Original article
Oral glycopyrrolate as second-line treatment for primary pediatric hyperhidrosis

https://doi.org/10.1016/j.jaad.2012.02.012Get rights and content

Background

Primary focal hyperhidrosis not uncommonly begins during the first two decades of life, and can have a profound effect on quality of life. Few treatment options have been studied in children.

Objective

We sought to evaluate the response to oral glycopyrrolate in pediatric patients.

Methods

Records of pediatric patients with hyperhidrosis seen at a pediatric hospital in a 10-year period were reviewed retrospectively and, if possible, parents and patients were also interviewed. The efficacy and adverse effects of oral glycopyrrolate were assessed.

Results

In all, 31 children took at least one dose of oral glycopyrrolate. All had daily hyperhidrosis that affected their quality of life and were resistant or intolerant of aluminum salts. The mean age of hyperhidrosis onset was 10.3 years, and mean age of initiation of glycopyrrolate was 14.8 years. At a mean dosage of 2 mg daily, 90% of patients experienced improvement, which was major in 71% of responders. Improvement occurred within hours of administration and disappeared within a day of discontinuation. Duration of treatment averaged 2.1 years (range to 10 years). Side effects were noted by 29% of children, most commonly dry mouth (26%) and eyes (10%), and were dose-related. One patient developed blurred vision, which resolved with dosing below 5 mg/d; one patient experienced palpitations and discontinued the medication.

Limitations

This was a retrospective analysis of a limited number of pediatric patients.

Conclusion

Oral glycopyrrolate is a cost-effective, painless second-line therapy for children and adolescents with primary focal hyperhidrosis that impacts their quality of life.

Section snippets

Methods

After approval by the Institutional Review Board at Children’s Memorial Hospital/Northwestern University, Chicago, IL, the charts of all 3- to 17-year-old patients for whom the International Classification of Diseases, Ninth Revision code corresponded to focal (705.2) primary hyperhidrosis were systematically reviewed. All patients had been personally evaluated by a board-certified pediatric dermatologist. Patients with hyperhidrosis for less than 6 months or with generalized or secondary

Results

Records for 159 pediatric patients with the diagnosis of hyperhidrosis who were seen between January 2001 and December 2010 were available for review. Of these patients, 31 (19%) were determined to have severe hyperhidrosis at presentation (interfered with activities daily) and had been administered at least one dose of oral glycopyrrolate. All of these pediatric patients were confirmed to have had: (1) at least weekly episodes of excessive sweating during waking hours; (2) involvement in a

Discussion

Hyperhidrosis can be of significant psychosocial concern for older children and adolescents. Over-the-counter and prescription aluminum salts have traditionally been the initial therapeutic choice, but can cause significant irritation. Our experience during the past decade shows excellent efficacy (90%) and a low risk of side effects from the administration of oral glycopyrrolate in pediatric patients with primary focal hyperhidrosis whose response or tolerance to topical application of

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    Funding sources: None.

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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