The patient was treated with topical 20% aluminum chloride hexahydrate in anhydrous ethanol applied at night to the areas of sweating using a roll-on applicator. After two weeks of nightly application, she reported dramatic improvement of the sweating, with no local or systemic side-effects. She was able to maintain control of her gustatory hyperhidrosis with application every third night. Over the next two months she gained 13 lbs. She reported normalization of food intake along with improved mood and resolution of anxiety associated with eating.
There is a paucity of treatment options described in the literature which relieve sweating in diabetics with gustatory hyperhidrosis (Table 1). Topical glycopyrrolate preparations have been reported to be successful outside of the United States.3 Isolated cases have reported use of oxybutynin with success, however, the associated systemic anticholinergic side effects make it less than ideal.4,5 Injections of botulinum toxin-A are effective, but may be painful, have insurance coverage barriers, or be cost-prohibitive.6 Topical aluminum chloride has been used successfully in treating gustatory hyperhidrosis in Frey syndrome, and but there is a scarcity of literature describing the successful use of aluminum chloride to treat diabetic gustatory hyperhidrosis.7,8
Aluminum chloride is an inexpensive medication used to reduce focal sweating. Aluminum ions form a precipitate with mucopolysaccharides in the sweat ducts, physically obstructing the flow of sweat and damaging epithelial cells along the lumen of the duct.9 This obstruction is temporary however, and normal sweat gland function returns with epidermal renewal, thus necessitating continued therapy. In our patient, application