Hyperhidrosis, Gustatory

Description

Gustatory sweating results from a disruption of the auriculotemporal nerve pathways. Damage to the nerve may cause a misdirected regrowth that results in parasympathetic innervation of sympathetic receptors and, therefore, facial sweating and flushing with gustatory stimulation (summary by Dunbar et al., 2002).

Clinical Features

Mailander (1967) described excessive sweating of the face with eating of spicy or sour foods in 5 persons of 3 generations. The sweating was limited mainly to the forehead, nasal tip and upper lip. There was no male-to-male transmission and 1 instance of 'skipped generation' was known.

This condition is also referred to Frey syndrome in honor of Lucja Frey (1889-?1942), a Warsaw neurologist who was a victim of the Holocaust. Dunbar et al. (2002) stated that Frey (1923) was the first to describe gustatory sweating as a disorder of both sympathetic and parasympathetic innervation.

Weber (1897) described a case of a 19-year-old boy who developed sweating and flushing on his left ear and face following an episode of parotiditis that had required incision and drainage. There was a 6-month time delay in the onset of symptoms (enough time for regrowth to occur). Weber wrote: 'The scar is partly adherent to the parotid salivary gland, and I suppose that when physiological swelling of the gland takes place during eating, the scar is dragged on in some way, and the nerve-fibres which are involved in it become so compressed that their function is temporarily completely abolished.'

Reich and Grill (2005) described a 44-year-old man who developed sweating of the left side of the face while eating. The gustatory sweating began one year after resection of a parotid neoplasm. He had to continuously dab his face with a cloth during a meal. He was treated successfully with botulinum toxin. Reich and Grill (2005) republished Frey's diagram of the auriculotemporal nerve.