Wollina U, Konrad H
Department of Dermatology, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany.
J Eur Acad Dermatol Venereol. 2002 Sep;16(5):469-71. doi: 10.1046/j.1468-3083.2002.00490.x.
Anal fissures are common and painful. Botulinum toxin A (BTXA) is considered to be the most potent non-surgical treatment; however, no attention has been paid to associated hyperhidrosis.
To compare traditional BTXA treatment of muscular spasticity in anal fissures with combined treatment of spasticity and focal hyperhidrosis of the anal fold and perianal skin.
Outpatient department of a dermatological hospital.
Ten patients with chronic anal fissures (of more than 6 months duration who failed to respond to conservative treatment and who had refused surgery) associated with focal hyperhidrosis as assessed by Minor's sweat test were investigated in an open, two-armed trial. Intramuscular injections of 20-25 U BTXA (Botox) were performed in group A (n = 5). In group B (n = 5) those injections were combined with intracutaneous injection of 30-50 U BTXA to treat focal hyperhidrosis. Mean follow-up was 5 months.
Five of five patients in group B but only two of five patients in group A experienced a complete remission despite the fact that relief of pain was evident in eight of 10 patients within 2 weeks. Patient satisfaction with treatment was high but slightly better in group B.
This open trial suggests that combined therapy of both muscular spasticity and focal hyperhidrosis may provide better results than intramuscular injections alone in anal fissure therapy with BTXA.
肛裂常见且疼痛。A型肉毒杆菌毒素（BTXA）被认为是最有效的非手术治疗方法；然而，相关的多汗症却未受到关注。
比较传统的BTXA治疗肛裂肌肉痉挛与联合治疗肛裂肌肉痉挛及肛褶和肛周皮肤局灶性多汗症的效果。
一家皮肤病医院的门诊部。
在一项开放性双臂试验中，对10例慢性肛裂患者（病程超过6个月，对保守治疗无效且拒绝手术）进行了研究，这些患者经Minor汗液试验评估伴有局灶性多汗症。A组（n = 5）肌肉注射20 - 25 U BTXA（保妥适）。B组（n = 5）在肌肉注射的基础上，联合皮内注射30 - 50 U BTXA以治疗局灶性多汗症。平均随访5个月。
B组5例患者中有5例完全缓解，而A组5例患者中只有2例完全缓解，尽管10例患者中有8例在2周内疼痛明显缓解。患者对治疗的满意度较高，但B组稍好。
这项开放性试验表明，在使用BTXA治疗肛裂时，联合治疗肌肉痉挛和局灶性多汗症可能比单纯肌肉注射效果更好。
