Axillary Skin Research Articles

Interplay of human ABCC11 transporter gene variants with axillary skin microbiome functional genomics

The human armpit microbiome is metabolically entangled with skin cell physiology. This “meta-organism” symbiotic mutualism results in sweat either with or without odor (osmidrosis), depending on host ABCC11 gene haplotypes. Apocrine metabolism produces odorless S-glutathione conjugate that is transferred by ABCC11 transporters into secretory vesicles, deglutamylated to S-Cys-Gly-3M3SH thiol, and exuded to skin surface. An anthropogenic clade of skin bacteria then takes up the thiol and bioconverts it to malodorous 3-methyl-3-sulfanylhexan-1-ol (3M3SH). We hypothesized a familial meta-organism association of human ABCC11 gene non-synonymous SNP rs17822931 interplaying with skin microbiome 3M3SH biosynthesis. Subjects were genotyped for ABCC11 SNPs, and their haplotypes were correlated with axilla microbiome DNA sequencing profiles and predicted metagenome functions. A multigeneration family pedigree revealed a Mendelian autosomal recessive pattern: the C allele of ABCC11 correlated with bacterial Cys-S-conjugate β-lyase (PatB) gene known for Staphylococcus hominis biosynthesis of 3M3SH from human precursor; PatB was rescinded in hosts with homozygous TT alleles encoding ABCC11 loss-of-function mutation. We posit that a C allele encoding functional ABCC11 is key to delivering host conjugate precursors that shape heritable skin niche conditions favorable to harboring Staphylococcus having genomics of odor thiol production. This provides existential insights into human evolution and global regional population ancestries.

Evidence-based recommendations regarding risk reduction practices for people at risk of or with breast cancer-related lymphedema: consensus from an expert panel.

Several recent studies have investigated the validity of precautionary practices for lymphedema risk reduction after breast cancer treatment, such as avoidance of blood pressure measurements, skin puncture, blood draws, and use of prophylactic compression during air travel. Other studies have elucidated risk factors for breast cancer-related lymphedema, such as axillary lymph node dissection and skin infection (cellulitis). Combining the current evidence base with the consensus opinion of lymphatic experts assembled at the American Cancer Society/Lymphology Association of North America Summit in October 2023, updated evidence-based risk reduction recommendations are presented for those with or at risk of breast cancer-related lymphedema. Recommendation topics include prospective surveillance, patient education, individual risk factors, exercise, blood pressure, skin care and hygiene, skin puncture and blood draws, surgical procedures, prophylactic compression, air travel, and hot climate and sauna. These recommendations will help inform education and medical choices for individuals treated for breast cancer who are at risk of or diagnosed with breast cancer-related lymphedema. More high-quality evidence is required to allow the development of risk reduction recommendations for other cancer types such as gynecological, melanoma, and head and neck. It is recommended that clinicians and organizations serving people at risk of or with lymphedema align risk reduction guidelines with the evidence-based recommendations provided within this consensus document and companion manuscripts from the American Cancer Society/Lymphology Association of North America Lymphedema Summit: Forward Momentum: Future Steps in Lymphedema Management.

Identification of Microbiota Causing Bromhidrosis in the Axillary

Bromhidrosis is a clinical condition defined by an uncomfortable or unpleasant body odor. Since the apocrine glands are only active during puberty, most bromhidrosis occurs in the apocrine glands in the armpit and occurs when apocrine gland secretions approach the skin's surface, where they undergo various biochemical reactions caused by the presence of microbiota in the axillary skin, resulting in odor in the axilla. This research aims to identify microbiota species in the axilla that can cause bromhidrosis. A laboratory experimental research design with purposive sampling is used in this study. In this study, 60 samples were collected from students aged 15 to 18 years old at a high school in Medan, and the samples were analyzed at the University of North Sumatra Hospital's Microbiology Laboratory. All samples were taken from the right axillary skin swab, a Gram stain was performed, and the identified microbiota isolates were identified. The results of skin smear culture revealed a Gram-positive cocci group in 59 samples (98.3%) and a Gram-positive bacilli group in only one sample (1.7%). The microbiota responsible for bromhidrosis was identified as Staphylococcus hominis spp. hominins (30.4%), Staphylococcus epidermidis (27.8%), Staphylococcus aureus (16.5%), Kocuria kristinae and Staphylococcus haemolyticus (6.3%), Staphylococcus lugdunensis and Staphylococcus saprophyticus. The most common microbiota that causes bromhidrosis in the axilla is Staphylococcis hominis spp. Hominis, Staphylococcus epidermidis, and Staphylococcus aureus.

