Bromhidrosis treatment modalities: A literature review

Background: Treatment options for Bromhidrosis include botulinum toxin therapy, microwave-based therapy, laser therapy, and surgical intervention. Limited studies compare their efficacies.Objective: The purpose of this literature review is to compare the efficacy and safety of these treatments for bromhidrosis.Methods: A PubMed search included terms bromhidrosis and bromhidrosis AND treatment.Results: A total of 25 articles were reviewed. Botulinum toxin therapy shows consistent benefit but requires repeated therapies. Microwave therapies have shown promising results but require larger cohort sizes with bromhidrosis. Similarly, laser therapy has shown promise with biopsy-proven results, but long-lasting effects remain unknown. Surgery has the best long-term prognosis, but the ideal surgical method remains unknown.Limitations: Each study varied in their treatment interval and method of assessing bromhidrosis, making direct comparisons difficult.Conclusions: Managing bromhidrosis requires shared decision making with the patient. Mild-to-moderate symptoms may be treated initially with botulinum toxin therapy. In cases that are refractory, laser therapy should be considered, as it is better studied than microwave therapy currently. Lastly, if the condition is severe and refractory to other options, surgery can be considered, although the ideal method remains unknown. ( J Am Acad Dermatol 2023;89:81-9.)