Clinical and Experimental Dermatology 1998; 23: 204–205.
The use of topical glycopyrrolate in the treatment of
hyperhidrosis
D.C.SEUKERAN AND A.S.HIGHET* Department of Dermatology, Leeds General Infirmary, Leeds
LS13EX, UK and *Department of Dermatology, York District Hospital, York YO3 7HE, UK
Accepted for publication 12 May 1998
Summary
The use of an aqueous solution of 0·5% topical glyco-
pyrollate was effective in the treatment of hyperhidrosis
of the scalp and forehead after other treatments had
proved ineffective; this appears to be the first report of its
use in this condition.
Introduction
The treatment of hyperhidrosis remains difficult and
treatment methods can be divided into those which
affect the sweat gland directly and those which modify
its innervation.1,2 Thus topical agents including alumin-
ium chloride, formaldehyde, glutaraldehyde and potas-
sium permanganate have been used but all produce only a
short-term effect.3–6 In addition, oral anticholinergics
have been tried but adverse effects such as blurred vision
and urinary retention limit their efficiency, although
iontophoresis has led to some success with tapwater1
and topical anticholinergics.7 Next, the surgical excision
of affected areas, for example the eccrine glands of the
axilla, has been useful in appropriate cases,8 while more
recently, endoscopic sympathectomy has been used, but
this can result in significant adverse effects such as
compensatory hyperhidrosis, cardiac sympathetic dener-
vation and Horner’s syndrome.9 Recently the use of
botulinum toxin10,11 has been advocated, but this
requires subcutaneous injections and there may be neu-
rological impairment such as a weakened hand grip,
which lasted up to three weeks in one patient.10 Finally,
however, Hays successfully used topical glycopyrrolate
for the treatment of Frey’s syndrome of gustatory sweat-
ing following parotidectomy,12 and we have now used this
in a patient with hyperhidrosis who was refractory to
other treatments.
Correspondence: Dr Daron C. Seukeran, Department of Dermatol-
ogy, Leeds General Infirmary, Great George St., Leeds LS1 3EX,
UK.
204
Case report
A 24-year-old man presented with a 5-year history of
localized hyperhidrosis of the scalp and forehead, the
excessive sweating severely limiting his social activities
and having led to the loss of his job as a barman.
No abnormal findings were found on examination,
thereby excluding Ross’ syndrome13 (tonic pupil, hypo-
reflexia and segmental anhidrosis with compensatory
hyperhidosis).
All investigations were normal including full
blood count, serum electrolytes, thyroid function
tests, hydroxymethylmandelic acid, homovanillic acid
and 5-hydroxyindole acetic acid concentration and chest
X-ray.
He had already applied aluminium chloride (Anhydrol
Forte; Dermal Laboratories Ltd, Herts UK) to his fore-
head but this had only partially helped; sweating had
resumed within 30 min. Further, in view of the site it was
felt that iontophoresis was not a feasible option.
Glycopyrollate (2% in cetomacrogol cream) was there-
fore used; this was of some benefit on the forehead, but
was impractical on the scalp. In addition, when sweating
resumed, the combination of sweat and cream on the
forehead was messy.
A 0·5% aqueous solution of glycopyrrolate was then
tried on both scalp and forehead, and this led to a
dramatic improvement with complete control of the
hyperhidrosis. Initially the patient applied this twice
daily, but found that a once daily application worked
just as well. The only adverse effect he experienced was
slight dryness of the mouth for less than an hour after
application.
Discussion
This case demonstrates a simple but effective treatment
for hyperhidrosis of the scalp, Hays having already
described the successful use of such topical glycopyr-
rolate applied to the face for the treatment of Frey’s
syndrome, i.e. the presence of gustatory sweating follow-
ing parotidectomy.12,14
q 1998 Blackwell Science Ltd
 GLYCOPYRROLATE FOR HYPERHIDROSIS
Glycopyrrolate, an anticholinergic drug, is a quaternary
ammonium compound that does not cross the blood–brain
barrier. It also penetrates biological membranes more
slowly than other anticholinergics and appears to lead to
fewer side-effects.
In Hays’s study, the aqueous solution was found to be
more effective than cream preparations. The duration of
control was 2–18 days with a median of 3 days. Over 1000
individual applications were used with only seven cases of
minor side-effects.12
The success of glycopyrrolate in Frey’s syndrome was
confirmed by May,15 the only precaution emphasized
being that it should not be used in patients with narrow
angle glaucoma. In addition, the preparation has also
been used in the iontophoresis of plantar and palmar
hyperhidrosis, but such an approach is impractical in hair-
bearing areas because of poor skin contact.7
In summary, the negative emotional, professional and
social consequences of hyperhidrosis on this patient’s life
have been transformed by the topical use of a 0·5%
aqueous solution of glycopyrrolate.
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