An axillary skin lesion revealing disseminated paracoccidioidomycosis.

Paracoccidioidomycosis, uncommon in Europe, primarily affects South America travellers. We report a 58-year-old Colombian man, who has lived in France for 20years, presented with an axillary skin lesion seven years after his last trip to Colombia. The diagnosis of paracoccidioidomycosis was established using histopathological, mycological, and molecular analyses.

Implications of Adnexal Invasions in Primary Extramammary Paget’s Disease: A Systematic Review

Extramammary Paget’s disease (EMPD) is an erratic malignant skin disorder primarily affecting skin areas abundant with skin appendages like hair follicles. The vulva is most involved site, followed by genital areas, penoscrotal regions and axillary skin. EMPD presents as erythematous skin lesions resembling eczema, typically progressing slowly, either primary or secondary manifestations. Primary EMPD originates as an intraepithelial neoplasm of the epidermis, often leading to local lymph node metastases and distant metastases. A systematic literature search using targeted keywords across multiple databases was conducted. Studies focusing on EMPD, adnexal involvement, depth, recurrence, and prognosis were included by keeping in view the objective which is to determine the significance of adnexal involvement and depth concerning recurrence and prognosis in the primary EMPD. Adnexal involvement, especially in hair follicles and eccrine ducts, is prevalent in primary EMPD. However, its correlation with tumor progression or recurrence rates remains inconclusive. Surgical excision, including Mohs micrographic surgery, is the primary therapeutic approach, with topical agents and systemic treatments used in advanced cases. Future studies regarding understanding adnexal involvement's depth and significance are essential in designing effective targeted therapeutic approaches in EMPD.

Erythrasma of the Vulva: An Invisible Dermatosis.

Erythrasma is a prevalent superficial bacterial infection typically caused by Corynebacteria species and preferentially affecting intertriginous sites including axillary, interdigital, and inguinal skin folds. However, erythrasma of the vulva is uncommon, with only 2 cases previously reported. Although erythrasma can be diagnosed clinically using Woods lamp examination, it may not always be considered in the differential diagnosis for patients presenting with persistent vulvar pruritus. We report 12 cases of vulvar erythrasma identified by histopathology, with a review of clinical and histologic features. The mean patient age was 60.1yr and the mean patient BMI was 30.5. Five of 12 patients presented with pruritic rash. The time from symptom onset to diagnosis was 9mo in 1 case, >18mo in 4 cases, and unknown in the remaining cases. The characteristic histologic features were compact orthokeratosis and mild perivascular chronic inflammation. In all 12 cases, Periodic Acid-Schiff-diastase (PAS-D) staining highlighted intracorneal filamentous rods which were not readily appreciable on H&E. After the diagnosis of erythrasma, 4 patients were treated with topical lincomycin, of whom 3 had clinical improvement in symptoms. One patient was treated with topical macrolide antibiotic and also reported improvement in symptoms. Consideration of erythrasma on the differential for patients presenting with vulvar rash and pruritus may shorten the time to diagnosis and treatment, minimize patient discomfort, and reduce the scope and cost of diagnostic testing.

Primary Mucinous Carcinoma of the Axillary Skin: A Case Report & The Role of Adjuvant Tamoxifen

Primary mucinous carcinoma of the skin (PMCS) is a rare cancer. It is indolent and progresses slowly but can recur locally, damaging the structure. The majority of mucinous carcinoma that occurs in the skin are metastatic lesions originating from various sites. In terms of morphology, PMCS is almost indistinguishable from secondary metastatic deposits. We reported a case of a 44-year-old male with left axillary skin PMCS that had spread to axillary lymph nodes. The pathologic diagnosis was challenging but was facilitated by expert pathologists from different centers. A multidisciplinary meeting concluded that the best managementapproach was to include a wide local excision and axillary clearance followed by adjuvant tamoxifen. The role of adjuvant radiotherapy was discussed but was declined by the patient. The patient is well now with no recurrence, 22 months since the diagnosis.

