수종의 부교감신경봉쇄약물이 땀분비에 미치는 영향

Abstract

[한글]

A Study on the Effect of Anticholinergic Drugs on Sweat Secretion

Chung Koo Cho, M.D.

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Prof. Tae Ha Woo, M.D., D.M.Sc.)

The most important function of sweating is to control the body temperature by

evaporating a large quantity of water over the skin, and it is well known that the

sweat gland is more developed in man than in other mammals.

Problems of perspiration are among the oldest in the history of medicine. Already

Hippocrates stated that vaporous substances are given off through the skin. Galen

stated that, though insensible, perspiration is discharged continuously and

uniformly from the whole body surface and this discharge can occasionally be

increased, so it takes the form of fluid, sweat. In the 17th century, Sanctorius

Sanctorio demonstrated to the great surprise of his contemporaries that insensible

perspiration could be measured exactly by means of a blance. He observed the gain

in weight when he took food and the continuous loss of the weight when nothing was

taken. Such observations of his own body weight were continued through out thirty

years(Kuno, 1956).

After the discovery of the sweat glands on the skin by Purkinj'e (1833),

insensible perspiration and sweat secretion became an inseparable subject.

Insensible perspiration had so far been a matter of the whole body, but now the

object of study was reduced to the skin (Kuno, 1956).

Dale and Feldberg (1934) first demonstrated that eccrine sweat glands are

supplied with nerves that, although belonging anatomically to the sympathetic

nervous system, are cholinergic.

In dermatologic field, the management of many skin diseases related to

hyperhidrosis and dyshildrosis demands to inhibit sweat secretion. In our present

knowledge, such inhibition is most readily achieved by the use of anticholinergic

drugs which temporarily prevent acetylcholine from acting on the sweat glands. An

attempt has been made to develop derivativies or analogs which would exhibit a

selective or specific anticholinergic effect with respect to a given organ (e.g.

the gastrointestinal tract). In this regard, evaluation of the effectiveness of the

anticholinergic drugs has been confined to organs other than the sweat glands.

After the first encouraging report of Grimson et al (1950) on the effect of

Banthine on sweat secretion, their hyperhidrotic patients. But Shelly and Horvath

(1951) reported that 15 anticholinergic drugs given orally to man in clinical

dosages proved to have no effect on sweating. According Sulzberger and Herrmann

(1954), one of seven patients on Banthine and six of fifteen patients on Prantal

were only effective. The effectiveness of the anticholinergic drugs varies from

definitely encouraging results to most disappointing one.

The present investigation, therefore, was undertaken to evaluate the

effectiveness of Probanthine, Daricon and Buscopan on the human sweat secretion.

Method

Subjects were nine healthy men raning 19 to 24 years of age. Five men were

studied in the summer (August) and 4 were studied in the winter (November and

December). No dietary restrictions were imposed except alcohols.

Immediately before the sweating test, the test sties were gently cleansed with

soap and water, rinsed with ion-free distilled water and air dried. The plastic

sweat collectors (according to Sato and Dobson, 1969) with an internal diameter of

2.5cm were secured to the skin with plaster. The subjects entered into the

Environ-Room(Dry bulb 46℃, wet bulb 41℃; Lab-Line Inst. Inc. Melrose Park, Ⅲ).

Two pre-weighed, 1mm thick, filter papers were introduced into plastic sweat

collectors and sealed at time zero. Every 15 minutes for 1 hour the filter papers

were collected and fresh, pre-weighed filter papers were inserted in the plastic

sweat collectors. Sweat volumes were determined by weight differences of the filter

papers(mg/1.25**2πcm**2). All studies were conducted using the skin of the both

side of the upper back and forearm.

Anticholinergic drugs used in this study were Pro-banthine (propantheline,

Searle), Daricon (oxyphencyclimine, Pfizer), Buscopan (hyoscine N-butylbromide,

C.H. Baehringer Sohn Ingellheim).

The above anticholinergic drugs were given orally 2 hours after breakfast, and

observations of sweat secretion were made 1 hour after ingestion of the drugs.

summary and Conclusion

In nine healthy men, the sweat secretion was observed in summer and winter and

the effects of anticholinergic drugs on sweat secretion were studied.

1. The amounts of sweat secretions in summer were markedly increased than those

of the winter.

2. The sweat secretion of the back was markedly increased than those of the

forearm in the summer and winter. No regional differences of sweat secretion

between the right to the left side of the subjects were observed.

3. The sweat secretion was increased progressively with the passage of time for 1

hour in summer but in winter it was decreased after 45 minutes.

4. When 4 subjects were exposed to Environ-Room for 1 hour daily for 5 to 8 days,

there was no tendency of sweat adaptation.

5. Pro-banthine with 15 mg was the most effective inhibitor of sweat secretopm

exce[t pm tje fprear,s om womter/

6. Inhibition of sweating by 10mg of Daricon was not statistically significant

though the sweat secretion was slightly decreased in all experimental cases.

7. Buscopan with 20mg was no inhibitory effect on sweat secretion in summer and

winter.

