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Gustatory Hyperhidrosis & Facial/Scalp Sweating
Gustatory hyperhidrosis is characterized by profuse sweating of the face, scalp, and neck during or immediately after ingestion of food or drink. Within social settings, gustatory sweating can be a significant source of embarrassment. In diabetic patients, blood sugar control can become difficult due to altered eating patterns. A study has demonstrated that taste buds appear to play a role related to triggering symptoms.
Essentially there are several types of gustatory sweating conditions. One variant of the condition may occur in temperate climates or with the ingestion of certain substances, including spicy foods. Other forms include Frey's syndrome and diabetic gustatory sweating. The most commonly reported form is Frey's syndrome*, which results from surgical or traumatic damage to a nerve that passes through the parotid gland. In the latter case, symptoms are localized to one side of the head as per the distribution of the affected nerve. Frey's syndrome occurs in up to 60% of patients having surgery of the parotid gland (parotidectomy).
Gustatory sweating can also be the result of a side effect (compensatory hyperhidrosis) from thoracoscopic sympathectomy (a surgical intervention in the treatment of hyperhidrosis.). Studies** have determined that the incidence of this side effect is one third to one half of individuals opting for this treatment.
*named after Polish physician and neurologist Lucja Frey (1889-1942). See our Sweating Matters blog for more information on L. Frey. **Licht PB, Pilegaard HK. Ann Thorac Surg 2006
Sweating of the facial and/or scalp areas unrelated to eating is likely to be focal hyperhidrosis of these areas - or craniofacial hyperhidrosis. Excessive face or scalp sweating can treated similarly to other areas of excessive sweating such as the underarms, palms or soles. Click here for information on treating craniofacial sweating.
Gustatory sweating and diabetes
Unlike Frey's syndrome, gustatory sweating in individuals with diabetes is usually bilateral (sweating both sides of the head). It is also more common in individuals that have had diabetes for a relatively long period of time. Spicy foods, chocolate and cheese are often implicated as the culprit foods. In individuals with renal impairment, the condition was reversed with renal transplantation. Stricter glycemic control or regulation of blood sugar does not appear to improve the gustatory sweating condition.
There are several treatment options available. DryDerm Gel or Solution (10, 15, or 20%) is a good option (DryDerm Solution particularly if a hairy area such as the scalp is involved) and is recommended as a first line treatment by the Canadian Hyperhidrosis Advisory Committee. Click on icon below for more information.
Oral therapy with a class of agents called anticholinergics is effective but not without side effects such as dry mouth, constipation and confusion. Botulinum toxin is usually reserved for Frey's syndrome. Having said this, when used topically, the anticholinergic agent called glycopyrrolate (see DryDerm G cream below) is also effective. Topical application is advantageous from the point of view that its absorption is minimized significantly (vs oral administration). Also, glycopyrrolate does not cross the blood brain barrier - in other words, it does not reach brain tissue and therefore is void of any side effects related to the nervous system.
*Kim WO et.al. Br J Dermatol 2008; 158(5):1094-7