Comparative Study Between The Conventional Modified Radical Mastectomy And Modified Radical Mastectomy With Quilting Technique To Axillary Skin Flap In Reduction Of Postoperative Seroma In Surgical Management Of Breast Cancer

Comparative Study Between The Conventional Modified Radical Mastectomy And Modified Radical Mastectomy With Quilting Technique To Axillary Skin Flap In Reduction Of Postoperative Seroma In Surgical Management Of Breast Cancer

Genetic susceptibility to Tuberculosis in an infant with BCG-osis

Mendelian susceptibility to mycobacterial diseases (MSMD) is a group of innate immunity defects characterized by inborn susceptibility to intracellular pathogens. These are due to defects in the interleukin 12-23-interferon gamma y axis. Twenty-three genetic mutations have been identified in this axis, of which mutation in the IL12RB1 gene is the most common genetic defect of MSMD identified. An 11-month-old infant presented with features of axillary lymphadenitis and skin lesions both of which were positive for acid-fast bacilli on Ziehl– Neelsen stain and GeneXpert. Keeping a high index of suspicion of primary immunodeficiency, the child was evaluated further and was diagnosed as a case of MSMD with IL12RB1 gene mutation.

Nursing care of an adolescent with hidradenitis suppurativa complicated with bilateral axillary skin ulcers

Nursing care of an adolescent with hidradenitis suppurativa complicated with bilateral axillary skin ulcers

Case report: Posterior arm perforator flap for reconstruction of axillary defect after infected radiation-induced ulcer

Axillary soft tisue defects are uncommon in Vietnam. We report a case of an 81-year-old female patient had an infected axillary skin ulcer after going through a radical surgery and radiation therapy 30 years ago. In this case, a CT scanner was used to evaluate the fundus of the lesion and biopsy to rule out malignancy. The treatment procedure was eliminating infection based on the antibiogram, wound care, debridement, negative pressure wound therapy and reconstruction of defect. The optimal choice in this case was to use posterior arm perforator flap. After the surgery, the flap had a good vitality and the wound healed after 3 weeks. The case affirmed that the posterior arm perforator flap is suitable for axillary coverage and should be considered as one of the main options for axillary reconstruction.

Preoperative predictors for recurrence sites associated with poor post-recurrence survival after surgery of non-small cell lung cancer: a multicenter study

BackgroundThe recurrence site that influences post-recurrence survival (PRS) in patients with non-small cell lung cancer (NSCLC) undergoing surgery and the preoperative predictors of recurrence remain unclear.MethodsCohorts 1 and 2 had 4520 (who underwent complete resection for p-stage 0-IIIA NSCLC) and 727 (who experienced recurrence after surgery) patients, respectively. The initial sites of recurrence were the lungs (309 cases), thoracic lymph nodes (225 cases), pleura (112 cases), bone (110 cases), central nervous system (86 cases), adrenal gland (25 cases), abdomen (60 cases), cervical and axillary lymph nodes (38 cases), chest wall (13 cases), skin (5 cases), and eye and tongue (3 cases). For cohort 2 analysis, the initial recurrence site that resulted in poor PRS was analyzed by multivariable analysis using a Cox proportional hazard model. For cohort 1 analysis, the preoperative predictors of recurrence patterns with poor PRS were analyzed by multivariable analysis using a logistic regression model.ResultsIn cohort 2 analysis, recurrence in the central nervous system (hazard ratio [HR], 1.70; p < 0.001), bone (HR, 1.75; p < 0.001), abdomen (HR, 2.39; p < 0.001), and pleura (HR, 1.69; p < 0.001) were independent poor prognostic recurrent sites for PRS and they were high-risk sites (HRS). Intrathoracic lymph nodes, cervical and axillary lymph nodes, lungs, chest wall, adrenal gland, eye and tongue, and skin were low-risk sites (LRS) that did not affect PRS. Patients with multiple LRS without HRS recurrence had a worse prognosis than those with a single LRS without HRS recurrence (5-year PRS 20.2% vs. 37.7%, p < 0.001) and were comparable to those with HRS recurrence (p = 1.000). In cohort 1 analysis, preoperative predictors for HRS and multiple LRS recurrences were positron emission tomography (PET) maximum standardized uptake value (maxSUV) ≥ 3.2 (HR, 5.09; p < 0.001), clinical nodal metastasis (HR, 2.00; p < 0.001), tumor size ≥ 2.4 cm (HR, 1.96; p < 0.001) and carcinoembryonic antigen (CEA) ≥ 5 ng/ml (HR, 1.41; p = 0.004). The cumulative incidence rates of HRS and multiple LRS recurrences within 5 years were 55.9%, 40.9%, 26.3%, 11.1%, and 3.5% (p < 0.001) in patients with 4, 3, 2, 1 and 0 of the above risks, respectively.ConclusionsHRS and multiple LRS were vital recurrences associated with poor PRS. Preoperative PET maxSUV, clinical nodal metastasis, tumor size, and CEA level predicted the incidence of vital recurrence.