8. First ingestion of 15mg of Pro-banthine showed the most powerful inhibitory

effect on sweat secretion, but in the repeated administration 15mg, even 30mg of

it, the inhibitory effects were decreased.

[영문]

The most important function of sweating is to control the body temperature by evaporating a large quantity of water over the skin, and it is well known that the sweat gland is more developed in man than in other mammals.

Problems of perspiration are among the oldest in the history of medicine. Already Hippocrates stated that vaporous substances are given off through the skin. Galen stated that, though insensible, perspiration is discharged continuously and uniformly from the whole body surface and this discharge can occasionally be

increased, so it takes the form of fluid, sweat. In the 17th century, Sanctorius Sanctorio demonstrated to the great surprise of his contemporaries that insensible perspiration could be measured exactly by means of a blance. He observed the gain

in weight when he took food and the continuous loss of the weight when nothing was taken. Such observations of his own body weight were continued through out thirty years(Kuno, 1956).

After the discovery of the sweat glands on the skin by Purkinj'e (1833), insensible perspiration and sweat secretion became an inseparable subject.

Insensible perspiration had so far been a matter of the whole body, but now the object of study was reduced to the skin (Kuno, 1956).

Dale and Feldberg (1934) first demonstrated that eccrine sweat glands are supplied with nerves that, although belonging anatomically to the sympathetic nervous system, are cholinergic.

In dermatologic field, the management of many skin diseases related to hyperhidrosis and dyshildrosis demands to inhibit sweat secretion. In our present knowledge, such inhibition is most readily achieved by the use of anticholinergic drugs which temporarily prevent acetylcholine from acting on the sweat glands. An attempt has been made to develop derivativies or analogs which would exhibit a selective or specific anticholinergic effect with respect to a given organ (e.g.

the gastrointestinal tract). In this regard, evaluation of the effectiveness of the anticholinergic drugs has been confined to organs other than the sweat glands.

After the first encouraging report of Grimson et al (1950) on the effect of Banthine on sweat secretion, their hyperhidrotic patients. But Shelly and Horvath (1951) reported that 15 anticholinergic drugs given orally to man in clinical

dosages proved to have no effect on sweating. According Sulzberger and Herrmann (1954), one of seven patients on Banthine and six of fifteen patients on Prantal were only effective. The effectiveness of the anticholinergic drugs varies from

definitely encouraging results to most disappointing one.

The present investigation, therefore, was undertaken to evaluate the effectiveness of Probanthine, Daricon and Buscopan on the human sweat secretion.

Method

Subjects were nine healthy men raning 19 to 24 years of age. Five men were studied in the summer (August) and 4 were studied in the winter (November and December). No dietary restrictions were imposed except alcohols.

Immediately before the sweating test, the test sties were gently cleansed with soap and water, rinsed with ion-free distilled water and air dried. The plastic sweat collectors (according to Sato and Dobson, 1969) with an internal diameter of

2.5cm were secured to the skin with plaster. The subjects entered into the Environ-Room(Dry bulb 46℃, wet bulb 41℃; Lab-Line Inst. Inc. Melrose Park, Ⅲ).

Two pre-weighed, 1mm thick, filter papers were introduced into plastic sweat collectors and sealed at time zero. Every 15 minutes for 1 hour the filter papers were collected and fresh, pre-weighed filter papers were inserted in the plastic

sweat collectors. Sweat volumes were determined by weight differences of the filter papers(mg/1.25**2πcm**2). All studies were conducted using the skin of the both side of the upper back and forearm.

Anticholinergic drugs used in this study were Pro-banthine (propantheline, Searle), Daricon (oxyphencyclimine, Pfizer), Buscopan (hyoscine N-butylbromide, C.H. Baehringer Sohn Ingellheim).

The above anticholinergic drugs were given orally 2 hours after breakfast, and observations of sweat secretion were made 1 hour after ingestion of the drugs.

summary and Conclusion

In nine healthy men, the sweat secretion was observed in summer and winter and the effects of anticholinergic drugs on sweat secretion were studied.

1. The amounts of sweat secretions in summer were markedly increased than those of the winter.

2. The sweat secretion of the back was markedly increased than those of the forearm in the summer and winter. No regional differences of sweat secretion between the right to the left side of the subjects were observed.

3. The sweat secretion was increased progressively with the passage of time for 1 hour in summer but in winter it was decreased after 45 minutes.

4. When 4 subjects were exposed to Environ-Room for 1 hour daily for 5 to 8 days, there was no tendency of sweat adaptation.

5. Pro-banthine with 15 mg was the most effective inhibitor of sweat secretopm exce[t pm tje fprear,s om womter/

6. Inhibition of sweating by 10mg of Daricon was not statistically significant though the sweat secretion was slightly decreased in all experimental cases.

7. Buscopan with 20mg was no inhibitory effect on sweat secretion in summer and winter.

8. First ingestion of 15mg of Pro-banthine showed the most powerful inhibitory effect on sweat secretion, but in the repeated administration 15mg, even 30mg of it, the inhibitory effects were decreased.