Wollina U, Karamfilov T
Department of Dermatology and Allergology, the Friedrich-Schiller-University of Jena, Germany.
J Eur Acad Dermatol Venereol. 2002 Jan;16(1):40-2. doi: 10.1046/j.1468-3083.2002.00361.x.
Dyshidrotic hand eczema is a therapeutic challenge. A prospective pilot study was performed with left-right comparison in order to investigate whether chemical de-innervation of sudoriferic nerves would be superior to standard therapy with topical corticosteroids.
Botulinum toxin A (BTXA) is a potent inhibitor of acetylcholine release, that induces eccrine sweat production and release. Inhibition of sweating by other measures such as tap water iontophoresis has been shown to be beneficial in dyshidrotic hand eczema.
Eight adult patients suffering from dyshidrotic hand eczema (atopic type) were included in a prospective, side-by-side controlled clinical pilot study using topical corticosteroids on both hands in combination with intracutaneous injections of 100 units of BTXA (Botox) on the more severely affected hand on day 1. The dyshidrotic hand eczema was classified using the DASI (Dyshidrotic Eczema Area and Severity Index) before treatment (0), after 1 week, 4 weeks and 8 weeks.
Six patients completed the study, two dropped out because of social and personal reasons. The mean DASI score changed from 28 to17 with topical therapy alone and from 36 to 3 with adjuvant BTXA (P < 0.01). Itching and vesiculation were inhibited earlier when using the combination of corticosteroids and BTXA. There was one relapse in the corticosteroid group. Relapses have not been seen in the BTXA group.
Interruption of sweating by BTXA improves the outcome and reduces relapses in patients with dyshidrotic hand eczema. BTXA is antipruritic as well suggesting that it does not only interact with acetylcholine release but substance P.
汗疱疹性手部湿疹是一个治疗难题。进行了一项前瞻性试验研究，采用左右对比的方式，以调查汗腺神经化学去神经支配是否优于外用糖皮质激素的标准疗法。
A型肉毒杆菌毒素（BTXA）是一种强效的乙酰胆碱释放抑制剂，可诱导小汗腺汗液的产生和释放。已证明通过其他措施（如自来水离子导入法）抑制出汗对汗疱疹性手部湿疹有益。
8例患有汗疱疹性手部湿疹（特应性类型）的成年患者纳入一项前瞻性、双侧对照临床试点研究，双手均使用外用糖皮质激素，并在第1天对受影响更严重的手皮内注射100单位BTXA（保妥适）。在治疗前（0周）、1周、4周和8周使用汗疱疹性湿疹面积和严重程度指数（DASI）对汗疱疹性手部湿疹进行分类。
6例患者完成研究，2例因社会和个人原因退出。单纯外用治疗时，平均DASI评分从28降至17，辅助使用BTXA时从36降至3（P<0.01）。联合使用糖皮质激素和BTXA时，瘙痒和水疱形成的症状更早得到抑制。糖皮质激素组有1例复发。BTXA组未见复发。
BTXA阻断出汗可改善汗疱疹性手部湿疹患者的治疗效果并减少复发。BTXA也具有止痒作用，这表明它不仅作用于乙酰胆碱释放，还作用于P物质。