Breast cancer metastasis patterns in Yenagoa, Nigeria

Objectives: The objective of this study was to study the characteristics and patterns of metastatic breast cancer in Yenagoa, Nigeria. Material and Methods: This study was a retrospective hospital-based study using a standardized data form for the capture of relevant information with definite exclusion criteria. Information gathered was captured in an Excel spreadsheet and subjected to statistical analysis. Subjects were 78 female patients diagnosed with breast cancer. Results: The mean age of the study population was 47.86 years. About 64% had 1–4 children while 26% had more than five children. The most common findings on general clinical examination were anemia (43.6%), cachexia (39.7%), and hepatomegaly (11.5%). On breast examination, the most common findings were axillary lymphadenopathy (87.2%), nipple changes (67.9%), peau d’orange (64.1%), skin nodules (64.1%), and chest fixity (60.3%). About 29.5% of patients had evidence of pulmonary metastasis, 19.2% had liver metastases, and 25.6% had spread to multiple sites. Central nervous system and spinal spread were found to be commoner in younger patients (&lt;48 years). Conclusion: Most of the patients presenting in the hospital had evidence of metastasis. This has been found to be due mostly to delay in hospital presentation due to a complex combination of patient and healthcare-related factors. Measures for improving the dire statistics are proffered.

Antibacterial Activity Test of Roll on Deodorant Extract Ethanol Tamarind Seed Coat

Introduction: Armpit odor is one of the problems caused by bacteria, one of which is Staphylococcus aureus. The rind of the tamarind seed contains tannins and flavonoids that function as antibacterial. Aims: The purpose of this study was to formulate the ethanolic extract of tamarind seed coat into roll-on deodorant preparations and to determine the zone of inhibition from variations in the concentration of the extract. Methods: The method used is the well diffusion method and the data obtained are then analyzed using Statistical Product and Service solution (SPSS). The level of confidence used is 95% to see the significance of each evaluation of the preparation. Result: The results showed that the roll on deodorant preparation of ethanol extract of tamarind seed coat did not meet the requirements for good dispersibility, adhesion and viscosity for topical preparations in general and emulsion preparations. The pH of the preparation met the axillary skin pH he standard for topical preparations. The roll-on deodorant preparation of ethanol extract of tamarind seed cultivars was effective in inhibiting the growth of Staphylococcus aureus bacteria. Conclusion: The results of inhibition zone 3 formulations containing extracts were in the strong category and the value increased with increasing concentration of tamarind seed coat extract in the deodorant preparation.

Comparing Methods for Targeted Axillary Dissection in Breast Cancer Patients: A Nationwide, Retrospective Study.

Several techniques exist for performing targeted axillary dissection (TAD) after neoadjuvant chemotherapy with the removal of the sentinel node and a marked metastatic lymph node (LN). Two-step methods include coil-marking of the metastatic LN at diagnosis and re-marking with an intraoperatively identifiable marker before surgery. Because nondetection of the marked lymph node (MLN) warrants axillary clearance and many patients achieve axillary pathological complete response (ax-pCR), the success of TAD is crucial. We compare various two-step TAD methods in a Danish national cohort. We included patients who received two-step TAD between January 1, 2016 and August 31, 2021. Patients were identified from the Danish Breast Cancer Group database and cross-checked with locally accessible lists. Data were extracted from the patient's medical files. We included 543 patients. In 79.4%, preoperative, ultrasound-guided re-marking was possible. Nonidentification of the coil-marked LN was more likely in patients with ax-pCR. The second markers used were hook-wire, iodine seeds, or ink marking on the axillary skin. Of patients with successful secondary marking, the MLN identification rate (IR) was 91%, and the sentinel node (SN) IR was 95%. Marking with iodine seeds was significantly more successful than ink marking with an odds ratio of 5.34 (95% confidence interval 1.62-17.60). The success rate of the complete TAD with the removal of MLN and SN was 82.3%. With two-step TAD, nonidentification of the coiled LN before surgery is frequent, especially in patients with ax-pCR. Despite successful remarking, the IR of the MLN at surgery is inferior to one-step TAD.

