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はじめに
原発性腋窩多汗症は著しくQOLを低下させる疾患であるが,従来は疾患として治療対象とされることが少なかった。しかし,2012年に,A型ボツリヌス毒素(以下,BT-A)(ボトックス Ⓡ:グラクソ・スミスクライン社)の局所注射療法が健康保険適用で受けられるようになったことを皮切りに,2018年にはマイクロ波メスによる腋窩多汗症治療器〔miraDry Ⓡシステム(以下,ミラドライ Ⓡ):ジェイメック社〕が国内薬事承認を取得し,さらに,2021年,2022年に健康保険適用の外用薬が相次いで発売されるなどして,治療の選択肢が大きく広がり,潜在患者が医療機関を受診する機会が急増している。
本稿では,当院における保険診療を中心とした腋窩多汗症・腋臭症治療の実際について紹介するとともに,特にBT-A局所注射療法の手技や注意点について述べる。
The details of the botulinum toxin injection treatment administered for axillary hyperhidrosis and osmidrosis at our clinic are described herein. In our experience, botulinum toxin A (BT-A) injection has been a highly satisfactory option for axillary hyperhidrosis and osmidrosis. It is simple to perform, has very high clinical efficacy, and is now covered by health insurance (which reduces its cost burden). The only drawback, i.e., injection-site pain, is alleviated by using a fine needle and a vibrator. The use of botulinum injection for axillary hyperhidrosis has also become more widespread following the recent launch of insurance coverage for treatment with topical anticholinergic drugs. Healthcare providers must select the best treatment strategy among the several options available for axillary hyperhidrosis and malodor, suiting the needs of their patients. Since surgery is one of the treatment options for axillary osmidrosis, plastic surgeons have a significant role to play in the development of treatment plans. We believe that by gaining proficiency in non-surgical techniques, plastic surgeons can also use techniques such as BT-A injection for axillary hyperhidrosis and osmidrosis, with better patient satisfaction.
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