M. Inaba. Y. Inaba. Human Body Odor. Etiology, Treatment, and Related Factors. With 12R Illustrations in 222 Parts, 1 in Color.

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2 M. Inaba. Y. Inaba Human Body Odor Etiology, Treatment, and Related Factors With 12R Illustrations in 222 Parts, 1 in Color Springer Japan KK

3 Masumi Inaba, M.D. Yoshikata Inaba, M.D. Inaba Clinic (Esthetic Surgery and Dermatology) , Asagaya-minami, Suginami-ku, Tokyo 166, Japan ISBN Library of Congress Cataloging-in-Publication Data Inaba, Masumi, Human body odor: etiology, trcatment, and related factors I M. Inaba, Y. Inaba. p. cm. Includes bibliographical references and index. ISBN ISBN (ebook) DOI / Bromhidrosis. 2. Hyperhidrosis. I. Inaba, Y. (Yoshikata), 1959-, II. Title. [DNLM: 1. Odors-prevention & control, 2. Skin-surgery, 3. Sweat-microbiology, WV 301 I35h]. RL141, l6.5'6-dc20 DNLM/DLC for Library of Congress CIP Springer Japan 1992 Originally published by Springer-Verlag Tokyo in 1992 This work is subject to copyright. All rights arc reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective ways and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.

4 Preface Among the scientific studies on the sensory organs of animal species, progress in the study of the olfactory sense is still well behind. The fact that human beings, who conduct thorough studies in scientific fields, have an olfactory sense which is duller than that of many other mammalian species or insects seems rather strange, but it can be attributed to the fact that the human olfactory sense was retrograded as we began to walk on our feet and the development of the human brain preceded that of other species. However, human beings have taken precedence in the development of feelings of joy, anger, and personal taste in fragrance. Looking back over human history, we can see that a number of races and nations experienced rises and falls in ancient Egypt, the Orient, India, and in the vast lands of China. The main cause of warfare was the acquisition of precious essences which were treasured not only by the nobles and kings as a symbol of their power but also by ordinary people in their daily lives as well as in religious rites. Fragrance has long been closely associated with human life and will be as long as we possess an olfactory sense. Among the various odors we encounter, human body odor commonly occurs among all populations, although its relative incidence may be lower among some racial groups than others. In a mild form, it may be treated effectively with proper hygiene and deodorants. In an extreme form, however, the odor may be so persistent and pervasive that a means of permanent relief is sought. Radical treatment procedures have been developed and employed over the years with varied success rates. The authors, who have developed a unique subcutaneous shaving technique over the past 20 years, have achieved a remarkable success record with the more than 30,000 v

5 VI Preface patients treated to the present. This procedure is fully detailed here for the first time. It is hoped that the information presented will lead to new treatment breakthroughs in the future in dealing with such conditions as osmidrosis, hyperhidrosis, and bromidrosis. Masumi Inaba Yoshikata Inaba Dr. MAsuMI INABA is an esthetic surgeon well known in Japan and overseas for his unique surgical method which completely eliminates underarm odor. He has also propounded a new hypothesis on the subject of human hair growth and has developed a new approach to the treatment of alopecia (baldness). Born in 1925, Dr. Inaba has practiced medicine since 1955 after graduating from Showa School of Medicine. He opened the Tokyo Research Center for Hircismus in Dr. Inaba has written a number of published papers and books in both Japanese and English. Dr. Inaba was awarded the highest honors by the Japan Medical Association in Dr. YOSHIKATA INABA is a dermatologist and dermatologic surgeon. He has also presented new findings on human hair growth in terms of the hair cycle by extension of his father's research. Born In 1959, Dr. Inaba has practiced medicine since 1984 after graduating from The Jikei University School of Medicine. He is now a research associate in the Jikei University department of dermatology under Professor M. Niimura.

