Thomas Isabelle, Brown Justin, Vafaie Janet, Schwartz Robert A
University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
Am Fam Physician. 2004 Mar 1;69(5):1117-20.
Excessive sweating from the palms and soles, known as palmoplantar hyperhidrosis, affects both children and adults. Diagnosis of this potentially embarrassing and socially disabling condition is based on the patient's history and visible signs of sweating. The condition usually is idiopathic. Treatment remains a challenge: options include topical and systemic agents, iontophoresis, and botulinum toxin type A injections, with surgical sympathectomy as a last resort. None of the treatments is without limitations or associated complications. Topical aluminum chloride hexahydrate therapy and iontophoresis are simple, safe, and inexpensive therapies; however, continuous application is required because results are often short-lived, and they may be insufficient. Systemic agents such as anticholinergic drugs are tolerated poorly at the dosages required for efficacy and usually are not an option because of their associated toxicity. While botulinum toxin can be used in treatment-resistant cases, numerous painful injections are required, and effects are limited to a few months. Surgical sympathectomy should be reserved for the most severe cases and should be performed only after all other treatments have failed. Although the safety and reliability of treatments for palmoplantar hyperhidrosis have improved dramatically, side effects and compensatory sweating are still common, potentially severe problems.
手掌和脚底过度出汗，即掌跖多汗症，在儿童和成人中均有发生。对这种可能令人尴尬且会导致社交障碍的病症的诊断基于患者的病史和明显的出汗迹象。该病症通常为特发性。治疗仍然是一项挑战：治疗选择包括局部和全身性药物、离子电渗疗法以及A型肉毒杆菌毒素注射，手术交感神经切除术则作为最后手段。没有一种治疗方法是没有局限性或不伴有相关并发症的。局部用六水合氯化铝疗法和离子电渗疗法是简单、安全且廉价的治疗方法；然而，由于效果通常持续时间较短且可能不充分，所以需要持续应用。全身性药物如抗胆碱能药物在有效剂量下耐受性较差，且由于其相关毒性，通常不是一种选择。虽然肉毒杆菌毒素可用于治疗抵抗性病例，但需要进行多次疼痛注射，且效果仅持续几个月。手术交感神经切除术应仅用于最严重的病例，并且仅在所有其他治疗均失败后才进行。尽管掌跖多汗症治疗的安全性和可靠性已大幅提高，但副作用和代偿性出汗仍然是常见的、可能很严重的问题。
