. However, insurance coverage requires a physician’s diagnosis of axillary osmidrosis. miraDry and some suction-based procedures are not covered by insurance and are self-pay treatments. Our clinic handles both insurance-covered and self-pay treatments.

Axillary osmidrosis surgery is performed under local anesthesia, so discomfort during the procedure is minimal. You may feel a brief sting from the anesthetic injection, but the surgery begins only after the anesthesia has taken full effect. After surgery, some discomfort may occur as the anesthesia wears off, but it is generally manageable with the prescribed pain relief medication. Discomfort tends to peak around 2–3 days after surgery and gradually subsides thereafter.

After axillary osmidrosis surgery (excision method), it is generally necessary to avoid raising your arms and to keep the underarms immobilized for 3–7 days. Patients with desk jobs may be able to return to work 2–3 days after surgery, but activities that require use of the arms and exercise should be avoided for 2–3 weeks. Sutures are typically removed approximately one week after surgery, and it takes approximately 1–3 months for the incision site to settle. With miraDry, the recovery period is shorter, and most patients can resume daily activities the following day.

With axillary osmidrosis surgery (excision method), a scar of approximately 3–4 cm remains under the arm; however, because the incision is made along the natural creases of the armpit, the scar tends to become less noticeable over time. The visibility of the scar varies among individuals, and those with a tendency toward keloid formation may experience raised scarring. For those who wish to minimize scarring, miraDry (no scarring) or the suction method (a few millimeter opening) are also available as alternatives.

The cost of botulinum toxin injections differs depending on whether insurance coverage applies. For patients diagnosed with severe primary axillary hyperhidrosis, the treatment is covered by insurance; with a 30% co-payment, the cost for both underarms is approximately ¥25,000–¥30,000. When insurance does not apply, it is a self-pay treatment, and the general range for both underarms is approximately ¥50,000–¥100,000. Since the effects last approximately 4–6 months, treatments are typically needed 2–3 times per year.

IC Clinic Shinjuku is open from 10:00 to 19:00 (closed 14:00–15:00; last appointment at 18:30). We are open on Saturdays and Sundays as well, making it convenient for those who are busy on weekdays. There are some days when the clinic is closed, such as during the New Year holiday period. Please check by phone or on our website for the latest information.

IC Clinic Shinjuku is located a 3-minute walk from the South Exit of JR Shinjuku Station. Our address is 2F Imasu Aoi Building, 2-5-3 Yoyogi, Shibuya-ku, Tokyo. Exit through the South Exit of Shinjuku Station, walk along Koshu Kaido Avenue toward Hatagaya, and the clinic is on the street to your left.

Our clinic operates on an appointment basis. Please make a reservation by phone (0120-780-194) or through our website. Walk-in visits are welcome, but patients with appointments are seen first, so you may need to wait. If you are considering surgery, a prior consultation and examination are required, so please be sure to make an appointment.

IC Clinic Shinjuku specializes in the treatment of Underarm Odor (Axillary Osmidrosis) and Hyperhidrosis. We offer a wide range of treatments, including insurance-covered axillary osmidrosis surgery (excision method), botulinum toxin injections, and topical medications (aluminum chloride solution, Ecclock Gel). We also perform same-day surgery for Epidermoid Cysts (Atheromas), Lipomas, and similar conditions by our board-certified plastic surgeon. Please feel free to consult us even if you are simply wondering whether you have axillary osmidrosis.

Yes, a consultation alone is perfectly fine. Many patients come to us unsure whether they have axillary osmidrosis, or simply wanting an objective assessment of their odor level. Our physician will evaluate the degree of odor during the examination and provide a diagnosis. If treatment is recommended, we will suggest the most suitable approach, but we will never pressure you into receiving treatment on the day of your visit. Please feel free to come in with any questions or concerns.