Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, U.K.
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, U.K.
Br J Dermatol. 2018 Sep;179(3):599-608. doi: 10.1111/bjd.16558. Epub 2018 Jun 29.
Hyperhidrosis is uncontrollable excessive sweating, which occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life.
To undertake a systematic review of the clinical effectiveness and safety of treatments available in secondary care for the management of primary hyperhidrosis.
Fifteen databases (including trial registers) were searched to July 2016 to identify studies of secondary-care treatments for primary hyperhidrosis. For each intervention randomized controlled trials (RCTs) were included where available; where RCT evidence was lacking, nonrandomized trials or large prospective case series were included. Outcomes of interest included disease severity, sweat rate, quality of life, patient satisfaction and adverse events. Trial quality was assessed using a modified version of the Cochrane Risk of Bias tool. Results were pooled in pairwise meta-analyses where appropriate, otherwise a narrative synthesis was presented.
Fifty studies were included in the review: 32 RCTs, 17 nonrandomized trials and one case series. The studies varied in terms of population, intervention and methods of outcome assessment. Most studies were small, at high risk of bias and poorly reported. The interventions assessed were iontophoresis, botulinum toxin (BTX) injections, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland.
The evidence for the effectiveness and safety of treatments for primary hyperhidrosis is limited overall, and few firm conclusions can be drawn. However, there is moderate-quality evidence to support the use of BTX for axillary hyperhidrosis. A trial comparing BTX with iontophoresis for palmar hyperhidrosis is warranted.
多汗症是一种不受控制的过度出汗，即使在休息时也会发生，且与温度无关。多汗症的症状会显著影响生活质量。
系统评价二级护理中可用于治疗原发性多汗症的各种治疗方法的临床疗效和安全性。
检索了 15 个数据库（包括试验注册库），截至 2016 年 7 月，以确定二级护理治疗原发性多汗症的研究。对于每一种干预措施，如果有随机对照试验（RCT），则纳入其中；如果缺乏 RCT 证据，则纳入非随机试验或大型前瞻性病例系列研究。感兴趣的结局包括疾病严重程度、出汗率、生活质量、患者满意度和不良事件。使用 Cochrane 偏倚风险工具的改良版评估试验质量。如果合适，采用成对的荟萃分析汇总结果，否则进行叙述性综合。
共纳入了 50 项研究：32 项 RCT、17 项非随机试验和 1 项病例系列研究。这些研究在人群、干预措施和结局评估方法方面存在差异。大多数研究规模较小，偏倚风险高，报告质量差。评估的干预措施包括离子电渗疗法、肉毒杆菌毒素（BTX）注射、抗胆碱能药物、刮除术和新型基于能量的破坏汗腺的技术。
原发性多汗症治疗方法的有效性和安全性证据总体上有限，因此无法得出确切结论。然而，有中等质量的证据支持 BTX 用于治疗腋窝多汗症。有必要开展一项比较 BTX 与离子电渗疗法治疗手掌多汗症的试验。
