Topical glycopyrrolate followed by microneedling: a novel treatment option for eccrine hidrocystomas

Eccrine hidrocystomas (EH) are benign cystic tumors of the eccrine glands with no established treatment yet. Eccrine glands are activated by acetylcholine released from innervating sympathetic nerve fibers. Use of oral anti-cholinergic agents is rare due to the possibility of systemic side effects while topical atropine and scopolamine have been found to be ineffective. In our patient, we tried using topical glycopyrrolate over the entire affected region followed by microneedling. Our aim was to create micro-channels through the epidermis and dermis, delivering the drug to EH lesions in the deeper dermis. We only performed microneedling over the left half of the chest to compare the difference made by microneedling. The effective percutaneous delivery of topical glycol was evident by our patient's transient systemic side effects and reduction of the EH lesions. Specifically, the lesions were reduced more significantly over the left where microneedles were applied. Our treatment was effective for our patient and he was satisfied with the improvement in cosmesis. The method described may serve as a therapeutic option for patients with EH.