Axillary skin crease incision versus conventional posterolateral incision in open repair of patent ductus arteriosus for extremely low birth weight infants: a retrospective study

BackgroundThoracotomy with posterolateral incision (PLI) is commonly used for surgical repair of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Some reports have described thoracotomy for PDA using an axillary skin crease incision (ASCI) in consideration of cosmetic problems such as surgical wounds and thoracic deformities, but the details remain unclear.MethodsIn this study, we performed clipping ligation by thoracotomy with ASCI for ELBW infants with PDA from 2011 to 2015 for the purpose of improving cosmetic results, and retrospectively compared the results with those for conventional PLI cases performed from 2016 to 2020.ResultsASCI was found to be associated with serious surgical complications and showed a significant difference in outcome parameters only for surgery time, suggesting a safety problem for ASCI. Considering these results, PLI allows clipping of the nearby PDA from the thoracotomy wound while looking straight ahead, whereas the PDA in ASCI is positioned deep and oblique to the thoracotomy wound, so the clipping angle is limited and accurate completion of the procedure is difficult.ConclusionsRegarding PDA repair in ELBW infants, ASCI shows a high risk of serious surgical complications. Conventional PLI remains preferable for safe and accurate results.

Investigating 3D-printed disk compressing against skin for pain relief in intradermal infiltration anesthesia: a randomized controlled trial

BackgroundPain intensity may be varied during the needle advancing through different skin layers, injection into the intradermal layer may exclude mixed pain from deeper planes. This study aimed to investigate whether compressing a three-dimensional (3D)-printed disk against the skin may relieve pain associated with intradermal injection of local anesthetic which mimics the skin test procedure.MethodsAfter institutional review board approval, 3D-printed disks with projections were designed for this study. Enrolled patients were randomized to receive either a disk compressing against the axillary skin during the intradermal injection of local anesthesia (compressing disk group) or an intradermal injection of local anesthesia without any compression (no compressing disk group). The primary outcomes were pain intensity (100-mm visual analog scale) and satisfaction (5-point Likert scale) as assessed by patients.ResultsNinety patients with American Society of Anesthesiologists I–II physical status receiving intradermal local anesthesia prior to an ultrasound-guided axillary approach were included. Eighty-seven patients completed the study, with 44 and 43 patients in disk and no disk groups, respectively. Pain scores were significantly different (P < 0.001) in compressing disk (median, 10; IQR, 5–20) and no compressing disk (median, 30; IQR, 20–40) groups. The median satisfaction score was 5 in both groups. No complications occurred during follow-up.ConclusionCompressing a 3D-printed disk against the skin may reduce intradermal needle pain and offers an effective alternative for nerve block induction.