6 Contents Preface... V 1. Introduction Skin Structure and Bromidrosis-Related Physiology Skin Structure Apocrine Gland Units Eccrine Gland Units Sebaceous Gland Units Hair Mechanisms of Odor Development in Bromidrosis Apocrine Glands Sebaceous Glands Mechanisms of Axillary Odor Bacterial Activity and Skin Odor Recent Research Methods of Odor Detection Relationship Between Hyperhidrosis and Bromidrosis Mechanisms of Sweating Essential Hyperhidrosis VII

7 VIII Contents 5. Relationship Between Cerumen and Bromidrosis Frequency of Wet Cerumen and Bromidrosis 5.2 Inheritance of Cerumen Types Relationship Between Bromidrosis and Wet Cerumen Differences Between Standard Apocrine Glands and Ceruminous Apocrine Glands Differences Between Wet and Dry Cerumen Differences Between Bromidrosis and Nonbromidrosis Patients Lipid Analysis of Axillary Skin Surface Lipid of Patients with Bromidrosis in Japan and Korea Determination of Triacylglycerol in Axillary Sebaceous Glands of Bromidrosis Patients Differences Between Bromidrosis-Type and Nonbromidrosis-Type Apocrine Glands Human Leukocyte Antigens (HLA) in Bromidrosis Patients Relationship Between Bromidrosis and Sense of Smell Sense of Smell Activation Offensive Bromidrosis Odor Odor Measurement Standardized Olfactory Test Developed in Japan Profiles of Bromidrosis Patients in Japan Cases of Bromidrosis (Wet Cerumen) and Hyperhidrosis (Dry Cerumen) Classified by Age and Sex Relationship Between Physical Type and Bromidrosis Recognition Source... 76

8 Contents IX 8.4 Relationship Between Bromidrosis and Seasonal Factors Relationship Between Onset of Menstruation and First Bromidrosis Occurrence in Female Patients Incidence of Bromidrosis Among Male and Female Senior High School Pupils Difference Between Left and Right Axillary Bromidrosis Relationship Between Bromidrosis and Aging Degree of Bromidrosis by Patient Perception Anxiety Over Bromidrosis Vs Hyperhidrosis Patients Concerned About Wearing Heavy Clothing Relationship Between Bromidrosis and Menstruation When Does Odor Increase? Relationship Between Bromidrosis and Psychosomatic Factors Mental State of Bromidrosis Patients Does Bromidrosis Influence Behavior? Sociability of Bromidrosis Patients Dislike of Bromidrosis Odor Attitudes of Bromidrosis and Nonbromidrosis Groups Toward Bromidrosis Shyness About Bromidrosis Patients Who First Learned About Their Condition from Other People Reaction of Bromidrosis Patients to Their Condition Mental Stress and Occurrence of Hyperhidrosis on Palms and Soles Presumed Loss of a Close Relationship Due to Bromidrosis... 89

9 X Contents R.25 Bromidrosis as a Cause of Marital Problems R9 R.26 Bromidrosis and Suicidal Thinking... R9 9. Body Odors and Associated Diseases and Disorders... 9 I 9.1 Genital Bromidrosis Male Odor Bromidrosis and Skin Diseases Halitosis Foot Odor \ Scalp Odor Other Odors and Disorders... lor 9.8 Feces Odor Body Odor as a Psychosomatic Disorder III 10.1 Examination of Psychosomatic Disorder (PSD) Patients for Psychological and Social Adjustment Physical Examination of Body Odor Body Odor as Delusion... I Case Reports Psychological Diagnosis Clinical Characteristics Identification of Olfactory Paranoia Treatments for Palmar, Foot, and Genital Hyperhidrosis and Bromidrosis Treatment of Palmar Hyperhidrosis Treatment of Halitosis Specific Treatments for Foot Odor 12.4 Treatment of Genital Bromidrosis Pharmaceutical and Physical Treatment Procedures for Axillary Bromidrosis I

10 Contents XI 13.1 Pharmaceutical Treatment Prior Treatments for Bromidrosis Physical Therapy Surgical Procedures Radical Removal of Axillary Skin Other Removal Methods Curettage Method Clearance Method Removal and Clearance Method Clearance Method and Electrocoagulation of Sebaceous Glands Cervicothoracic Sympathectomy Other Methods Follow-up Results by Updated Treatment Contrasting Methods of University Hospitals and Private Clinics The 1naba Method Subcutaneous Shaver Special Dressing Skin Grafting Dressing Development of a Special Dressing New Method: "Double Tie-over Dressing Method" Comparison Between Single Tie-over and Double Tie-over Dressings Surgical Procedure Problems Encountered with this Procedure The Question of Hair Regeneration Clinical Findings

11 XII Contents 16.2 Thick Tissue Specimen Preparation 16.3 Common Hair Cycle Histological Findings Hair Regeneration in the Mouse Vascular System for Hair Follicle Pilosebaceous Unit New Concept of the Hair Cycle Essential Hair Cycle Hypothesis and Supportive Findings Sebaceous Gland Hypothesis for Male Pattern Baldness Postscript References Index

12 Human Body Odor