Budamakuntla Leelavathy, Loganathan Eswari, George Anju, Revanth B N, Sankeerth V, Sarvjnamurthy Sacchidananda Aradhya
Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
J Cutan Aesthet Surg. 2017 Jan-Mar;10(1):33-39. doi: 10.4103/JCAS.JCAS_104_16.
Primary focal axillary hyperhidrosis is a chronic distressing disorder affecting both the sexes. When the condition is refractory to conservative management, we should go for more promising therapies like intradermal botulinum toxin A (BtxA) injections in the axilla, and surgical therapies like subcutaneous curettage of sweat glands.
The aim of this study is to compare the efficacy, safety and duration of action of intradermal BtxA injections in one axilla and subcutaneous curettage of sweat glands in the other axilla of the same patient with axillary hyperhidrosis.
Twenty patients (40 axillae) received intradermal BtxA injections on the right side (20 axillae) and underwent tumescent subcutaneous curettage of sweat glands on the left side (20 axillae). Sweat production rate was measured using gravimetry analyses at baseline and at 3 months after the procedure. Subjective analyses were done using hyperhidrosis disease severity scale (HDSS) score at baseline, at 3 and 6 month after the procedure.
At 3 months post-treatment, the resting sweat rate in the toxin group improved by 80.32% versus 79.79% in the subcutaneous curettage method ( = 0.21). Exercise-induced sweat rate in the toxin group improved by 88.76% versus 88.8% in the subcutaneous curettage group ( = 0.9). There was a significant difference in the HDSS score after treatment with both the modalities. There were no adverse events with BtxA treatment compared to very minor adverse events with the surgical method.
Both intradermal BtxA injections and tumescent subcutaneous curettage of sweat glands had a significant decrease in the sweat rates with no significant difference between the two modalities. Hence, in resource poor settings where affordability of BtxA injection is a constraint, subcutaneous curettage of sweat glands can be preferred which has been found equally effective with no or minimal adverse events.
原发性局灶性腋窝多汗症是一种困扰两性的慢性疾病。当病情对保守治疗无效时，我们应寻求更有前景的治疗方法，如在腋窝进行皮内注射肉毒杆菌毒素A（BtxA），以及手术治疗，如皮下刮除汗腺。
本研究的目的是比较在同一腋窝多汗症患者的一侧腋窝进行皮内注射BtxA与另一侧腋窝进行皮下刮除汗腺的疗效、安全性和作用持续时间。
20例患者（40个腋窝）右侧（20个腋窝）接受皮内注射BtxA，左侧（20个腋窝）进行肿胀麻醉下的皮下汗腺刮除术。在基线和术后3个月使用重量分析法测量出汗率。在基线、术后3个月和6个月使用多汗症疾病严重程度量表（HDSS）评分进行主观分析。
治疗后3个月，毒素组静息出汗率改善了80.32%，而皮下刮除术组为79.79%（P = 0.21）。毒素组运动诱发出汗率改善了88.76%，皮下刮除术组为88.8%（P = 0.9）。两种治疗方式治疗后的HDSS评分有显著差异。与手术方法出现的非常轻微的不良事件相比，BtxA治疗未出现不良事件。
皮内注射BtxA和肿胀麻醉下的皮下汗腺刮除术均可使出汗率显著降低，两种方式之间无显著差异。因此，在资源匮乏地区，若BtxA注射的可承受性受到限制，皮下刮除汗腺可能是更好的选择，因为已发现其同样有效，且不良事件极少或没有。
