Wollina Uwe, Karamfilov Theodor, Konrad Helga
Department of Dermatology, Friedrich Schiller University of Jena, Jena, Germany.
J Am Acad Dermatol. 2002 Apr;46(4):536-40. doi: 10.1067/mjd.2002.118341.
Axillary hyperhidrosis is a common condition that can be personally distressing and can interfere with professional and social life. Intracutaneous injections of botulinum toxin type A (BTXA) have recently been shown to induce an effective but temporary anhidrosis, usually for 4 to 6 months. High-dose BTXA was shown to have a lower relapse rate, but it remained unclear whether it could induce a prolongation of the antihidrotic effect.
Our aim was to evaluate the long-term effectiveness of "high-dose" botulinum toxin therapy in axillary hyperhidrosis, the response to repeated treatment, and the possible side effects.
In an open study in a university medical center, 47 patients with axillary hyperhidrosis unresponsive to previous therapies were treated with intracutaneous injections of botulinum A toxin. A total dose of 200 U of BTXA was used per axilla. Patients were followed up for periods up to 29 months. The main outcome measures were patients' satisfaction with the antihidrotic effect, response to repeated treatment, and safety of treatment.
Within 6 days of the injection of BTXA, all patients reported cessation of excessive sweating. The follow-up was 17.0 +/- 8.3 months (range, 3-29 months). The relapse rate within 12 months of treatment was 4 of 34 patients (11.8%). The longest relapse-free interval observed was 29 months. Twenty-two patients showed a relapse-free interval of 19 months or more. The number of patients with at least 12 months of remission was significantly higher with 200 U of botulinum toxin than with lower doses reported in current literature (P <.05). Relapsed patients (a total of 6/47) showed an unchanged excellent response to a second or third treatment. The only side effect was temporary pain and burning during the injections. No muscular weakness, insensitivity, or systemic reactions were observed.
High-dose BTXA treatment is capable of prolonging the antihidrotic effect of intracutaneous BTXA in most patients for more than 19 months. It reduces the percentage of relapses after 12 months of follow-up to less than 12%. So far, there is no clinical evidence of the induction of neutralizing antibodies. High-dose treatment seems to be as safe as low-dose treatment.
腋窝多汗症是一种常见病症，会给患者带来个人困扰，并可能影响其职业和社交生活。皮内注射A型肉毒杆菌毒素（BTXA）最近已被证明可诱导有效但短暂的无汗症，通常持续4至6个月。高剂量BTXA显示复发率较低，但尚不清楚它是否能延长止汗效果。
我们的目的是评估“高剂量”肉毒杆菌毒素疗法治疗腋窝多汗症的长期疗效、重复治疗的反应以及可能的副作用。
在一所大学医学中心进行的一项开放性研究中，对47例对先前治疗无反应的腋窝多汗症患者进行皮内注射A型肉毒杆菌毒素治疗。每侧腋窝使用的BTXA总剂量为200 U。对患者进行了长达29个月的随访。主要观察指标为患者对止汗效果的满意度、重复治疗的反应以及治疗的安全性。
注射BTXA后6天内，所有患者均报告多汗症状停止。随访时间为17.0±8.3个月（范围3 - 29个月）。治疗12个月内的复发率为34例患者中的4例（11.8%）。观察到的最长无复发间隔为29个月。22例患者的无复发间隔为19个月或更长。与当前文献报道的较低剂量相比，使用200 U肉毒杆菌毒素至少缓解12个月的患者数量显著更多（P <.05）。复发患者（共6/47）对第二次或第三次治疗显示出不变的良好反应。唯一的副作用是注射期间的短暂疼痛和烧灼感。未观察到肌肉无力、感觉迟钝或全身反应。
高剂量BTXA治疗能够在大多数患者中延长皮内注射BTXA的止汗效果超过19个月。它将随访12个月后的复发率降低至不到12%。到目前为止，尚无诱导中和抗体的临床证据。高剂量治疗似乎与低剂量治疗一样安全。
