Rompel R, Scholz S
Department of Dermatology, Klinikum Kassel, Germany.
J Eur Acad Dermatol Venereol. 2001 May;15(3):207-11. doi: 10.1046/j.1468-3083.2001.00226.x.
Axillary hyperhidrosis is a functional non-inflammatory abnormality of the eccrine sweat glands. The cause of genuine hyperhidrosis is unknown and, therefore, no specific corrective therapy is available and conservative treatment often fails. Subcutaneous sweat gland curettage of the axillae is one of the proven surgical modalities. Local injection of botulinum toxin A (BT-A) is a promising new conservative approach.
The purpose of this study was to compare the efficacy of subcutaneous curettage vs. injection of BT-A in axillary hyperhidrosis.
A total of 113 patients (36.3% males, 63.7% females) suffering from genuine axillary hyperhidrosis were treated by either subcutaneous curettage (n = 90) or local injection of BT-A (n = 23). Median follow-up period was 23.5 months. Questionnaires were handed out to patients for a subjective assessment of symptoms before treatment, 6 months after the procedure, and at the time of last follow-up. The patients were asked to rate the amount of axillary sweating based on a score ranging from 1 (no axillary secretion) to 6 (maximum axillary secretion). The subjective scores of sweating at rest, at high temperatures, under physical stress, under emotional stress and after spicy meals were assessed.
The patients' subjective assessments of the overall outcome after subcutaneous curettage were 'very good' in 36.4%, 'good' in 29.9% and 'satisfactory' in 16.9%. The subjective score of axillary sweating at rest was reduced to 40.0% after 6 months, and finally to 45.7% at the end of follow-up (median: 28.2 months). Patients treated by BT-A injection assessed outcome as 'very good' in 39.1%, 'good' in 21.7% and 'satisfactory' in 8.7%. Sweating at rest was reduced to 48.5% after 6 months, and finally to 68.8% at the end of follow-up (median: 16.1 months). The mean duration of the antiperspiration effect of BT-A was 7.6 months (median: 7 months), but there were two cases of long durations, i.e. 14 and 18 months.
Subcutaneous curettage and injection of BT-A both present major advantages compared with earlier methods. Subcutaneous curettage offers the same permanent efficacy but far fewer side-effects than sympathectomy, and less scarring than local excisional procedures, respectively. Of the conservative approaches BT-A is by far the most efficacious. Patients should be informed of the advantages and disadvantages of both methods.
腋窝多汗症是一种功能性非炎性小汗腺异常。真性多汗症的病因尚不清楚，因此没有特定的矫正治疗方法，保守治疗往往失败。腋窝皮下汗腺刮除术是一种已被证实的手术方式。局部注射A型肉毒杆菌毒素（BT-A）是一种有前景的新保守治疗方法。
本研究旨在比较皮下刮除术与注射BT-A治疗腋窝多汗症的疗效。
总共113例（男性占36.3%，女性占63.7%）真性腋窝多汗症患者接受了皮下刮除术（n = 90）或局部注射BT-A（n = 23）治疗。中位随访期为23.5个月。在治疗前、术后6个月以及最后一次随访时向患者发放问卷，以进行症状的主观评估。要求患者根据从1分（无腋窝分泌）到6分（腋窝分泌最多）的评分标准对腋窝出汗量进行评分。评估了静息时、高温时、身体应激时、情绪应激时以及进食辛辣食物后的出汗主观评分。
皮下刮除术后患者对总体结果的主观评估为“非常好”的占36.4%，“好”的占29.9%，“满意”的占16.9%。静息时腋窝出汗的主观评分在6个月后降至40.0%，随访结束时最终降至45.7%（中位时间：28.2个月）。接受BT-A注射治疗的患者对结果的评估为“非常好”的占39.1%，“好”的占21.7%，“满意”的占8.7%。静息时出汗在6个月后降至48.5%，随访结束时最终降至68.8%（中位时间：16.1个月）。BT-A的止汗效果平均持续时间为7.6个月（中位时间：7个月），但有2例持续时间较长，即14个月和18个月。
与早期方法相比，皮下刮除术和注射BT-A均具有主要优势。皮下刮除术具有相同的永久疗效，但与交感神经切除术相比副作用少得多，与局部切除手术相比瘢痕形成也少得多。在保守治疗方法中，BT-A是迄今为止最有效的。应告知患者两种方法的优缺点。
