出汗多的好处与坏处（出汗排毒好处多多）

出汗排毒好处多多，但无时无刻的汗如雨下让人尴尬和困扰

——了解一下多汗症

最近门诊连续遇到因为出汗来就诊的患者，排汗（出汗）本来是人体的正常生理反应，但汗液分泌量超过自身体温调节及体内平衡所需而发生的过量出汗就是多汗症，常发生于手掌、足跖、腋窝等外泌汗腺密集的部位。给患者的生活及人际交往造成了极大困扰，严重影响了患者的生活质量。

Hyperhidrosis (HH) is a dermatologic disorder defifined by sweat production exceeding thermoregulatory needs. Clinically, HH is diagnosed when excess sweating creates signifificant emotional, physical, or social discomfort, causing a negative impact on the patient’s quality of life.

分类

1、原发性多汗症是指患者存在汗液分泌增多，而汗腺没有任何的病理改变或腺体增生。93%是原发性多汗，典型局限性多汗症则多为特发性（原发性），双侧对称，累及腋窝、手掌、脚底和颅面区域。

2、继发性多汗症通常是由于其他基础疾病导致的全身性多汗，双侧不对称。

This condition is categorized as primary or secondary HH. Approximately 93% of patients with HH have primary HH, of whom>90% have a typical focal and bilateral distribution affecting the axillae, palms, soles, and craniofacial areas. Secondary HH presents in a more generalized and asymmetric distribution and is generated by various underlying diseases or medications. Secondary causes of HH need to be excluded before diagnosing primary HH.

流行病学

93%是原发性多汗，多发生在14-25岁之间，累及腋窝、手掌、脚底和颅面区域。

• Hyperhidrosis is a dermatologic disorder characterized by excessive sweat production.

• Existing data imply that this condition may affect at least 4.8% of the US population

• Primary hyperhidrosis constitutes 93% of all cases of hyperhidrosis

• The onset of primary hyperhidrosis typically occurs between 14 and 25 years of age

• Common locations affected by primary hy perhidrosis include the axillae, palms, soles of the feet, and craniofacial areas

出汗的解剖和机制

外分泌汗腺和自主神经系统调节

• Three types of sweat glands exist: eccrine, apocrine, and apoeccrine

• Eccrine sweat glands are the most abundant type of sweat glands

• The autonomic nervous system regulates sweat production

病理生理机制

原发性多汗来自于汗腺过多的神经活动，于汗腺的大小、数量和组织学无关。可能的原因是复杂的自主神经功能失调和异常情绪中枢控制。

• Primary hyperhidrosis results from the excessive neurogenic activity of otherwise normal eccrine sweat glands

• There is no change in the size, number, or histologic appearance of sweat glands in hyperhidrotic patients

• Hypothesized etiologies of primary hyperhidrosis include complex autonomic nervous system dysfunction and abnormal central control of emotions

分类和鉴别诊断

原发性多汗症是特发性的，通常是局部、双侧和对称的多汗。

继发性多汗症与潜在病因有关。

全身原发性多汗症

• Primary hyperhidrosis is idiopathic and typically has a focal, bilateral, and symmetric distribution of excessive sweat production

• Secondary hyperhidrosis is related to an underlying cause

• Generalized primary hyperhidrosis

继发性多汗的病因

1、全身性继发性多汗

1）生理性的：热，发烧，怀孕，更年期

2）病理性的：恶性疾病、感染、内分泌/代谢疾病、心血管病、呼吸疾病，神经疾病、药物

2、对称性局部继发性多汗

3、不对称性局部继发性多汗

4、区域性继发性多汗

多汗是抗抑郁药的副作用之一。针对抗抑郁药的多汗副作用，《中国抑郁障碍防治指南》（第二版）建议加用α1-肾上腺素能受体阻滞剂（如特拉唑嗪），中枢α2-肾上腺素能受体激动剂（如可乐定），或抗胆碱能药物（如苯扎托品）。

神经科疾病：当T8以上脊髓病变时容易引起自主神经功能反射异常；急性大脑半球

诊断

诊断原发性多汗症之前排除继发性多汗

考虑原发性多汗不必做实验室诊断测试

继发性多汗症是不对称的，单侧的或全身的

继发性多汗通常开始于25岁以后，没有家族史，经常伴夜汗

• Secondary hyperhidrosis needs to be excluded before diagnosing primary hyperhidrosis

• Laboratory diagnostic tests are not necessary when primary hyperhidrosis is suspected

• In contrast to primary hyperhidrosis, secondary hyperhidrosis is asymmetric, unilateral, or generalized

• Secondary hyperhidrosis commonly begins after 25 years of age, lacks a family history, and often involves nocturnal sweating

原发局灶性多汗症的诊断标准

①局部的、可见的、大量出汗，持续 6 个月或以上；

②无明显的继发因素；

③同时满足以下 2 种或以上的特征：（1） 双侧相对对称，（2）发病年龄 <25 岁，（3）家族史阳性，（4）睡眠时停止出汗，（5）每周至少发作 1 次，（6）影响日常活动。

出汗测试

不同的定量和定性测试

不常规用于临床

有助于确定出汗的严重性和直接治疗

Various quantitative and qualitative tests for hyperhidrosis exist

Hyperhidrosis testing is not commonly used for clinical purposes

Hyperhidrosis tests can help determine sweating severity and direct therapy

对生活质量的影响

多汗症影响日常生活和社交

容易发生焦虑和抑郁

患者出汗不会随时间而改善

Hyperhidrosis impairs daily functions and social interactions

Depression and anxiety occur more commonly in patients with hyperhidrosis

than in nonhyperhidrotic individuals

The ability of patients to cope with hyperhidrosis does not seem to improve with time

多汗的严重程度

治疗

预防：建议避免辛辣刺激食物、穿着棉料服装，避免情绪激动，避免过度活动等。

治疗：

1、局部治疗：氯化铝（AlCl₃）涂抹

2、肉毒素局部注射

3、离子导入治疗

4、微波热解

5、药物：全身应用抗胆碱能药，中药治疗

6、手术：局部多汗，交感神经切除手术或许有效

The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review

,