Incidence and Associated Risk Factors of Axillary Bromhidrosis Following Laser Hair Removal: A Prospective Cohort Study
Keywords:
Axillary, Bromhidrosis, Hair removal, IncidenceAbstract
Background: Axillary bromhidrosis causes a considerable negative effect on social, psychological, and emotional well-being. Laser hair removal has recently been reported as the most used cosmetic procedure. Objective: To investigate the incidence, severity, and determinants of axillary bromhidrosis in healthy individuals undergoing laser hair removal. Methods: A prospective longitudinal cohort study was carried out in a private dermatology clinic in Baghdad during February 2024 to February 2026. It included 184 individuals who underwent axillary hair removal laser by one of two Alexandrite laser systems (Candela or DEKA). A total of six sessions (1.5 to 2.5 months apart depending on hair growth cycle) is recommended, followed by maintenance sessions as needed. The severity of axillary bromhidrosis was assessed clinically based on the distance from which the odor can be detected. Results: In this study, axillary bromhidrosis was noticed in 41 participants (22.3%); 58.5% experienced a moderate level of severity, and 95.1% of them were resolved after finishing all sessions. Multivariable logistic regression identified obesity and Fitzpatrick skin type II as independent predictors of axillary bromhidrosis following laser hair removal. These factors were obesity (OR=2.55 with 95% CI:1.61-4.44) and Fitzpatrick skin type II (OR=3.27 with 95% CI:1.89-6.41). Conclusions: Although laser hair removal is generally safe and successful, certain individuals, especially those at higher risk, may develop transient axillary bromhidrosis during treatment, a condition that can be treated. Important patient-related characteristics that contribute to vulnerability include obesity and Fitzpatrick skin type II.
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