A Dramatic Case of Diabetic Gustatory Hyperhidrosis Successfully Treated with Topical Glycopyrrolate

A 67-year-old man with uncontrolled type 2 diabetes, neuropathy, and nephropathy experienced severe diabetic gustatory hyperhidrosis (DGH), a condition causing excessive sweating in response to food, leading to significant weight loss and quality of life impact. Initial treatments, including oral glycopyrrolate and onabotulinumtoxinA injections, only partially alleviated symptoms. However, the application of compounded topical 2% glycopyrrolate in a light lotion base led to near resolution of symptoms within two weeks. Despite some side effects, the patient found the treatment tolerable and his weight stabilized. This case suggests that topical glycopyrrolate is a promising treatment option for severe DGH, even when applied to the hair-bearing scalp. The primary limitation is cost, as the medication needs to be compounded.