Neutrophilic granulocyte-derived B-cell activating factor supports B cells in skin lesions in hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful inflamed nodules, abscesses, and pus-draining tunnels appearing in axillary, inguinal, and perianal skin areas. HS lesions contain various types of immigrated immune cells. This study aimed to characterize mediators that support lesional B/plasma cell persistence in HS. Skin samples from several cohorts of HS patients and control cohorts were assessed by mRNA sequencing, quantitative PCR on reverse-transcribed RNA, flow cytometry, and immunohistofluorescence. Blood plasma and cultured skin biopsy samples, keratinocytes, dermal fibroblasts, neutrophilic granulocytes (neutrophils), monocytes, and B cells were analyzed. Complex systems biology approaches were used to evaluate bulk and single-cell RNA sequencing data. Proportions of B/plasma cells, neutrophils, CD8+ T cells, and M0 and M1 macrophages were elevated in HS lesions compared to skin of healthy and perilesional intertriginous areas. There was an association between B/plasma cells, neutrophils, and B-cell activating factor (BAFF, aka TNFSF13B). BAFF was abundant in HS lesions, particularly in nodules and abscesses. Among the cell types present in HS lesions, myeloid cells were the main BAFF producers. Mechanistically, granulocyte colony-stimulating factor in the presence of bacterial products was the major stimulus for neutrophils' BAFF secretion. Lesional upregulation of BAFF receptors was attributed to B cells (TNFRSF13C/BAFFR and TNFRSF13B/TACI) and plasma cells (TNFRSF17/BCMA). Characterization of the lesional BAFF pathway revealed molecules involved in migration/adhesion (eg, CXCR4, CD37, CD53, SELL), proliferation/survival (eg, BST2), activation (eg, KLF2, PRKCB), and reactive oxygen species production (eg, NCF1, CYBC1) of B/plasma cells. Neutrophil-derived BAFF supports B/plasma cell persistence and function in HS lesions.

Novel surgical use of electrosurgical tip cleaners in subdermal excision for axillary osmidrosis

Background Axillary osmidrosis is a disease characterized by axillary malodor. The conventional treatment method of subdermal excision uses Metzenbaum scissors. Recently, subdermal excision using the Versajet system was introduced. However, it is an expensive surgical tool, and a recent study demonstrated a higher frequency of axillary skin necrosis with the Versajet. We propose a novel, cost-effective, and safe subdermal excision method that utilizes an electrosurgical tip cleaner (ETC).Methods Our retrospective cohort study included 27 patients who underwent subdermal excision from June 2012 to November 2021. The patients were classified into three groups according to the surgical method: Metzenbaum scissors, Versajet, and ETC. The operation time, hospitalization cost, and postoperative complications were investigated.Results The number of patients in the Metzenbaum scissors, Versajet, and ETC groups was seven, eleven, and nine, respectively. The mean operation time and hospitalization cost were significantly different among the three groups (P&lt;0.05). The longest mean operation time was observed in the Metzenbaum scissors group (112.9±23.6 minutes), followed by the ETC and Versajet groups (76.4±27.1 and 64.2±24.8 minutes, respectively). The most expensive method was the Versajet ($2,346.1±517.7), followed by the ETC and Metzenbaum scissors ($1,391.8±317.7 and $1,279.6±287.5, respectively). No postoperative complications were observed.Conclusions The ETC is a novel method of subdermal excision, comparable to Metzenbaum scissors or Versajet. Therefore, it is recommended for situations where it is necessary to consider both the time and cost of surgery.

Uncommon manifestation of disseminated tuberculosis with metastatic skin abscesses in an immunocompromised adult patient: A case report

Background: Cutaneous lesions account for less than 2% of all extrapulmonary manifestations of tuberculosis (TB). Metastatic tuberculous abscesses (tuberculous gummas), uncommon forms of cutaneous TB, typically result from the bacillus spreading hematogenously from the main site of infection to the subcutaneous tissue when the body's cell mediated immunity is compromised and present with one or more non-tender and fluctuant subcutaneous nodules. Case Presentation: A 51-year-old male presented with dry cough of one month duration associated with loss of appetite, easy fatigability and vomiting of ingested matter. He had left armpit and lower back skin swellings of similar duration. Physical findings were remarkable for whitish coat over the dorsal part of the tongue, crepitation over the lower two-third of bilateral posterior chest, and non-tender fluctuant masses over the left axilla and lower back region. Chest X-ray revealed multiple bilateral air space nodules and abdominopelvic U/S showed numerous hypoechoic splenic lesions. Urine lipoarabinomannan and Xpert MTB/RIF (mycobacterium tuberculosis/rifampicin) assay from the axillary skin abscess were positive for MTB. He was started on anti-tuberculous therapy and showed marked improvement after a month of follow up. Conclusion: It is worth considering the uncommon manifestations of tuberculosis including metastatic skin abscesses in the appropriate clinical context, to avoid misdiagnosis and underreporting in high tuberculosis burden countries. We strongly advise the utilization of Xpert MTB/RIF assay and/or urine lipoarabinomannan for the diagnosis of different forms of tuberculosis including cutaneous TB in HIV positive patients, especially in the absence of sputum for microbiologic tests, like in our patient