Ultraviolet radiation exposure through window glass may be associated with localization of nonmelanoma skin cancer in organ transplant recipients: a study in France and the U.K

had failed treatment with all aluminium chloride preparations (26 female and nine male subjects; mean age 27 years, range 18–43). They had no other sites of HH, nor concurrent medications influencing their HH. Patients were counselled on application and the possible side-effect profile with a written information leaflet. Advice was given to avoid shaving the axillae and to apply 1% glycopyrrolate in Cetomacrogol cream BP, once daily (nocte), sparingly to hair-bearing skin of the axillae for 1 month. The Dermatology Life Quality Index (DLQI) was chosen in preference to hydration of stratum corneum and transepidermal water loss estimation, as we have found this method inconsistent in a previous study of patients with axillary HH. DLQI was measured before, during and after the treatment course. The glycopyrrolate preparation was tolerated well without significant irritation or other compliance-limiting factors, such as the staining of clothing. Only one patient developed significant side-effects – xerostomia and mydriasis. He was a young, large man applying the cream more liberally than advised. The side-effects resolved on reducing the strength to 0 5% glycopyrrolate in Cetomacrogol cream BP, and the amount applied. However, otherwise, only nine patients had a notable reduction in their HH (> 50% reduction in their DLQI score) and, most importantly, only two of the 35 patients wished to continue this treatment. We have been unable to demonstrate a consistent and predictable benefit from 1% Cetomacrogol Cream BP in our patients with axillary HH. Although our study is uncontrolled and our observations relate to this specific formulation of topical glycopyrrolate, we conclude its use at this site is limited by its efficacy, price (£60 for 50 g), availability and short shelf-life (3 months). In our experience it appears to be much more effective for craniofacial sites, and this may explain why most of the literature on its benefit is in diabetes or otolaryngology journals. In contrast, Botox injections (Allergan Inc., Irvine, CA, U.S.A.) for axillary HH provide a reliable and durable efficacy, and are becoming more cost-effective, particularly if the 200 iu vial is used, available to the U.K. National Health Service for £276 40.