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The Issue of Underarm Odor Pits Man Versus Bacteria

Dear Dr. Roach: I have underarm odor. I wash daily, use deodorant and change my shirts daily. I use mostly cotton shirts and undershirts. I launder my shirts with soap mixed with bicarbonate sodium (baking soda) to eliminate odor. In spite of all this, deodorants seem to work for few hours and then fade away.

What other solutions do you have for this problem, whether it’s what to use for the underarm or what to wash the clothes with? Thanks. — N.I.

Answer: Body odor comes mainly from bacteria that grow in the moist areas, like axillae (armpits). Keeping them dry and minimizing bacteria are then the ways to minimize body odor.

Antiperspirant, rather than deodorant, is effective at keeping the axillae dryer. Applying at nighttime after shower or bath may be more effective. Occasional use of a topical antibiotic to the axillae can keep bacteria growth down as well.

Diet can have a role, too. Sulfur-containing foods like garlic, along with onions and many curries, can cause a strong odor.

As far as washing clothes, most detergents do a very good job of removing the odor-causing bacteria.

Dear Dr. Roach: In 2005, I was operated on for a T-cell lymphoma on my back. The oncologist admitted knowing little about this form of cancer. No follow-up treatment was recommended.

Last week, another eruption was biopsied, and a second T-cell lymphoma was revealed. I am scheduled to see a different oncologist in February.

Can you tell me more about this rare form of cancer? What is the prognosis? I am 87 and in good health, with a positive outlook. — R.B.W.

Answer: T-cell lymphomas of the skin are highly variable, with symptoms ranging from rare, nonspecific skin findings to life-threatening systemic disease. There are two main types of conditions that can show up with a positive skin biopsy:

Cutaneous T-cell lymphoma comes in many forms, but mycosis fungoides and Sezary syndrome are the most common for CTCL. These tend to occur in older adults, and typically feature several skin lesions, along with generalized itching. Other organs besides the skin may be affected.

Adult T-cell leukemia-lymphoma always is associated with and probably caused by a virus, HTLV-1. Although it also has characteristic skin lesions, sometimes looking identical to CTCL, ATL looks more like a leukemia, with more abnormal blood cells and bone marrow involvement than CTCL. ATL can be rapidly progressive, but there is a “smoldering” type that has only occasional skin lesions.

I can’t tell you your prognosis until you know exactly what diagnosis you have. That means you need an oncologist with expertise in lymphoma. You may never get another skin lesion, or you may need aggressive treatment. Your new oncologist will order many blood tests, and may need to have additional skin biopsies. I suspect you may have a more indolent (slow-growing) form, since the time between the first skin lesion and now is quite a long time.

It has been my experience that a positive outlook is always a good sign.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, F L 32853-6475.