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首页> 外文期刊>Clinics in dermatology >Anatomy of the sweat glands, pharmacology of botulinum toxin, and distinctive syndromes associated with hyperhidrosis.
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Anatomy of the sweat glands, pharmacology of botulinum toxin, and distinctive syndromes associated with hyperhidrosis.

机译：汗腺解剖，肉毒杆菌毒素的药理学以及与多汗症相关的独特综合征。

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For a long period the therapeutic modalities to treat focal hyperhidrosis (HH) were very limited. Due to this the problem of focal HH was delt with stepmotherly. Nowadays we can consider BTX as the therapy of choice for axillary HH after topical treatment with aluminium salts have failed. The amount of successful reports on botulinum toxin (BTX) in the treatment of focal HH brought a change and the interest for this specific disorder grew. This article gives details on anatomy and physiology of sweating and mechanism of BTX. Further distinctive syndromes associated with HH, which all can be treated with BTX like localized unilateral hyperhidrosis (LUH), Ross' Syndrome and Frey' Syndrome are presented. A diagnosis of primary HH is usually based on the patients's history, typical younger age and visible signs of excessive sweating. Before treatment it is important to objectify focal HH with performing sweat tests such like Minor starch test and/or gravimetry. The total number of sweat glands is somewherebetween 2 and 4 million and only about 5% are active at the same time, indicating the enormous potential for sweat production. The eccrine sweat gland is a long-branched tubular structure with highly coiled secretory portion and a straight ductular portion. Sweat is produced by clear and dark cells and is a clear hypotonic, odorless fluid. In response to nerve impulses, Acetylcholine (ACh) is released from the presynaptic nerve endings and then binds to postsynaptic cholinergic receptors presumably present in the basolateral membrane of the clear cells. This activates a complex in- and efflux of electrolytes creating the hypotonic sweat. Injection of BTX leads to temporary chemodenervation with the loss or reduction of activity of the target organ. BTX is consisted of a heavy and a light chain. The structural architecture of BTX comprises three domains-L, H(N) and H(C)-each with a specific function in the mechanism of cell intoxication. The heavy chain is responsible for binding to the nerve cell, whereas thelight chain catalyzes the proteolysis of one of the three SNARE proteins (Snap-25, Vamp or Syntaxin) depending to the serotype of BTX (7 serotypes A-G). Once cleaved by BTX, the SNARE proteins cannot become part of the complex capable of mediating the vesicle membrane fusion and therefore prevents the release of ACh and hence transmission of the nerve impulse.
机译：长期以来，治疗局灶性多汗症（HH）的治疗方式非常有限。由于这个原因，焦点HH的问题被继母解决了。如今，在铝盐局部治疗失败后，我们可以将BTX视为腋窝HH的首选治疗方法。关于治疗局灶性HH的肉毒毒素（BTX）的成功报道的数量带来了变化，并且对该特定疾病的兴趣也在增长。本文详细介绍了出汗的解剖学和生理学以及BTX的机制。还介绍了与HH相关的其他特殊综合征，这些综合征均可通过BTX进行治疗，例如局部单侧多汗症（LUH），罗斯综合征和弗雷综合征。原发性HH的诊断通常基于患者的病史，典型的年轻年龄和明显出汗的迹象。在治疗之前，重要的是通过进行汗液测试（例如次要淀粉测试和/或重量测定法）来确定局部HH。汗腺的总数在2到4百万之间，而同时只有5％处于活动状态，这表明产生汗水的巨大潜力。外分泌汗腺是具有高度卷曲的分泌部分和笔直的导管部分的长分支管状结构。汗液由透明和深色细胞产生，是透明的低渗，无味的液体。响应神经冲动，乙酰胆碱（ACh）从突触前神经末梢释放，然后与可能存在于透明细胞基底外侧膜中的突触后胆碱能受体结合。这会激活复杂的电解质流入和流出，从而产生低渗汗液。注射BTX导致暂时的化学神经支配，靶器官的活性丧失或降低。 BTX由重链和轻链组成。 BTX的结构结构包括三个域-L，H（N）和H（C），每个域在细胞中毒的机制中具有特定的功能。重链负责与神经细胞结合，而轻链则根据BTX的血清型（7种血清型A-G）催化三种SNARE蛋白（Snap-25，Vamp或Syntaxin）之一的蛋白水解。 SNARE蛋白一旦被BTX裂解，就不能成为能够介导囊泡膜融合的复合物的一部分，因此无法阻止ACh的释放以及神经冲动的传递。

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