Axillary osmidrosis (AO) is a chronic dermatological condition characterized primarily by persistent malodor in the axillary region. Its prevalence is relatively high among East Asian populations, and the condition can adversely affect patients’ social functioning, self-esteem, and psychological well-being. In recent years, advances in molecular biology, microbiome research, and energy-based devices have improved understanding of the pathogenesis of AO and expanded available management strategies. This narrative review summarizes current evidence on the epidemiology and pathogenesis of AO, including genetic susceptibility, apocrine sweat gland function, cutaneous microbiota, and psychosocial aspects of odor perception. It also discusses diagnostic and assessment approaches and compares therapeutic strategies, including surgical procedures, energy-based interventions, botulinum toxin injections, topical agents, and emerging targeted therapies. Particular attention is paid to the strength and limitations of evidence supporting each modality and to treatment selection according to disease severity, concomitant hyperhidrosis, recurrence risk, and patient tolerance of scarring or repeated treatment. Future research directions are also discussed, with the aim of providing clinicians with a practical and evidence-informed reference for the diagnosis and management of AO.
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