Department of Surgery, Royal Free Hospital, Pond St, London, NW3 2QG, UK.
Am J Clin Dermatol. 2015 Oct;16(5):361-70. doi: 10.1007/s40257-015-0136-6.
Primary craniofacial hyperhidrosis (CH) can have a profoundly negative impact on quality of life. No comprehensive review of its management exists.
The objective of this review is to present the best clinical evidence to guide CH management.
A systematic review was performed using PRISMA guidelines. MEDLINE and EMBASE were searched from 1966 to 2014 for articles using the MeSH terms "Hyperhidrosis", "Head", "Neck" and synonymous text words. Inclusion criteria were experimental and observational studies addressing CH treatment. Two reviewers independently assessed study quality and analysed data.
Of 833 references yielded, 27 met inclusion criteria and were analysed. Twenty-two studies evaluated T2 sympathetic ablation (Level III evidence). Outcome measures were subjective and mean follow-up was 29 months. Reported efficacy was high (70-100%), recurrence rates were generally low (0-8%) and complications largely transient (e.g. pneumothorax 0-1%). However, 8-95.4% experienced troubling compensatory sweating. One randomised controlled trial and one observational study evaluated botulinum toxin A (Level Ib and III, respectively). Both employed objective outcome measures and demonstrated similar findings. Efficacy was 100%, lasted a median of 5-6 months and frontalis muscle inhibition was the main adverse effect (50-100%). Three studies evaluated anticholinergic therapy: topical glycopyrrolate demonstrated high efficacy (96%) with minimal adverse effects (Level Ib) and oral oxybutynin demonstrated relatively high efficacy (80-100%) but with noticeable adverse effects (76.6-83.6%) (Level III).
There are few quality studies evaluating CH treatment. Based on available evidence, we recommend topical glycopyrrolate, oral oxybutynin and intradermal botulinum toxin A as first-line therapies due to their efficacy and safety. T2 sympathectomy should be considered for patients refractory to first-line therapy.
原发性颅面多汗症（CH）会对生活质量产生深远的负面影响。目前尚无关于其管理的综合综述。
本综述的目的是提供最佳的临床证据来指导 CH 的管理。
使用 PRISMA 指南进行系统综述。从 1966 年至 2014 年，在 MEDLINE 和 EMBASE 上使用 MeSH 术语“多汗症”、“头部”、“颈部”和同义文本词搜索文章。纳入标准为针对 CH 治疗的实验和观察性研究。两名评审员独立评估研究质量并分析数据。
从 833 条参考文献中，有 27 条符合纳入标准并进行了分析。22 项研究评估了 T2 交感神经消融（III 级证据）。疗效评估指标为主观指标，平均随访时间为 29 个月。报道的疗效较高（70-100%），复发率一般较低（0-8%），并发症多为暂时性（如气胸 0-1%）。然而，8-95.4%的患者出现令人困扰的代偿性出汗。一项随机对照试验和一项观察性研究评估了肉毒杆菌毒素 A（分别为 Ib 级和 III 级）。两者均采用客观的疗效评估指标，结果相似。疗效为 100%，中位持续时间为 5-6 个月，额肌抑制是主要的不良反应（50-100%）。三项研究评估了抗胆碱能药物治疗：局部给予格隆溴铵显示出较高的疗效（96%），且不良反应最小（Ib 级），口服奥昔布宁显示出相对较高的疗效（80-100%），但不良反应明显（76.6-83.6%）（III 级）。
评估 CH 治疗的高质量研究很少。根据现有证据，我们建议将局部给予格隆溴铵、口服奥昔布宁和皮内注射肉毒杆菌毒素 A 作为一线治疗方法，因为它们的疗效和安全性较好。对于一线治疗无效的患者，应考虑 T2 交感神经切除术。
